Dental restoration molding technology

Abstract

To provide mold cavities customized to suit an individual patient.SOLUTION: A custom tool for forming a dental restoration molding in a mouth of a patient includes a mold body providing a customized fit with at least a specific tooth of the patient. The mold body includes a facial portion 12 forming a facial surface corresponding to a facial surface of the specific tooth, a lingual portion 30 forming a lingual surface corresponding to a lingual surface of the specific tooth, and an incisal portion forming an incisal surface corresponding to an incisal surface of the specific tooth. The mold body is configured to combine with the specific tooth to form a mold cavity encompassing a missing tooth structure of the specific tooth.SELECTED DRAWING: Figure 4

Description

[Technical Field]

[0001] The present disclosure relates to dental restorations. [Background technology]

[0002] Dental restorations, or dental fillings, utilize dental restorative materials used to improve the function, integrity, and form of missing or irregular tooth structure. For example, dental restorations may be used to repair missing tooth structure after trauma or as part of the restorative treatment of tooth decay, i.e., caries.

[0003] Restorative dentistry traditionally consists of drilling carious areas from infected teeth (commonly referred to as "cavitating" the tooth), then using simple instruments and advanced techniques to isolate, retract, fill, and contour the finished restoration. High-quality isolation with rubber dams is cumbersome and is often omitted, replaced with less effective cotton roll isolation—which increases the risk of contamination and shortens the lifespan of the restoration. Soft and hard tissue retraction involves the manipulation of cords, wedges, and matrix bands, and imperfect technique can lead to contamination, leave burrs in the interproximal areas, and cause poor bite fit.

[0004] While "bulk-fill" restorative materials and high-intensity curing lights facilitate relatively fast filling of deep cavities (e.g., 4-5 mm), many restorations are completed with a single shade because practitioners may be uncertain about the correct layering protocol for multiple shades or types of restorative material. Finally, little geometric guidance is available for the cavity-prepared tooth, and creating the final fill height and occlusal geometry may involve repeated overfilling of dental restorative material, followed by grinding with the patient under anesthesia, and checking tooth contacts and occlusal function. This process can be the most time-consuming part of dental restorations, and negligence can result in tooth sensitivity and a return visit for adjustments. Summary of the Invention

[0005] The present disclosure relates to dental restoration techniques that involve molding dental restoration materials directly onto teeth in a patient's mouth. The disclosed techniques include dental restoration methods, custom appliances used in dental restorations, and techniques for manufacturing custom appliances for dental restorations. The disclosed techniques include appliances that provide mold cavities customized for individual patients. In some instances, such custom appliances may be manufactured using three-dimensional printing technology.

[0006] In one example, the present disclosure relates to a custom appliance for forming a dental restoration in a patient's mouth. A mold body provides a customized fit with at least one tooth of the patient. The mold body includes a facial portion forming a facial surface corresponding to a facial surface of the tooth, and further includes a separate lingual portion forming a lingual surface corresponding to a lingual surface of the tooth. The mold body is configured to mate with the patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of the tooth.

[0007] In a further example, the present disclosure relates to a kit including a custom appliance and a dental restorative material.

[0008] In another example, the present disclosure relates to a method of forming a dental restoration in a patient's mouth, the method including the steps of positioning a mold over a portion of the patient's tooth, the mold combining with the tooth to form a mold cavity that covers and encloses missing tooth structure of the tooth, the method further including the steps of injecting a dental restorative material into the mold cavity, allowing the dental restorative material to harden in the mold cavity, thereby reshaping the tooth, and removing the mold from the patient's tooth.

[0009] In a further example, the present disclosure relates to a method of forming a dental restoration in a patient's mouth, the method including the steps of placing a dental restorative material on a portion of the patient's tooth and positioning a mold over the portion of the tooth. The mold combines with the tooth to form a mold cavity that covers and encloses missing tooth structure of the tooth. The method further includes the steps of hardening the dental restorative material in the mold cavity, thereby reshaping the tooth, and removing the mold from the patient's tooth.

[0010] In another example, the present disclosure relates to a method of manufacturing a custom appliance for forming a dental restoration of a tooth in a patient's oral cavity, the method including obtaining three-dimensional scan data of the patient's oral cavity and three-dimensionally printing a custom appliance for forming the dental restoration of the tooth based on the three-dimensional scan data of the patient's oral cavity, the custom appliance configured to mate with the patient's tooth to form a mold cavity over and surrounding missing tooth structure of the tooth.

[0011] The details of one or more embodiments of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the disclosure will be apparent from the description and drawings, and from the claims. [Brief explanation of the drawings]

[0012] [Figure 1] FIG. 1 is a diagram of a system for detecting and defining missing tooth structure using a digital three-dimensional model based on an intraoral scan, an impression scan, or a cast scan.

[0013] [Figure 2] 1 illustrates components of a custom appliance for forming a dental restoration in a patient's mouth, with a mold body including snap-fit ​​lingual and facial portions and a slidable occlusal portion. [Figure 3] 1 illustrates components of a custom appliance for forming a dental restoration in a patient's mouth, with a mold body including snap-fit ​​lingual and facial portions and a slidable occlusal portion.

[0014] [Figure 4] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including snap-fit ​​together lingual and facial portions and a hinged occlusal portion. [Figure 5] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including snap-fit ​​together lingual and facial portions and a hinged occlusal portion. [Figure 6] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including snap-fit ​​together lingual and facial portions and a hinged occlusal portion.

[0015] [Figure 7] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including a lingual portion and a facial portion that snap together to form the occlusal surface of the mold. [Figure 8] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including a lingual portion and a facial portion that snap together to form the occlusal surface of the mold. [Figure 9] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including a lingual portion and a facial portion that snap together to form the occlusal surface of the mold. [Figure 10] 1 illustrates a custom appliance for forming a dental restoration in a patient's mouth, comprising a mold body including a lingual portion and a facial portion that snap together to form the occlusal surface of the mold.

[0016] [Figure 11] 1 shows a custom appliance for forming dental restorations for two adjacent teeth in a patient's mouth, the custom appliance having a mold body including snap-fit ​​lingual and facial portions and a slidable occlusal portion that includes an injection port for delivering dental restorative material to a mold cavity of the custom appliance. [Figure 12] 1 shows a custom appliance for forming dental restorations for two adjacent teeth in a patient's mouth, the custom appliance having a mold body including snap-fit ​​lingual and facial portions and a slidable occlusal portion that includes an injection port for delivering dental restorative material to a mold cavity of the custom appliance. [Figure 13] 1 shows a custom appliance for forming dental restorations for two adjacent teeth in a patient's mouth, the custom appliance having a mold body including snap-fit ​​lingual and facial portions and a slidable occlusal portion that includes an injection port for delivering dental restorative material to a mold cavity of the custom appliance. [Figure 14] 1 shows a custom appliance for forming dental restorations for two adjacent teeth in a patient's mouth, the custom appliance having a mold body including snap-fit ​​lingual and facial portions and a slidable occlusal portion that includes an injection port for delivering dental restorative material to a mold cavity of the custom appliance.

[0017] [Figure 15] 1 illustrates a custom appliance for forming dental restorations of two adjacent teeth in a patient's mouth, configured to provide separation of the adjacent teeth during restoration. [Figure 16] 1 illustrates a custom appliance for forming dental restorations of two adjacent teeth in a patient's mouth, configured to provide separation of the adjacent teeth during restoration. [Figure 17] 1 illustrates a custom appliance for forming dental restorations of two adjacent teeth in a patient's mouth, configured to provide separation of the adjacent teeth during restoration. [Figure 18] 1 illustrates a custom appliance for forming dental restorations of two adjacent teeth in a patient's mouth, configured to provide separation of the adjacent teeth during restoration.

