Condyle positioner

Abstract

The present invention relates to a condyle positioner device that allows the guided positioning of the mandibular condyles in the glenoid fossa, thereby improving the quality of life of many people.

Description

[0001] CONDYLAR POSITIONER

[0002] TECHNICAL FIELD

[0003] The request refers to a device to obtain a permanent postural change of the jaw, in order to position the mandibular condyles in a functional or therapeutic area.

[0004] BACKGROUND

[0005] Dentistry is the science that prevents, treats, and diagnoses dental and oral diseases through the application of knowledge in health areas and specialized equipment; also, through orthodontics, diseases can be diagnosed or even mandibular deviations or problems can be corrected, as well as correct the shape of the dental arches and the position of the jaws, in order to restore the morphological and functional balance of the mouth and face, to promote good craniomandibular and craniocervical function, giving good body posture.

[0006] Regarding the mandible, there are the mandibular condyles, anatomical structures located on the posterosuperior aspect of the ascending rami of the mandible. Together with the glenoid fossa, these condyles form the temporomandibular joints (TMJs). The TMJs are mobile joints, classified as specialized fibrocartilaginous ginglymodiarthroid joints, that allow rotational and translational movement across the surface of the temporal bone. Therefore, they are considered joints with a complex function. Any alteration in any part of the TMJ can lead to growth and developmental disturbances, especially in pediatric patients, affecting the function of the stomatognathic system, as well as facial aesthetics and posture.

[0007] Likewise, the Temporomandibular Joint (TMJ), also called the craniomandibular joint complex, is a bicondylar type synovial joint that exists between the temporal bone and the mandible; there are two joints, one on each side of the head, that function synchronously.It can be called the temporomandibular joint (TMJ) because it maintains a tripodistic relationship between the two mandibular condyles and the teeth. Furthermore, any pathological or functional disorder can alter the integrity of its constituent elements. The only mobile joints in the head capable of producing rotation and translation are the TMJ and the atlanto-occipital joint. These joints balance to maintain the skull in an orthocentric and / or functional position, but this position can be modified by factors that change posture, such as respiratory, muscular, neurological, or stressful problems. Therefore, the TMJ is the neurofunctional axis of the body, aligning dental occlusion with body mechanics. The different structures that make up the TMJ are illustrated below.

[0008] The temporomandibular joint (TMJ) is an anatomical structure composed primarily of bone, muscle, and ligamentous tissue that enables important movements such as opening, closing, protrusion, retrusion, and right or left lateral movement of the mandible. It also contains fibrocartilaginous tissue in the form of a disc, which divides the joint into two compartments, superior and inferior, protecting it from rubbing and / or friction during movement.

[0009] The mandibular condyles are located on each side of the mandible (lower jawbone). They articulate with the temporal bone of the skull to allow jaw movement. Their functions are important because they enable basic oral functions such as chewing, swallowing, and speech. In other words, the mandibular condyles act as the pivot joint that allows the mouth to open and close, as well as lateral and gliding movements of the mandible. Their main characteristics include a convex surface in the anteroposterior direction and a slightly convex surface in the transverse direction. The mandibular condyle is a portion of the bone that connects the mandible to the skull, making it important for oral health.

[0010] The mandibular condyles are divided into:

[0011] Head: stands out for having an oval shape with approximate dimensions of 20mm in transverse diameter and about 10mm in anteroposterior diameter; Neck: is the bony portion that has a function of separating the cranial part, where it stands out for being well defined thanks to its size;

[0012] The glenoid cavities consist of:

[0013] -Articular tubercle: Prominence located on the squamous process of the temporal bone.

[0014] -Mandibular fossa: Composed of an anterior zone or articular area and a posterior zone that corresponds to the posterior wall of the tympanic region of the temporal bone.

[0015] Pterygoid fossa: communication point between different areas of the cranial cavity through various clefts and foramina.

[0016] However, there are several common pathologies that affect the mandibular condyle, the main one being condylar hyperplasia, whose origin is unknown but is characterized by accelerated or persistent growth of the condyle, bringing with it a series of consequences that are reflected in the oral health of the patient, such as malocclusion due to crossbite, one of the most common consequences among those patients who suffer from this disease, as well as problems related to facial symmetry.