[0018] [Figure 19]1 shows a custom appliance for forming a dental restoration in a patient's mouth, the appliance comprising a mold body including a lingual portion and a facial portion, a clamp that holds the lingual portion and the facial portion together, a slidable occlusal portion, and a wedge that promotes separation of adjacent teeth during restoration. [Figure 20] 1 shows a custom appliance for forming a dental restoration in a patient's mouth, the appliance comprising a mold body including a lingual portion and a facial portion, a clamp that holds the lingual portion and the facial portion together, a slidable occlusal portion, and a wedge that promotes separation of adjacent teeth during restoration. [Figure 21] 1 shows a custom appliance for forming a dental restoration in a patient's mouth, the appliance comprising a mold body including a lingual portion and a facial portion, a clamp that holds the lingual portion and the facial portion together, a slidable occlusal portion, and a wedge that promotes separation of adjacent teeth during restoration. [Figure 22] 1 shows a custom appliance for forming a dental restoration in a patient's mouth, the appliance comprising a mold body including a lingual portion and a facial portion, a clamp that holds the lingual portion and the facial portion together, a slidable occlusal portion, and a wedge that promotes separation of adjacent teeth during restoration.

[0019] [Figure 23] 1 is a flowchart illustrating an exemplary technique for forming a dental restoration in a patient's mouth. DETAILED DESCRIPTION OF THE INVENTION

[0020] While traditional dental restoration techniques often involve repetitive steps and rely heavily on the skill and experience of the practitioner, the present disclosure includes techniques that may facilitate the formation of dental restorations in a patient's mouth more accurately and quickly through the use of custom molds than is generally possible using traditional dental restoration techniques.

[0021] The disclosed techniques include acquiring a patient's three-dimensional dentition with an intraoral scanner. Custom appliances for dental restorations may include molds based on the patient's three-dimensional (3D) dentition. The disclosed techniques may facilitate high-quality dental restorations with reduced time and skill requirements compared to traditional dental restoration techniques.

[0022] FIG. 1 is a diagram of a system 10 for detecting and defining tooth structure using a digital three-dimensional model based on an intraoral three-dimensional scan or a three-dimensional scan of a tooth impression or cast. The system 10 includes a processor 20 that receives a digital three-dimensional tooth model (12) from the intraoral scan or tooth impression scan. The system 10 may also include an electronic display device 16, such as a liquid crystal display (LCD) device, that displays an indication of changes in tooth shape, and an input device 18 that receives user commands or other information. Systems for generating digital three-dimensional images or models based on image sets from multiple views are disclosed in U.S. Patent Nos. 7,956,862 and 7,605,817 (both of which are incorporated herein by reference). These systems can use an intraoral scanner to obtain digital images from multiple views of teeth or other intraoral structures, which are then processed to generate a digital three-dimensional model representing the scanned teeth. The system 10 can be implemented, for example, on a desktop, notebook, or tablet computer. The system 10 may receive the three-dimensional scans locally or remotely over a network such as a local area network (LAN) and / or the Internet.

[0023] Figures 2 and 3 illustrate components of a custom appliance for forming a dental restoration in a patient's mouth. The custom appliance of Figures 2 and 3 includes a mold body including a lingual portion 30 and a facial portion 12 that snap together with a snap fit, and a slidable occlusal portion 50. More specifically, the lingual portion 30 defines a recess 38 configured to receive the protrusion 24 of the facial portion 12 to provide a snap-fit ​​connection between the facial portion 12 and the lingual portion 30. Additionally, the facial portion 12 and the lingual portion 30 may be further held together by the slidable occlusal portion 50 including tabs 56, 57, or tabs 56 and hinge elements (as shown in Figures 4-6).

[0024] The facial portion 12 and the lingual portion 30 are configured to surround the patient's tooth. Specifically, the facial portion 12 forms the customized facial surface 14 of the tooth, while the lingual portion 30 forms the customized lingual surface 32 of the tooth. In addition, the facial portion 12 and the lingual portion 30 form customized distal surfaces 18a and 18b, respectively, corresponding to the surfaces of the tooth, and customized mesial surfaces 20a and 20b, respectively, corresponding to the mesial surfaces of the tooth. Similarly, the occlusal portion 50 forms an occlusal surface 52, corresponding to the occlusal surface of the tooth. The facial portion 12 and the lingual portion 30 also include customized gingival surfaces 22a and 22b, respectively, which seal the corresponding gingival surfaces in the patient's mouth.

[0025] The mold body, including the facial portion 12, the lingual portion 30, and the occlusal portion 50, mates with a tooth (not shown) to form a mold cavity. The mold cavity surrounds missing tooth structure of the tooth, such as tooth structure removed when the tooth was cavity-prepared by removing carious lesions (or caries) to form a cavity 104 (FIG. 4) suitable for receiving a dental restorative material. By placing the custom appliance over the tooth, the dental restorative material can be placed into the mold and conform to the missing tooth structure of the cavity 104.

[0026] The facial portion 12 and the lingual portion 30 each form a top surface 26 and portions of the inner side surface 28 and inner receiving surface 25 of the custom appliance, which are configured to receive the slidable occlusal portion 50 of the mold body. The occlusal portion 50 forms a bottom surface 58, which is configured to mate with the inner receiving surface 25. The occlusal portion 50 also forms a tab 56 configured to mate with the outer surface 16 of the facial portion 12 and a tab 57 configured to mate with the outer surface 34 of the lingual portion 30. The occlusal portion 50, including the tabs 56 and 57, may serve to hold the facial portion 12 and the lingual portion 30 together when they surround a patient's teeth.

[0027] The facial portion 12 and the lingual portion 30 are also configured to match adjacent teeth in the patient's mouth to facilitate accurate positioning within the patient's mouth. Specifically, the facial portion 12 and the lingual portion 30 form customized mesial surfaces 40a and 40b, respectively, that correspond to the mesial surfaces of the distally adjacent teeth. The facial portion 12 and the lingual portion 30 also form customized distal surfaces 42a and 42b, respectively, that correspond to the distal surfaces of the mesially adjacent teeth.

[0028] Figures 4-6 illustrate the custom appliance 10. The custom appliance 10 is substantially similar to the custom appliance of Figures 2 and 3, except that the occlusal portion 50 includes a hinged connection with the lingual portion 30 rather than a slidable connection. For the sake of brevity, features already discussed in connection with the custom appliance of Figures 2 and 3 will not be repeated in detail in connection with the custom appliance 10.

[0029] 4-6 further illustrate the custom appliance 10 in combination with teeth 100, 106, 108 within a patient's mouth. The patient's mouth further includes gums 110. The tooth 100 includes a crown 102 having a cavity 104. As shown, the cavity 104 may have been a carious lesion in the tooth 100 that was previously created by drilling or other cavity creation to remove damaged tooth material. The facial portion 12 covers and surrounds a facial surface 116 of the tooth 100, while the lingual portion 30 covers and surrounds a lingual surface 118 of the tooth 100. The custom appliance 10 facilitates dental restoration of the tooth 100, including a restoration surrounding the cavity 104.

[0030] The custom appliance 10 can be created based on a digital model of the patient's teeth and oral cavity, which may be created by intraoral three-dimensional scanning using a multi-channel scanner (e.g., the TRUE DEFINITION SCANNER available from 3M Company, Saint Paul, Minnesota). Methods for obtaining the digital dentition model include intraoral scanning or scanning of a physical dental impression, or scanning a cast cast from a physical dental impression. At a minimum, the scan includes the target area of ​​the tooth to be restored. The scan may further include one or more of the target area, the entire tooth to be restored, adjacent teeth, surrounding soft tissue, opposing dentition, and bite registration. Data may be obtained during a routine checkup, when caries is diagnosed, or during restorative treatment. The acquired data may be processed by trimming, error correction, and hole filling. The acquired data may be augmented with one or more additional data sets, such as two- or three-dimensional x-ray data of opposing dentition, internal or subgingival features, and non-patient-specific standard root data.

[0031] In one detailed example, the custom appliance 10 may be digitally designed using CAD software, such as solid modeling software based on a digital model. For example, a library of fixed, parametric, or appliance blank forms may be created in CAD software (e.g., Solidworks, NX / Unigraphics, ProEngineer, etc.). These objects are typically exported to a separate three-dimensional virtual workspace (e.g., Materialise Magics, SpaceClaim) that can manage point cloud or triangular mesh data and perform Boolean operations. Optionally, the standard forms are scaled to ensure a proper fit between the standard parts and the patient's dentition. Patient data may then be subtracted from the standard forms. As an alternative to Boolean subtraction, the appliance design may be cut from a virtual shell constructed on the target tooth structure.

[0032] The custom appliance 10 is designed to fit over the tooth 100 (first molar) to be restored, as well as portions of the adjacent teeth 106, 108. The shape of the occlusal surface 52 may correspond to the shape of the crown 102 before the cavity 104 is formed. In some other instances, the shape of the occlusal surface 52 may correspond to the contact surface of an opposing tooth to identify missing tooth structure corresponding to the cavity 104 in the crown 102. In other instances, the shape of the occlusal surface 52 may be derived from a projection by smoothing or flattening a digital model of the surface adjacent to the cavity 104. Alternatively or additionally, the occlusal surface may be derived from an occlusal surface that will not be restored (e.g., using a reversed image of the occlusal surface of another first molar in the same dental arch or by designing based on the opposing dentition). Alternatively or additionally, the occlusal surface may be constructed to achieve a desired treatment benefit, such as occlusal gap, or to optimize occlusion. Useful software for such design includes Lava Design, available from 3M Company, Saint Paul, Minnesota; 3Shape CAD Design, available from 3Shape, Copenhagen, Denmark; or exocad, available from exocad GmbH, Darmstadt, Germany. In any case, to design the components of the custom appliance 10, a virtual mold block may be created on the digital model and segmented into mold components—in this example, the facial portion 12, the lingual portion 30, and the occlusal portion 50. The precise location of one or more elements of the custom appliance 10 may be selected based on the digital model to, for example, facilitate assembly of the components in the patient's mouth and / or ensure access to the mold cavity through injection ports or vents. Such custom-positioned features may include parting lines, injection ports, vents, gates, and / or boundaries between components. These mold components thus facilitate the final assembly of the custom appliance 10 onto the tooth 100 without geometrical obstructions.

[0033] The design of the appliance 10 may optionally be tested and / or optimized in a virtual environment that simulates its function in the oral cavity, such as a virtual articulator. The mold tool or form may be segmented along the parting line to define volumes to mitigate undercuts where the material is not compliant enough for demolding, or to create transitions or gradients of various material properties.

[0034] In the example shown in Figures 4-6, the occlusal portion 50 is attached to the lingual portion 30 via a hinged connection. In contrast, in Figures 2 and 3, the occlusal portion 50 is configured to be slidably received in the facial portion 12 and the lingual portion 30. In either case, the components in the CAD software can be converted into a three-dimensional point mesh file or other format to facilitate fabrication by a three-dimensional printer, CNC mill, or the like. The appliance design is then exported to a device capable of fabricating three-dimensional objects, such as a CNC mill or a wide variety of additive manufacturing / three-dimensional printing equipment. The parts may be treated with a surface finish or release modifier. The manufactured parts are then used in the dental procedure. The parts may be printed in situ, or they may be delivered as part of a procedure kit that includes adhesives, dental restorative materials, and other procedure consumables. In some instances, the dental restorative materials are provided in a dental capsule that includes a cannula adapter that mates with a port on the custom appliance.

[0035] In some specific examples, components of the custom fixture 10 were printed on Object Connex 500 using VeroWhite, VeroBlack, Tango+, TangoBlack, as well as a metered blend of VeroWhite and Tango+. Objects were also optionally printed using VeroClear or on the 3D system SLA Viper si. 2They can also be printed using Accura 60 or Clearview. VeroBlack represents a hard material, and TangoBlack represents an elastomeric material, both of which block actinic radiation. Accura 60, Veroclear, and VeroWhite represent hard materials, and Tango+ represents an elastomeric material, all of which are transparent to actinic radiation. Tango+ can also be blended with hard "Vero family" materials to achieve intermediate durometer hardness. The deformability of elastomeric materials allows for improved compliance as well as improved demolding mechanics. Materials can optionally be selected to facilitate hardening of the dental restoration material within the mold cavity of the custom appliance 10.

[0036] Fabrication may optionally include other steps, such as curing in a UV chamber, cleaning with, for example, an alcohol solution, polishing, coating, and / or assembling various components, such as assembling the hinged portion of the occlusal portion 50 to the lingual portion 30. The printed custom appliance 10 can be pressed against uncured dental restorative material to form an anatomical bite structure. Optionally, the custom appliance 10 may include an engineered break line to aid in easier removal of the custom appliance 10 from the patient's oral cavity.

[0037] The completed appliance 10 can be used to perform dental restorations on the tooth 100, including restoring the cavity 104. Initially, the lingual portion 30 and facial (buccal) portion 12 may reside in the patient's mouth, with these components surrounding the tooth 100 and isolating, separating, or retracting oral tissues; however, the appliance 100 may optionally be placed in combination with other devices, such as a matrix band. In this example, the cavity 104 may be filled with a dental restorative material, such as FILTEK Supreme Ultra Universal Restorative, available from 3M of Saint Paul, Minnesota, to a volume slightly exceeding the cavity volume of the cavity 104. Once the occlusal portion 50 is hinged closed and fully seated, details of the occlusal surface 52 may then be transferred to the dental restorative material 105 within the cavity 104 (FIG. 6). In this manner, the occlusal surface 52 of the occlusal portion 50 mates with the tooth 100 to form a mold cavity that covers and surrounds the missing tooth structure of the tooth 100 (corresponding to the cavity 104 ).

[0038] When the hinge is closed, excess restorative dental material may protrude from the parting line of the appliance components. The dental restorative material may be light-cured through the appliance, such as with an XL 3000 curing light. For example, the appliance 10 may be formed of a material that is transparent to actinic radiation. Alternatively, a freshly mixed, chemically cured dental restorative material, such as 3M Concise Composite Restorative or 3M Ketac Molar glass ionomer filler, may be filled into the mold and then incubated in the mold for a sufficient time to fully harden. After hardening, the appliance components can be removed from the patient's mouth, and any burrs (excess) of restorative dental material may be removed with a dental scaler. The restored tooth 100 thus has an occlusal surface corresponding to that of the occlusal surface 52 of the occlusal portion 50. In this manner, complex surfaces can be easily formed when restoring the crown 102 of the tooth 100.

[0039] In some cases, the facial portion 12, the lingual portion 30, and the occlusal portion 50 may be designed so that their placement forces separation of the teeth 100, 106, and / or 108. For example, the facial portion 12, the lingual portion 30, and the occlusal portion 50 may be designed to precisely match the geometry of the teeth 100, 106, 108, except that the interproximal extent of the gingival surfaces 22a and 22b (FIG. 6) of the facial portion 12 and the lingual portion 30 may be slightly wider than the gaps between the teeth 100 and 106 and between the teeth 100 and 108. For example, the interproximal extension of the gingival surfaces 22a and 22b (FIG. 6) of the facial portion 12 and the lingual portion 30 may extend mesiodistally so that placement of the facial portion 12 and the lingual portion 30 exerts outward pressure on one or both of the teeth 106, 108 and / or exerts pressure on the tooth 100. In this manner, fitting the facial portion 12 and the lingual portion 30 over the teeth 100, 106, 108 may force separation of the gaps between the teeth 100 and 106 and between the teeth 100 and 108.

[0040] FIGS. 7-10 illustrate a custom appliance 210 for forming a dental restoration within a patient's mouth. The custom appliance 210 includes a mold body having a facial portion 212 and a lingual portion 230. The facial portion 212 and the lingual portion 230 snap together and, in combination, define the surface of the desired dental restoration. FIGS. 8 and 9 further illustrate the custom appliance 210 in combination with teeth 120, 126, and 128 within a patient's mouth. The patient's mouth further includes gums 110. The tooth 120 may contain a significant amount of missing tooth material and may have been ground to remove carious material to facilitate dental restoration of the entire exposed surface of the tooth 120. In some instances, a three-dimensional image of the patient's mouth (or dental impression) may be taken prior to removal of the carious material from the tooth 120, as the shape of the carious material may aid in the design of the custom appliance 210. In the same or a different example, the shape of the contralateral tooth may be inverted in software, or the design may be created in commercially available crown design software such as 3Shape CAD Design, available from 3Shape of Copenhagen, Denmark, or exocad, available from exocad GMBH of Darmstadt, Germany.