[0017] Furthermore, among the problems we have:

[0018] Temporomandibular joint (TMJ) dysfunction, where a dysfunction of the TMJ occurs, known as temporomandibular disorder (TMD) or TMJ dysfunction, causing pain, clicking or crepitus of the joints, limitation in mouth opening, facial pain and headaches;

[0019] Dislocation of the mandibular condyle, which can occur (in rare cases), causes sharp pain, difficulty opening or closing the mouth, and misalignment of the jaw; Fractures of the mandibular condyle occur due to trauma or accidents and affect the function and movement of the jaw;

[0020] Malocclusion consists of a misaligned bite or dental malocclusion, where the upper and lower teeth do not fit together correctly.

[0021] Therefore, there is currently a wider variety of treatments available to address any problems affecting the joint; for this reason, it is recommended to visit a specialist regularly, as they have the tools and resources to anticipate any future problems. However, the diagnosis and treatment of related problems are performed by maxillofacial surgeons and dentists specializing in temporomandibular disorders.

[0022] Treatments for these conditions can vary, ranging from conservative therapies such as physical therapy exercises and medications for pain and inflammation, to, in more severe cases, corrective or reconstructive surgery.

[0023] Shultz and Meilman reported that in children under 10 years of age, two-thirds of mandibular fractures involved the condylar region, and in the 11- to 15-year-old age group, 40% involved the condyle. Similarly, Kaban et al. found that more than 50% of pediatric fractures involved the condylar region. The diagnosis of mandibular fractures should begin with a thorough medical history and physical examination, and immediate attention should always be paid to problems associated with airway compromise and hemorrhage.

[0024] Melvin Moss, in his functional matrix theory, proposed that the mandible develops according to the morphogenetic demands of the surrounding soft tissues, especially the muscles and ligaments. This theory states that the mandibular condyle is not the site of primary growth, but rather has a secondary adaptive response, allowing its head to remain in the fossa as the mandible develops. Therefore, the condyle has lost its primary role in mandibular growth due to the functional matrix being damaged in some way, possibly secondary to soft tissue trauma.

[0025] Therefore, in the state of the art there are devices designed to alter the action of various muscle groups that influence the function and position of the jaw in order to increase its length; they are of indirect action (not forces, they promote the muscle reaction), they are orthopedic and have an orthodontic action.

[0026] The Quiros-Crespo active mandibular positioner consists of a mandibular positioner made up of a series of elements that, according to its authors, are capable of producing a true stimulation of the muscles that favor the change in mandibular position. It consists of lateral shields made of 1mm gauge wire, whose function is to separate the action of the buccinator muscle on the dentoalveolar processes; a Hawley vestibular arch made of 0.7mm gauge wire, whose function is to control the protrusion of the anterior upper teeth; a lip retractor or lip bumper, which forms part of the lateral shields, consisting of two acrylic pads joined by a wire to protect the lower labial frenulum; and a bilateral posterior spring arch made of 1mm gauge wire, whose function is to join the two upper and lower acrylic parts that make up its body.

[0027] The article "Antero-posterior mandibular position at different vertical levels for mandibular advancing device design" was published by Doctors Mayoral et al., which consists of seeing how mandibular rotation occurs in the glenoid cavity and one of the benefits of the condylar positioner is the degree of rotation and the posterior displacement of the mandible to correct skeletal problems.

[0028] International application PCT / AU2012 / 000179 comprises a computer-implemented method, a computer device, and a computer-readable storage medium for providing alignment information data for the alignment of an orthopedic implant for a patient's joint. The computer-implemented method comprises the steps of responding to patient-specific information data to derive patient data, where the patient-specific information data is indicative of one or more dynamic characteristics, and responding to the patient data to provide the alignment information data for the orthopedic implant.

[0029] PCT / IB2015 / 001655 provides a method, a readable means for a computer device, and devices for dental appliances with repositioning jaw elements. An example of a method might include identifying a patient's misaligned jaw from a virtual image of the patient's jaw, providing a treatment plan for the patient that includes a virtual model of a dental appliance having a first and second housing configured to reposition itself on at least one of the patient's teeth, and adjusting the position of the jaw repositioning elements in the first and second housings to meet a set of constraints. The virtual model of the dental appliance, which includes jaw repositioning elements in the first and second housings, is configured to move the patient's misaligned jaw to a specific position.