[0041] The facial portion 212 forms a recess 238 configured to receive the protrusion 224 of the lingual portion 230 to provide a snap-fit ​​connection between the facial portion 212 and the lingual portion 230 .

[0042] The facial portion 212 and the lingual portion 230 are configured to surround the patient's tooth. Specifically, the facial portion 212 forms a customized facial surface 214 of the tooth, while the lingual portion 230 forms a customized lingual surface 232 of the tooth. The customized facial surface 214 and the customized lingual surface 232 include customized proximal surfaces corresponding to the proximal surfaces of the tooth and customized incisal surfaces corresponding to the incisal surfaces of the tooth. The facial portion 212 and the lingual portion 230 also form customized gingival surfaces 222a and 222b, respectively, corresponding to the gingival surfaces of the patient's mouth.

[0043] The mold body, including the facial portion 212 and the lingual portion 230, combines with the tooth 120 to form a mold cavity. The mold cavity surrounds and encloses the missing tooth structure of the tooth 120. By placing the custom appliance 210 over the tooth 120, a restorative dental material may be placed into the mold and take the shape of the missing tooth structure of the tooth 120. In some examples, the restorative dental material may be placed on the tooth 120 before the custom appliance 210 is assembled over the tooth 120. In the same or a different example, the restorative dental material may be placed on the surface 214 of the facial portion 212 and / or the surface 232 of the lingual portion 230 of the tooth 120 before the custom appliance 210 is assembled over the tooth 120. In another example, the custom appliance 210 may be first assembled over the tooth 120, and then the restorative dental material may be injected into the mold cavity. For example, one or both of the facial portion 212 and the lingual portion 230 may include a port configured to receive the injection of restorative dental material after the custom appliance 210 is placed over the tooth 120 to form a mold cavity.

[0044] The facial portion 212 and the lingual portion 230 are also each configured to match adjacent teeth in the patient's oral cavity to facilitate precise positioning within the patient's oral cavity. Specifically, the facial portion 212 and the lingual portion 230 form customized surfaces 240a and 240b, respectively, that correspond to the surface of the adjacent tooth 126. The facial portion 212 and the lingual portion 230 also form customized surfaces 242a and 242b, respectively, that correspond to the surface of the adjacent tooth 128. In this manner, the facial portion 212 and the lingual portion 230 match the teeth 126, 128, facilitating precise positioning of the custom appliance 210 within the patient's oral cavity for reconstruction of the tooth 120.

[0045] The custom appliance 210 facilitates the simultaneous dental restoration of two or more teeth. As shown in FIG. 8 , tooth 126, like tooth 120, also includes missing tooth structure at the crown of tooth 126. The custom appliance 210 facilitates the reconstruction of tooth 126 simultaneously with the reconstruction of tooth 120. Placing the custom appliance 210 over teeth 120 and 126 further forms a second mold cavity corresponding to the missing tooth structure at the crown of tooth 126. As described with respect to tooth 120, restorative dental material may be placed in the mold cavity adjacent to tooth 126 to facilitate the reconstruction of tooth 126. For example, the custom appliance 210 may include a second port configured to receive the injection of restorative dental material after the custom appliance 210 is placed over tooth 120 to form the mold cavity adjacent to tooth 126. FIG. 10 shows restored tooth 121 and teeth 126, 128 in a patient's mouth after being restored with custom appliance 210.

[0046] Custom instrument 210 may be formed in a manner similar to that previously described in connection with custom instrument 10. For the sake of brevity, the design and manufacturing details of custom instrument 210 previously described in connection with custom instrument 10 will not be repeated.

[0047] A crown preparation was drilled for the patient, who required restoration of the lower right canine, tooth 120. A full-arch digital impression of the prepared crown and adjacent teeth was taken. This digital impression was imported into CAD software, and the image of the lower left canine was inverted to create a target restoration shape for the lower right canine, tooth 120. The target restoration shape was virtually placed on the crown preparation in the software environment to create a design target for the restored dental arch. A mold form was digitally designed in the software to encompass the lower right arch form, including the lower right canine, tooth 120, and adjacent teeth 126 and 128, which required restoration. Any fill ports located in the sections of the tooth to be filled during the restoration process were digitally subtracted from the canine section of the mold form. The fill ports were located in the facial portion 212 and sized to accommodate the tip of a commercially available Compule restorative dental material, allowing the injection of restorative dental material into the mold cavity for tooth 120. A parting line was determined that divided the mold form into a facial portion 212 (labial side) and a lingual portion 230, and these two portions 212, 230 were provided with alignment features 224, 238 to facilitate accurate and secure assembly of the physical appliance components during the subsequent dental restoration process.

[0048] The components in the CAD software corresponding to the facial portion 212 and the lingual portion 230 may be converted into a 3D point mesh file or other format to facilitate fabrication by a 3D printer, CNC mill, etc. Fabrication may optionally include other steps such as curing (e.g., in a UV chamber), cleaning with, for example, an alcohol solution, etc.

[0049] 11-14 show a custom appliance 310 for molding dental restorations for two adjacent teeth 100, 101 using a mold body in a patient's mouth. The mold body includes a lingual portion 312 and a facial portion 330 that are snap-fit ​​together, and a slidable occlusal portion 350. The slidable occlusal portion 350 includes injection ports 354a, 354b for delivering dental restorative material to the mold cavities of the custom appliance 310 corresponding to the teeth 100, 101.

[0050] 12 and 13 further show the custom appliance 310 in combination with teeth 100, 101, 106, 108 within a patient's mouth. The patient's mouth further includes gums 110. Tooth 100 includes cavity 104 in the crown of tooth 100, and tooth 101 includes cavity 107 in the crown of tooth 101. As shown, cavities 104, 107 may have been previously carious cavity formed by drilling or other cavity formation to remove damaged tooth material to facilitate dental restoration using appliance 310. In some instances, a three-dimensional image of the patient's mouth may be taken prior to removal of the carious material from teeth 100, 101, as the shape of the carious material may aid in the design of the custom appliance 310.

[0051] The lingual portion 312 and the facial portion 330 are configured to surround the teeth 100, 101. In particular, the lingual portion 312 forms customized lingual surfaces 314, 315, while the facial portion 330 forms customized facial surfaces 332, 333. In addition, the customized lingual surfaces 314, 315 and the customized facial surfaces 332, 333 include customized proximal surfaces that correspond to the proximal surfaces of the teeth 100, 101. The lingual portion 312 and the facial portion 330 also form customized gingival surfaces 322a and 322b, respectively, that correspond to the gingival surfaces in the patient's mouth.

[0052] Optionally, the lingual portion 312 and the facial portion 330 may be further configured to include customized gingival surfaces 322a and 322b to provide features corresponding to an isolation matrix for a dental restoration. Thus, the lingual portion 312 and the facial portion 330 may include features that extend subgingivally or into hidden interproximal spaces. These extensions may be based on anatomical averages or patient x-ray data. The appliance may incorporate elastomeric materials that can be designed to undersize to create a tight seal against the actual geometry of the patient's dentition. The materials used may also vary in hydrophilicity to deflect water, saliva, and other fluids away from the tooth structure being restored. Microfluidic channels, vacuum line attachments, and bite blocks may also be incorporated.

[0053] The occlusal portion 350 provides a customized occlusal surface 352 that corresponds to the occlusal surfaces of the teeth 100, 101. The lingual portion 312 and facial portion 330 are configured to receive the slidable occlusal portion 350 of the mold body.

[0054] The lingual portion 312, the facial portion 330, and the occlusal portion 350 are also configured to match the adjacent teeth 106, 108 in the patient's oral cavity to facilitate accurate positioning within the patient's oral cavity. Specifically, the lingual portion 312, the facial portion 330, and the occlusal portion 350 form customized mesial proximal surfaces 340a, 340b, 340c, respectively, that correspond to the mesial surface of the distal adjacent tooth 108. The lingual portion 312, the facial portion 330, and the occlusal portion 350 also form customized distal proximal surfaces 342a, 342b, respectively (the distal proximal surface of the occlusal portion 350 is not shown) that correspond to the distal surface of the mesial adjacent tooth 106.

[0055] The mold body, including the lingual portion 312, facial portion 330, and occlusal portion 350, combines with the teeth 100, 101 to form two separate mold cavities that surround the missing tooth structure of the teeth 100, 101. By placing the custom appliance 310 over the teeth 100, 101, restorative dental material can be placed into the mold cavities and take the shape of the missing tooth structure of the cavities 104, 107.

[0056] In particular, the occlusal portion 350 includes ports 354a, 354b configured to receive the injection of restorative dental material into the mold cavities corresponding to the teeth 101, 100, respectively. After the restorative dental material is injected into the mold cavities of the custom appliance 310, the press 370 may be positioned such that plugs 374a, 374b block the ports 354a, 354b, respectively. The plugs 374a, 374b further include bottom surfaces 372a, 372b that provide defined shapes corresponding to the occlusal surfaces of the restored teeth 101, 100. The plugs 374a, 374b have different shapes (square, circular) to prevent misalignment of the press 370 relative to the occlusal portion 350. The occlusal portion 350 further includes vent holes 355a, 355b to allow air and excess dental material to escape from the mold cavity when material is injected through the fill ports 354a, 354b and when the press 370 is positioned so that the plugs 374a, 374b block the ports 354a, 354b, respectively. Figure 14 shows the restored teeth 101, 100 in a patient's mouth after being restored with the custom appliance 310.

[0057] Custom instrument 310 may be formed in a manner similar to that previously described in connection with custom instrument 10 and custom instrument 210. For the sake of brevity, the design and manufacturing details of custom instrument 310 previously described in connection with custom instrument 10 will not be repeated.

[0058] The custom appliance 310 can be created based on a digital model of the patient's teeth and oral cavity, which may be created by a three-dimensional intraoral scan, such as with a multi-channel scanner. In one detailed example, the custom appliance 310 can be digitally designed using CAD software, such as solid modeling software, based on the digital model. The custom appliance 310 was designed to fit over portions of the teeth 100, 101 (the adjacent first and second molars) and the adjacent teeth 106, 108. The tooth structure of the teeth 100, 101, 106, 108 can then be digitally subtracted from the mold block, as can the fill and vent ports (354a, 354b, 355a, 355b). Alternatively, the mold block can be defined by inverting a reversed image of the tooth structure in software. The ports can be positioned in areas of the occlusal section that correspond to the areas of the teeth that will ultimately be removed during the cavity preparation process, for example, adjacent to the mold cavities of the teeth 100, 101. Fill ports 354a, 354b may be sized to accommodate the tip of a commercially available dental restorative material compule to allow injection of the dental restorative material during filling. Vent ports 355a, 355b may be sized to be smaller in diameter than the fill ports.

[0059] The mold block design may be segmented into three sections (lingual portion 312, facial portion 330, and occlusal portion 350) to facilitate final geometrically unobstructed assembly of the appliance components onto the teeth. Alternatively, additional segments may be provided so that the lingual portion 312, facial portion 330, and occlusal portion 350 can each be divided into two or more components to separate the mold for the teeth 100, 101. The occlusal section was designed to provide a boundary in the mold block to aid in aligning the occlusal section with the facial (buccal)-lingual assembly mesially and distally. Handle features (318) may be included and added to the lingual portion 312 and facial portion 330 to facilitate grasping the portions with hemostats or cotton pliers during appliance placement.

[0060] The occlusal section may include tabs or sliders on the lingual and facial (cheek) sides to provide precise alignment with the lingual and labial sections. An additional element, the handle section, is designed to mate with the occlusal section and be inserted into the fill ports 354a, 354b such that the plug tip surfaces 372a, 372b may be at or slightly occlusal to the desired occlusal surface of the restoration of the teeth 100, 101.

[0061] Components in the CAD software can be converted into a three-dimensional point mesh file or other format to facilitate fabrication with a three-dimensional printer, CNC milling machine, etc. Orientation marks (e.g., colored marks on the distal end of each appliance component) may be added to the appliance components to facilitate assembly. Fabrication may optionally include other steps, such as curing (e.g., in a UV oven), cleaning with, e.g., an alcohol solution, and / or assembling the various components, polishing the tooth surfaces, or coating, e.g., with clear acrylic, to improve visibility of the restoration area during injection of the restorative dental material. Additionally, surfaces of the appliance components expected to come into contact with the restorative dental material can optionally be coated with a release agent layer (e.g., a thin layer of petroleum jelly).

[0062] An exemplary method for restoring teeth 100, 101 using custom appliances 310 is described as follows: Matrix bands were trimmed so that their occlusal-gingival height, once in place, slightly exceeded the height of the facial (buccal) and lingual portions. These matrix bands were placed interproximal to the first and second molars, teeth 100, 101, where tooth structure had been removed. The lingual portion 312 and facial portion 330 were assembled over the teeth 100, 101 to aid in isolation and secure the matrix bands in place (and help conform the shape of the matrix bands to the contours of the teeth 100, 101). Because tooth cavity preparations may be prepared to a depth that exceeds the maximum recommended cure depth of restorative dental materials, optionally, a thin base layer of restorative dental material may be applied deep into the cavity preparation, and the dental restorative material may be light-cured with an XL 3000 curing light. The occlusal portion 350 may be placed before adding the final restorative dental material build-up through the ports 354a, 354b. The final restorative dental material build-up is then formed into the desired anatomical shape by injecting the restorative dental material with a Compule tip through the fill ports 354a, 354b while visually observing the filling process through the instrument and at the vent ports 355a, 355b. After filling, the removable press 370 is fitted to the occlusal portion 350. With the occlusal portion 350 and removable press 370 in place, the final restorative dental material build-up on both teeth 100, 101 may be light-cured through the instrument 310. After curing, the instrument 310 is removed from the patient's mouth and the matrix band is removed, resulting in a shaped restoration with fully formed contacts. If necessary, excess restorative dental material may be removed, for example, with a dental scaler.

[0063] 15-18 illustrate a custom appliance 410 for forming dental restorations of two adjacent teeth 100, 101 in a patient's mouth, configured to provide separation of the adjacent teeth 100, 101, 106, 108 during restoration. The custom appliance 410 includes a mold body with a facial portion 430 and a lingual portion 412 that snap together, and a slidable occlusal portion 450. The slidable occlusal portion 450 includes injection ports 454a, 454b for delivering dental restorative material to the mold cavities of the custom appliance 410 corresponding to the teeth 100, 101.

[0064] The custom appliance 410 is substantially similar to the custom appliance 310, except that the geometry of the lingual portion 312, facial portion 330, and occlusal portion 350 is designed to provide separation of adjacent teeth 100, 101, 106, 108 during restoration, rather than precisely matching the positions of the teeth 100, 101, 106, 108 in the patient's mouth. In this manner, the custom appliance 410 may facilitate tooth separation without the use of separate matrix bands or wedges as described in connection with the custom appliance 310 or as is typically done with conventional direct restorations.

[0065] 16 and 17 further illustrate the custom appliance 410 in combination with teeth 100, 101, 106, and 108 within a patient's mouth. The patient's mouth further includes gums 110. Tooth 100 includes cavity 104 in the crown of tooth 100, and tooth 101 includes cavity 107 in the crown of tooth 101. As shown, cavities 104 and 107 may have been previously carious cavity formed by drilling or other cavity formation to remove damaged tooth material to facilitate dental restoration using appliance 410. In some instances, a three-dimensional image of the patient's mouth may be taken prior to removal of the carious material from teeth 100 and 101, as the shape of the carious material may aid in the design of the custom appliance 410.