[0030] The document PCT / FR2012 / 051957 indicates that the invention relates to a method for designing a dental appliance for the facial skeleton, including dental crowns and their corresponding roots, said method including the following steps: producing a volumetric image of the facial skeleton, in the form of an initial digital file, using medical images; modifying said volumetric image by computer processing of said initial digital file, and obtaining a modified digital file, said modification including at least one tooth movement with a view to implementing a desired correction of the dentition; designing said dental appliance using said initial digital file and said modified digital file, and producing a file that can be used by digitally controlled machines capable of manufacturing a dental appliance;In the volumetric image modification stage, for each moving tooth, its crown is individually identified and associated with its corresponding root. The volumetric image of the facial skeleton includes an image of the mandibular joint and a record of the mandibular movements during a plurality of movements, to account for possible joint movements after capturing the mandibular movement. The invention also relates to a method for recording mandibular movements, characterized in that the method includes a step in which active diodes (dark dots in Figure 17) are placed on the facial skeleton and on the mandibular arch, and in that the mandibular movements are recorded by an optoelectronic camera that detects the active diodes.

[0031] Document EP3216430 describes a device manufactured using CAD / CAM, comprising an upper splint (1) with followers (19) and several lower splints (2) that include contact surfaces (3a) on which the followers (19) make contact. Interchanging one lower splint for another, according to a manufacturing sequence, results in different controlled mandibular advancements. The contact surfaces (3a) reproduce a movement resulting from the contact of the followers (19) on said contact surfaces (3a). The device is customized for each patient based on a set of anatomical parameters and a series of input data measured by physicians, who personalize the device to achieve an opening movement with a single protrusive advancement in each of the lower splints (2).

[0032] The ES2232323 refers to a self-drilling screw-shaped device with a polished, spherical head, designed to be inserted into the bone to provide rigid support and facilitate certain surgical and dental procedures. The screw serves as a temporary anchor, and both its insertion and removal are minimally invasive surgical techniques. This device is particularly useful in orthodontics, as it allows for tooth movement without the need for support from other teeth in cases of insufficient or no tooth support. This device is compatible with orthodontic appliances, as all types of orthodontic archwires can be inserted through holes located at the base of the screw head, and the appliance can then be secured with an internal fixing screw. The device remains attached to the tooth or group of teeth to be moved.These tooth movements, performed with bone support, produce no side effects on other dental structures, transforming orthodontics into a safer, faster, and more effective technique and enabling tooth movements that are difficult or nearly impossible with conventional methods. This device has other potential applications in surgical specialties such as maxillofacial surgery. In this specialty, the device could be used as an intermaxillary fixation screw in facial traumatology, as a condylar positioner in orthognathic surgery, and as bone support in maxillomandibular and alveolar distraction.

[0033] The invention C020210005505 consists of an intraoral positioner for taking interocclusal records, while also allowing for the correction of different body postures due to the direct functional correlations between various head and neck structures, as well as the body, and occlusion or bite in humans. Thus, the device of the present invention allows for corrective modifications of the bite in a user, thereby correcting various bodily imbalances. In this sense, the intraoral positioner of the present invention is a prefabricated attachment that consolidates and standardizes the bite measurements of each individual patient, after performing a cephalometric analysis, a craniocervical analysis, and a postural analysis of the patient's body using any type of computer program component or software.The positioner of the present invention is removable and can be used in orthodontic treatments, maxillofacial orthopedics, maxillofacial surgery, otolaryngology, plastic surgery, craniocervicomandibular dysfunctions, temporomandibular joint dysfunction and respiratory disorders, among others.

[0034] Likewise, the Brazilian Utility Model application BRMU8801060 establishes a Dental Articulator and Facebow that locates, relates, records, individualizes, and calibrates the intercondylar axis in a three-dimensional manner, using predetermined specific planes perpendicular to each other as a base, and from there, positions and transfers it to the articulating plaster models of the dental arches. The facebow includes adjustable individual locators of the median plane 2, 2A, 2B, 2C, and 2D for nasion and subnasion. of the Sagittal or Frankfurt Plane 3, 3A, 3A1 and 3D, 3B, 3B1 and 3E, 3C and 3C1 for the Infra-Orbitals, together with Lateral Wings and Independent Condylar Locators 1A2, 1A3, 1A4 and 1A5, 1B2, 1B3, 1B4 and 1B5; and to position the dental arches 4-, 4A, 4B and 4C.The Universal Dental Articulator, in its Lower Arm, includes Condyle Locators and Positioners 6A1, 6A2, 6A3, and 6A4, 6B1, 6B2, 6B3, and 6B4, where they are actually located. In its Upper Arm, it includes the Location and Three-Dimensional Registration of the Intercondylar Axes 7A and 7D, 8, and the Glenoid Complex 8A, 8A1, 8B, and 8B1; and Broadrick Flag 11, which relates the Median Plane to the Frontal Plane (facebow). Therefore, the existing technical problem in the state of the art is the position of the condyle in the glenoid fossa.