[0066] The lingual portion 412 and the facial portion 430 are configured to surround the teeth 100, 101. In particular, the lingual portion 412 forms customized lingual surfaces 414, 415, while the facial portion 430 forms customized facial surfaces 432, 433. In addition, the customized lingual surfaces 414, 415 and the customized facial surfaces 432, 433 include customized proximal surfaces that correspond to the proximal surfaces of the teeth 100, 101. The lingual portion 412 and the facial portion 430 also form customized gingival surfaces 422a and 422b, respectively, that correspond to the gingival surfaces in the patient's mouth.

[0067] Optionally, the lingual portion 412 and the facial portion 430 may be further configured to include customized gingival surfaces 422a and 422b to provide features corresponding to an isolation matrix for a dental restoration. Thus, the lingual portion 412 and the facial portion 430 may include features that extend subgingivally or into hidden interproximal spaces. These extensions can be based on anatomical averages or patient x-ray data. The elastomeric components can be designed to be undersized to create a tight seal against the actual geometry of the patient's dentition. The materials used may also vary in hydrophilicity to divert water and saliva away from the restored tooth structure. Microfluidic channels, vacuum line attachments, and bite blocks can also be incorporated.

[0068] The occlusal portion 450 provides a customized occlusal surface 452 that corresponds to the occlusal surfaces of the teeth 100, 101. The lingual portion 412 and the facial portion 430 are configured to receive the slidable occlusal portion 450 of the mold body.

[0069] The lingual portion 412, the facial portion 430, and the occlusal portion 450 are also configured to match the adjacent teeth 106, 108 in the patient's oral cavity to facilitate accurate positioning within the patient's oral cavity. Specifically, the lingual portion 412, the facial portion 430, and the occlusal portion 450 form customized mesial proximal surfaces 440a, 440b, 440c, respectively, that correspond to the mesial surface of the distal adjacent tooth 108. The lingual portion 412, the facial portion 430, and the occlusal portion 450 also form customized distal proximal surfaces 442a, 442b, respectively (the distal proximal surface of the occlusal portion 450 is not shown) that correspond to the distal surface of the mesial adjacent tooth 106.

[0070] The mold body, including the lingual portion 412, facial portion 430, and occlusal portion 450, combines with the teeth 100, 101 to form two separate mold cavities that surround and enclose the missing tooth structure of the teeth 100, 101. By placing the custom appliance 410 over the teeth 100, 101, restorative dental material can be placed into the mold cavities and take the shape of the missing tooth structure of the cavities 104, 107.

[0071] In particular, the occlusal portion 450 includes ports 454a, 454b configured to receive injection of restorative dental material into the mold cavities corresponding to the teeth 101, 100, respectively. After the restorative dental material is injected into the mold cavities of the custom appliance 410, the press 470 may be positioned so that plugs 474a, 474b block the ports 454a, 454b, respectively. The plugs 474a, 474b further include bottom surfaces 472a, 472b that provide defined shapes corresponding to the occlusal surfaces of the restored teeth 101, 100. The occlusal portion 450 further includes vent holes 455a, 455b to allow air and excess dental material to escape from the mold cavities when material is injected through the fill ports 454a, 454b and when the press 470 is positioned so that the plugs 474a, 474b block the ports 454a, 454b, respectively. FIG. 18 shows restored teeth 101, 100 in a patient's mouth after being restored with custom appliances 410.

[0072] Custom instrument 410 may be formed in a manner similar to that previously described in connection with custom instrument 10 and custom instrument 210. For the sake of brevity, the design and manufacturing details of custom instrument 410 previously described in connection with custom instrument 10 and custom instrument 210 will not be repeated.

[0073] The custom appliance 410 can be created based on a digital model of the patient's teeth and oral cavity, which may be created by an intraoral three-dimensional scan, such as with a multi-channel scanner. In one detailed example, the custom appliance 410 can be digitally designed using CAD software, such as solid modeling software, based on the digital model. The custom appliance 410 was designed to fit over portions of the teeth 100, 101 (the adjacent first and second molars) and the adjacent teeth 106, 108. In contrast to the custom appliance 310, the CAD model of the scan for the custom appliance 410 was digitally segmented at the proximal surfaces to be restored, and the resulting segments were each translated 100 μm to create gaps between the contacts of the teeth 100, 101, 106, and 108. The tooth structures of teeth 100, 101, 106, 108, as modified to include gaps between the teeth, may then be digitally subtracted from the mold block, as may the fill and vent ports (454a, 454b, 455a, 455b). The ports may be positioned in areas of the occlusal section corresponding to the areas of the teeth that will ultimately be removed during the cavity preparation process, for example, adjacent to the cavities of teeth 100, 101. The fill ports 454a, 454b may be sized to accommodate the tip of a commercially available dental restorative material compule to allow injection of the dental restorative material during filling. The vent ports 455a, 455b may be sized to be smaller in diameter than the fill ports.

[0074] The mold block design can be segmented into three sections (lingual portion 412, facial portion 430, and occlusal portion 450) to facilitate the final assembly of the appliance components onto the teeth. The parting line between the lingual portion 412 and the facial portion 430 in the interproximal region was designed at the angle of the dental arch line. This ensured that when the "wedge" portions came into contact, they would overlap at the contact area, reducing the risk of material extrusion during filling. As a secondary measure, the interproximal "wedge" portions of the lingual portion 412 and the facial portion 430 were digitally expanded to create a 500 μm interference. Due to the finite resolution of the printing equipment used in manufacturing, there can be a loss of feature fidelity as the size is reduced to zero (as is the case with wedges or knife edges). Expanding the interproximal "wedge" components can compensate for this "underprinting" seen during physical fabrication.

[0075] The occlusal section was designed to be a boundary in the mold block that aids in aligning the occlusal section mesial and distal to the facial (buccal)-lingual assembly. Handle features (418) may be included and added to the lingual portion 412 and facial portion 430 to facilitate grasping the portions with hemostats or cotton pliers during placement of the appliance.

[0076] The occlusal section may include tabs or sliders on the lingual and facial (cheek) sides to provide precise alignment with the lingual and labial sections. An additional element, the handle section, is designed to mate with the occlusal section and be inserted into the fill ports 454a, 454b such that the plug tip surfaces 472a, 472b may be at or slightly occlusal to the desired occlusal surface of the restoration of the teeth 100, 101.

[0077] Components in the CAD software can be converted into a three-dimensional point mesh file or other format to facilitate fabrication by a three-dimensional printer, CNC milling machine, etc. Orientation marks (i.e., colored marks on the distal end of each appliance component) may be added to the appliance components to facilitate assembly. Fabrication may optionally include other steps, such as curing in a UV chamber, cleaning with, for example, an alcohol solution, and / or assembling the various components, polishing the tooth surfaces, or coating, such as with clear acrylic, to improve visibility of the restoration area during injection of the restorative dental material. Additionally, surfaces of the appliance components expected to come into contact with the restorative dental material can optionally be coated with a release agent layer (e.g., a thin layer of petroleum jelly).

[0078] An exemplary method for restoring teeth 100, 101 using the custom appliance 410 is described as follows. The lingual portion 412 and facial portion 430 were assembled over the teeth 100, 101 to aid in isolation, slightly separate the teeth, and create a matrix between the teeth. Because the tooth cavity preparation may be formed deeper than the recommended maximum cure depth of the restorative dental material, a thin base layer of restorative dental material may optionally be applied to the deep cavity preparation and light-cured with an XL 3000 curing light. The occlusal portion 450 may be placed before adding the final restorative dental material buildup through ports 454a, 454b. The final restorative dental material buildup was then formed into the desired anatomical shape by injecting the restorative dental material with a Compule tip through fill ports 454a, 454b while visually monitoring the filling process through the appliance and at vent ports 455a, 455b. After filling, the removable press 470 was fitted onto the occlusal portion 450. With the occlusal portion 450 and removable press 470 in place, the final build-up of restorative dental material on both teeth 100, 101 could be light-cured through the appliance 410. After curing, the appliance 410 was removed from the patient's mouth and the matrix bands were removed, resulting in a shaped restoration with well-formed contacts. If necessary, excess restorative dental material could be removed, for example, with a dental scaler.

[0079] 19-22 show a custom appliance 510 for forming a dental restoration in a patient's mouth, the custom appliance 510 including a mold body including a facial portion 530, clamps 580a, 580b that hold the lingual and facial portions together, a slidable occlusal portion 550, and a wedge 590 that facilitates separation of adjacent teeth during restoration. FIGS. 20 and 21 further show the custom appliance 510 in combination with teeth 100, 106, 108 in a patient's mouth. Tooth 100 includes a cavity 104 in the crown of tooth 100. As shown, cavity 104 may have been a carious lesion in tooth 100 that was previously cavity-formed by drilling or other cavity preparation to remove damaged tooth material to facilitate dental restoration using appliance 510. The patient's mouth also includes gums 110. The lingual portion 512 is configured to be secured to the facial portion 530 using clips 580a, 580b. The lingual portion 512 and the facial portion 530 are configured to surround the tooth 100 in the patient's mouth. In particular, the lingual portion 512 forms a customized facial surface 514 of the tooth, while the facial portion 530 forms a customized lingual surface 532 of the tooth.

[0080] The customized lingual surface 514 and the customized facial surface 532 include customized proximal surfaces that correspond to the proximal surfaces of the tooth 100. The lingual portion 512 and the facial portion 530 also form customized gingival surfaces 522a and 522b, respectively, that correspond to the gingival surface 110 in the patient's oral cavity. The occlusal portion 550 includes a customized occlusal surface 552 that corresponds to the occlusal surface of the tooth 100.

[0081] The mold body, including the lingual portion 512, the facial portion 530, and the occlusal portion 550, combines with the tooth 100 to form a mold cavity that covers and encloses the cavity 104 in the crown of the tooth 100. By placing the custom appliance 510 over the tooth 100, restorative dental material can be placed into the mold and take the shape of the missing tooth structure in the cavity 104.

[0082] The lingual portion 512 and the facial portion 530 are also configured to match the adjacent teeth 106, 108 in the patient's oral cavity to facilitate precise positioning within the patient's oral cavity. Specifically, the lingual portion 512 and the facial portion 530 form customized mesial proximal surfaces 540a and 540b, respectively, that correspond to the mesial surface of the distal adjacent tooth 108. The lingual portion 512 and the facial portion 530 also form customized distal proximal surfaces 542a and 542b, respectively, that correspond to the distal surface of the mesial adjacent tooth 106. Figure 22 shows the restored tooth 100 and tooth 101 in the patient's oral cavity after being restored with the custom appliance 510.

[0083] The custom appliance 510 can be created based on a digital model of the patient's teeth and oral cavity, which may be created by a three-dimensional intraoral scan, such as with a multi-channel scanner. In one detailed example, the custom appliance 510 can be digitally designed using CAD software, such as solid modeling software, based on the digital model. The custom appliance 510 is designed to fit over the tooth 100 (first molar), which is the tooth to be restored, and portions of the adjacent teeth 106, 108. To design the components of the custom appliance 510, a virtual mold block can be created on the digital model and segmented into mold components, in this example, a lingual portion 512, a facial portion 530, and an occlusal portion 550.

[0084] Components on the CAD software can be converted into a three-dimensional point mesh file or other format to facilitate fabrication by a three-dimensional printer, CNC mill, etc. Fabrication can optionally include other steps such as curing, cleaning, sanding, and / or coating with a clear coat and / or release agent, as previously described.

[0085] The completed appliance 510 can be used to perform dental restorations on the teeth 100. First, wedges 590 can be inserted into the custom channels to create gaps between the teeth 100, 106 and / or between the teeth 100, 108, and optionally to help seal the gingival portion of the matrix. Unlike off-the-shelf matrix insertion systems, the custom design of the appliance 510 allows for independent control of the gap creation and sealing aspects. Optionally, the lingual portion 512 and facial portion 530 may be designed with custom-shaped slots to allow for the insertion of a foil or plastic matrix from the occlusal side to ensure custom-shaped and burr-free contact points between the teeth 100, 106, 108.

[0086] The bottom of the tooth cavity may optionally be filled with a liner / adhesive and a build-up to prevent the layer from exceeding the thickness allowed for application of the dental restoration material. The final build-up of material may be placed directly on the tooth, placed within the custom appliance 510, or placed and injected into an entry port after the custom appliance 510 is placed over the tooth 100. The dental restoration material may then be allowed to harden. Removal of the custom appliance 510 may be facilitated by applying a release agent (e.g., petroleum jelly, alcohol, silicone, lecithin, etc.) to the custom appliance 510 prior to placement, fabricating key sections of the custom appliance 510 from a peelable or low surface energy material, and / or providing stress risers in the custom appliance 510 to allow for its fracture.

[0087] In another concept, different materials (e.g., shades, mechanical properties) are specified for placement in the cavity. The heights of the different materials can be marked on a custom appliance, or multiple occlusal caps can be created and each layer can be molded or pressed into its desired configuration. This feature allows any practitioner to create dental restorations with layers engineered for improved appearance and / or function.

[0088] In another concept, the restoration design is modified from the initial scan data to position some surfaces of the optimal design below the unprepared tooth surface. These locations are color-coded on the custom appliance to instruct the user during try-in that these areas must be removed with an excavator before filling the tooth.

[0089] FIG. 23 is a flowchart illustrating an exemplary technique for forming a dental restoration in a patient's mouth. First, a practitioner places a mold, such as mold 10, 210, 310, 410, or 510, over a portion of the patient's tooth (602). The mold combines with the tooth to form a mold cavity that encloses and covers the missing tooth structure of the tooth. Next, the practitioner injects a dental restorative material into the mold cavity (604). The practitioner hardens the dental restorative material in the mold cavity to reshape the tooth, which may include applying actinic radiation to harden the dental restorative material (606). Finally, the practitioner removes the mold from the patient's tooth, leaving a dental restoration on the patient's tooth in the shape defined by the mold cavity (608).

[0090] Various examples have been described. Modifications to the described examples may be made within the spirit of this disclosure. For example, custom appliances can be fabricated from initial tooth geometries or digitally optimized tooth geometries (e.g., by pulling data from a tooth library, scaling, and testing with a virtual articulator). Appliances can be printed or milled. Appliances can be made from any type of 3D printed material (strength, flexibility, transparency, color). Appliances can include features that indicate or define the fill height of various restorative materials (shade, fill height, physical properties). Appliance / mold sections can be connected to each other or to standard components (e.g., matrix bands). Appliances can be used intraorally or extraorally. Appliances can be degradable (e.g., solvent / heat) to release from restorative materials or to allow for undercut geometries / reduce parting lines. Appliances can be crushable (shrinkable, friable, etc.). Kits of patient-specific appliances and related products and quantities (e.g., adhesives, fillings, and polishing materials selected according to patient needs and / or physician preferences) can be created. A series of appliances used sequentially in direct filling techniques to control the geometry of multiple dental restoration layers on a tooth. To facilitate fabrication of custom appliances, dental scans may be taken at the diagnostic visit prior to the filling treatment visit. Appliances may be manufactured on-site, or digital scan data may be sent to a remote location for fabrication.