[0035] DETAILED DESCRIPTION OF THE INVENTION

[0036] As with any treatment technique, devices must be used for the correct placement of the mandibular condyles. It is common to use specialized tools and even perform maxillofacial surgery. Therefore, this invention details an apparatus that guides the positioning of the mandibular condyles in the glenoid fossa through occlusion in all three dimensions. A very meticulous study is performed to determine the position of the condyles in the glenoid fossa, and along with condylar rotation and translation movements, the functional position can be determined. We can also move or advance one condyle more than the other when mandibular deviations are present.

[0037] With the TMJ open and closed mouth radiograph, we can measure the condylar position in the glenoid cavity by means of the Condylar Position Indicator (CPI) and thus together with the anamnesis be able to diagnose any pathology that could be producing a cranio-mandibular, cranio-cervical, psycho-functional or postural dysfunction of the body.

[0038] The closed mouth position represents maximum intercuspation (MI) of the teeth, while the open mouth position represents the maximum opening the patient can achieve. These measurements allow us to observe the position of the mandibular condyle in the glenoid fossa and the degree of translation that occurs within the patient's oral cavity. We can also observe the shape of the glenoid fossa and the articular condyle.

[0039]

[0040] According to Dr. Mayoral et al in 2019, if there is pure rotation of the mandibular condyle, for every 1mm that the bite opens (intericis I), the mandible moves 0.3mm backwards.

[0041] JA Fleetham, in Encyclopedia of Respiratory Medicine, 2006, states that the jaw can be advanced up to 5mm without causing discomfort.

[0042] With these measurements and the anamnesis we can diagnose that the mandibular condyles are retropositioned and intruded; however, with our Condylar Positioner we can place the mandibular condyles in a functional or therapeutic area, which for Orthokinetics is a Structural Compatibility Relationship of Closure position (RCec. Dr. Diego Tatis) and Therapeutic Reference Position (TRP of Drs. R. Slavicek and S. Sato), which corresponds to an area where the mandibular condyle should be positioned or articulated in the glenoid cavity, to promote the health of the stomatognathic system.

[0043] From a clinical perspective, the patient's medical history reveals a symptom or series of symptoms that, depending on their individual pain tolerance and ability to cope, may be clinically relevant. The most common symptoms associated with craniocervical-mandibular dysfunction include: headaches (neuralgia, migraines, and others), neck and shoulder pain, difficulty chewing, malocclusion (a feeling of poor dental alignment), joint problems (TMJ, craniocervical, and others), bruxism, tinnitus, and other issues.

[0044] A very thorough diagnosis is necessary to find the cause of the dysfunction problem and thus be able to correct it.

[0045] MI position. RCec. or TRP position

[0046] A 4mm advancement and a 3mm descent were performed on both joints, and the patient's signs and symptoms were reduced.

[0047] In this new condylar position, we fabricate our splints to improve people's quality of life. We rely on our colleagues—physiotherapists, osteopaths, orthopedists, neurologists, and other healthcare professionals—to correct problems not related to the stomatognathic system and achieve the most orthocentric posture possible. The occlusion must then be adjusted orthodontically or prosthetically to maintain the new condylar position with the new axis of condylar rotation and translation, preventing undesirable effects.

[0048] To create our Condylar Positioner, an impression material such as addition silicone must be placed to take occlusal records and obtain the spatial relationship between the jaws. This provides the position of the condyles in three dimensions; these are measured differently depending on the needs of each patient. Positive values ​​(+) indicate a horizontal overbite where the maxilla is in front of the mandible; negative values ​​(-) indicate the mandible is in front of the maxilla; and zero values ​​(0) indicate the upper incisors are directly in contact with the incisal edges of the lower incisors (bit-to-bite).

[0049] Each Condylar Positioner contains a positive measurement of +1.1, which means: +1 mm of horizontal overjet and 1 mm of vertical overbite, and on the other side, it presents the negative measurement of -1.1, which means: -1 mm of horizontal overjet and 1 mm of vertical overbite. The other value, .1 (point one), means that the thickness of the interincisal space is 1 mm.

[0050] Condylar positioners also come with different incisal edge thicknesses (overbite) to adjust the anterior vertical dimension, ranging from 0.1 to 0.9 mm, with corresponding horizontal measurements (overjet) from 0 to +5 mm and negative measurements from 0 to -5 mm. This covers all possible condyle positions within the glenoid fossa, ensuring proper function and preventing functional problems. Furthermore, they are very simple and inexpensive, improving the quality of life for many patients.