[0091] These and other examples are within the scope of the following claims. In addition to the above and other examples, the following aspects are noted. (Appendix 1) 1. A custom instrument for forming a dental restoration in a patient's mouth, comprising: a mold body that provides a customized fit with at least one tooth of the patient, the mold body including a facial portion that forms a facial surface corresponding to a facial surface of the tooth, and further including a separate lingual portion that forms a lingual surface corresponding to a lingual surface of the tooth; A custom appliance, wherein the mold body is configured to mate with the patient's tooth to form a mold cavity that covers and surrounds missing dental structure of the tooth. (Appendix 2) 10. The custom appliance of claim 1, wherein the facial portion is separable and engageable with the lingual portion. (Appendix 3) 10. The custom appliance of claim 1, wherein the custom appliance forms a proximal surface that corresponds to a proximal surface of a first adjacent tooth. (Appendix 4) 4. The custom appliance of claim 3, wherein the facial portion defines the proximal surface, the proximal surface corresponding to the proximal surface of the first adjacent tooth. (Appendix 5) 4. The custom appliance of claim 3, wherein the lingual portion forms the proximal surface, the proximal surface corresponding to a second adjacent tooth. (Appendix 6) 10. The custom appliance of claim 1, further comprising an occlusal portion including an occlusal surface, the occlusal surface corresponding to an occlusal surface of the tooth. (Appendix 7) 7. The custom appliance of claim 6, wherein the facial portion, the lingual portion, and the occlusal portion are all customized to fit around a tooth receiving a restoration. (Appendix 8) 8. The custom appliance of claim 7, further comprising a tooth in the patient's mouth to receive the restoration. (Appendix 9) 10. The custom appliance of claim 1, wherein the facial portion and the lingual portion are based on three-dimensional scan data of the patient's oral cavity. (Appendix 10) 10. The custom appliance of claim 9, wherein the facial portion and the lingual portion are manufactured by three-dimensional printing. (Appendix 11) 10. The custom appliance of claim 1, wherein the facial surface and the lingual portion together form an inner surface that corresponds to an outer surface of the tooth before restoration. (Appendix 12) 10. The custom appliance of claim 1, further comprising a dental restorative material within the mold cavity. (Appendix 13) 10. The custom appliance of claim 1, wherein the custom appliance forms a gingival surface that corresponds to the gingiva surrounding the tooth. (Appendix 14) 14. The custom appliance of claim 13, wherein the custom appliance retracts the gums from the tooth for restoration of the tooth. (Appendix 15) 10. The custom appliance of claim 1, wherein the facial portion and the lingual portion assist in separating the first adjacent tooth and the second adjacent tooth from the tooth receiving the restoration. (Appendix 16) 10. The custom appliance of claim 1, wherein the facial portion and the lingual portion isolate the tooth receiving the restoration from blood or saliva. (Appendix 17) 10. The custom appliance of claim 1, wherein the facial portion and the lingual portion are manufactured by CAD / CAM milling. (Appendix 18) 10. The custom appliance of claim 1, further comprising a dental restoration material fill height indicator for the tooth receiving the restoration. (Appendix 19) 10. The custom appliance of claim 1, wherein the facial surface and the lingual surface correspond to an exterior surface of the tooth prior to a restoration of the tooth. (Appendix 20) 10. The custom appliance of claim 1, wherein the facial portion engages and disengages along a mesio-distal dental arch of the patient's oral cavity. (Appendix 21) 10. The custom appliance of claim 1, wherein the facial portion is a buccal portion. (Appendix 22) 10. The custom appliance of claim 1, wherein the facial portion is a labial portion. (Appendix 23) 10. The custom appliance of claim 1, wherein the custom appliance forms an occlusal surface that corresponds to an occlusal surface of the tooth. (Appendix 24) 12. The custom instrument of claim 1, the at least one tooth is a plurality of teeth, the mold cavity is a first mold cavity adjacent to a first tooth of the plurality of teeth; and A custom appliance, wherein the mold body is configured to mate with a second tooth of the plurality of teeth to form a second mold cavity over and surrounding missing dental structure of the second tooth of the plurality of teeth. (Appendix 25) The mold cavity is the occlusal or incisal surface of the tooth; the lingual surface of the tooth, and 10. The custom appliance of claim 1, adjacent to one or more of the group consisting of: a facial surface of the tooth. (Appendix 26) 12. The custom instrument of claim 1, the custom appliance is the first custom appliance in a set of custom appliances that, in combination, facilitate a dental restoration of the patient's tooth, the mold cavity is a first mold cavity; and a second custom appliance in the set of substantially similar custom appliances in combination with the tooth and dental restorative material applied to the tooth using the first custom appliance to form a second mold cavity configured to cover and surround additional missing tooth structure of the tooth. (Appendix 27) 10. The custom instrument of claim 1, wherein the mold body forms a port leading to the mold cavity, the port configured to receive injection of dental restorative material. (Appendix 28) 28. The custom instrument of claim 27, wherein the mold body defines a vent port configured to facilitate venting of the mold cavity during the injection of dental restorative material. (Appendix 29) an element, the position of which is selected based on optical scan data, the element comprising: Parting line, injection port, Vent, Gate, and 2. The custom appliance of claim 1, wherein the custom appliance is selected from the group consisting of a border. (Appendix 30) 1. A kit for forming a dental restoration in a patient's mouth, comprising: a custom fixture as described in Appendix 1; A dental restorative material. (Appendix 31) 31. The kit of claim 30, further comprising a dental capsule including a cannula adapter that mates with a port of the custom instrument, wherein the dental restorative material is provided in the dental capsule. (Appendix 32) 31. The kit of claim 30, further comprising an adhesive. (Appendix 33) 31. The kit of claim 30, further comprising a matrix band. (Appendix 34) Pads and A brush and 31. The kit of claim 30, further comprising a dispenser well. (Appendix 35) 31. The kit of claim 30, further comprising components for secondary isolation. (Appendix 36) 31. The kit of claim 30, further comprising polishing and finishing components. (Appendix 37) 31. The kit of claim 30, further comprising a dental restorative material capsule of a preselected shade for the patient's tooth. (Appendix 38) 1. A method of forming a dental restoration in a patient's mouth, comprising: placing a mold over a portion of the patient's tooth, the mold combining with the tooth to form a mold cavity that covers and surrounds missing dental structure of the tooth; injecting a dental restorative material into the mold cavity; allowing the dental restorative material to harden within the mold cavity, thereby reshaping the tooth; and removing the mold from the teeth of the patient. (Appendix 39) 39. The method of claim 38, wherein the mold is part of the custom fixture of claim 1. (Appendix 40) 40. The method of claim 39, wherein the appliance is based on three-dimensional scan data of the patient's oral cavity. (Appendix 41) 1. A method of forming a dental restoration in a patient's mouth, comprising: placing a dental restorative material on a portion of the patient's tooth; placing a mold over the portion of the tooth, the mold combining with the tooth to form a mold cavity that encloses missing dental structure of the tooth; allowing the dental restorative material to harden within the mold cavity, thereby reshaping the tooth; and removing the mold from the teeth of the patient. (Appendix 42) 42. The method of claim 41, wherein the mold is part of the custom fixture of claim 1. (Appendix 43) 43. The method of claim 42, wherein the appliance is based on three-dimensional scan data of the patient's oral cavity. (Appendix 44) 1. A method of manufacturing a custom appliance for forming a dental restoration of a tooth in a patient's mouth, comprising: obtaining a three-dimensional scan of the patient's oral cavity; and three-dimensionally printing a custom appliance for forming the dental restoration for the tooth based on the three-dimensional scan data of the patient's oral cavity; The method, wherein the custom appliance is configured to mate with the patient's tooth to form a mold cavity that covers and surrounds missing dental structure of the tooth. (Appendix 45) 45. The method of claim 44, wherein the custom instrument is the custom instrument of claim 1. (Appendix 46) 46. ​​The method of claim 45, wherein the facial portion and the lingual portion of the appliance are each customized to fit around the tooth receiving the restoration.

Claims

1. 1. A custom instrument for forming a dental restoration in a patient's mouth, comprising: a mold body that provides a customized fit with at least a particular tooth of the patient, the mold body including a facial portion that forms a facial surface corresponding to a facial surface of the particular tooth, and a lingual portion that forms a lingual surface corresponding to a lingual surface of the particular tooth; the facial portion and the lingual portion are separable and engageable with each other; the mold body is configured to combine with the specific tooth to form a mold cavity that covers and surrounds the missing tooth structure of the specific tooth; The custom appliance further includes a gingival surface corresponding to the gingiva surrounding the particular tooth, a distal surface corresponding to the distal surface of the particular tooth, and a mesial surface corresponding to the mesial surface of the particular tooth.

2. The custom appliance of claim 1 , wherein the facial surface and the lingual surface form an inner surface that corresponds to an outer surface of the particular tooth before restoration.

3. The custom appliance of claim 1 , further comprising a dental restorative material disposed within the mold cavity.

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