[0051] Our Condylar Positioners are made of materials that can be made in biocompatible plastics by means of 3D printing or casting, where each one has a computer-generated design to be able to print and / or manufacture them.

[0052] In addition, each Condylar Positioner has its specific size to be able to place the condyle in the glenoid cavity with respect to the required occlusal plane, for example: there are 30 Condylar Positioners and from them, 50 different positions can be obtained, where their dimensions are adjustable and vary depending on the desired effect or the patient's physiognomy, taking into account the occlusal plane.

[0053] As previously stated, the first number, +1, represents the horizontal overbite (incisal edge of the upper incisors to the incisal edge of the lower incisors). This value can be + (positive) if the upper teeth are in front of the lower teeth, 0 (zero) if the upper teeth are equidistant from the lower incisors, and - (negative) if the upper incisors are behind the lower incisors. Similarly, the second number, .1, represents the various vertical overbites, ranging from 1 mm to 9 mm.

[0054] Therefore, we can state that although the state of the art indicates many mandibular appliances, these are intended for patients who snore or suffer from obstructive sleep apnea; however, the closest document, C020210005505, which consists of a mandibular advancement device as indicated above, is very different from our invention, since it refers to an intraoral positioner that is placed in front of the mouth and requires a computer with software to obtain the necessary information, which makes it impractical; in contrast, our invention, through our Condylar Positioner, works with the entire diameter of the mandible and indicates the patient's dimensions without the need for a computer with specific software;Therefore, the present invention differs from the state of the art because the prior art does not indicate a Condylar Positioner that guides us to position the mandibular condyles in the glenoid cavity by means of occlusion, in the three directions of space.

[0055] BRIEF DESCRIPTION OF THE DRAWINGS

[0056] The preferred embodiments of the invention are explained in more detail below with reference to the drawings in which:

[0057] FIG. 1 is an image showing the entire device, its shape, and indicating the respective measurement.

[0058] FIG. 2 is a graphic image of the device that allows visualization of the different sizes and measurements of each Condylar Positioner.

[0059] FIG. 3 is a graphic image where the upper incisal edge in front of the lower incisal edge and the thickness between the incisal edges can be visualized.

[0060] FIG. 4 is a graphic image where the upper incisal edge can be visualized behind the lower incisal edge and its respective thickness.

[0061] FIG. 5 is a graphic image where the values ​​that demonstrate the horizontal overbite and the vertical overbite can be visualized.

Claims

CLAIMS 1. Condylar positioning device that allows positioning of the mandibular condyles, characterized in that it contains 3 rails that form a semicircle of various materials that allow placing an impression material of different sizes with different values, with an upper incisal edge; a lower incisal edge; and with its respective thickness.

2. Condylar positioning device, according to claim 1, characterized in that the materials are stainless steel; anodized aluminum; biocompatible plastic.

3. Condylar positioning device, according to claim 2, characterized in that the biocompatible plastic material is produced by means of 3D printing or casting.

4. Condylar positioning device, according to claim 1, which allows taking occlusal records and the spatial relationship between the jaws, providing the position of the condyles between the three directions of space, characterized in that the impression material comprises addition silicone.

5. Condylar positioning device, according to claim 1, characterized in that it contains positive, zero and negative values.

6. Condylar positioning device, according to claim 1, characterized in that the values ​​correspond to the horizontal overbite and the vertical overbite.

7. Condylar positioning device, according to claim 1, characterized in that the first numbers are the positive and negative values ​​(FIG.5) that correspond to the horizontal overbite.

8. Condylar positioning device, according to claim 1, characterized in that the second numbers (FIG. 5) are equivalent to the vertical overbite.

9. Condylar positioning apparatus, according to claim 6, characterized in that the positive values ​​(overjet) comprise from Omn to +9mn.

10. Condylar positioning device, according to claim 5, characterized in that the negative values ​​comprise from Omn to -5mn.

11. Condylar positioning device, according to claims 5 to 8, characterized in that the positive, zero and negative values ​​cover all the positions that the condyle can have in the glenoid cavity without producing functional disorders.

12. Condylar positioning device, according to claim 1, characterized in that the upper incisal edge is located lmn in front of the lower incisal edge +1.

13. Condylar positioning device, according to claim 1, characterized in that the upper incisal edge is located lmn behind the lower incisal edge -1.

14. Condylar positioning device, according to claim 1, characterized in that the thickness between the incisal edges is lmn.

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