阅读说明：本技术 正畸托槽、系统及方法 (Orthodontic brackets, systems and methods ) 是由 克里斯蒂娜·杰克逊 柯庆昌 于 2018-01-26 设计创作，主要内容包括：公开了一种正畸托槽。正畸托槽形成为使得本体和网部分一体地形成为一件,并且齿侧安装表面包括相对于安装表面具有倒凹角的粘合元件。粘合元件可进一步包括便于粘合材料的铺展的几何形状。在一些方面,托槽还可包括用于线安装和对齐器牙托相互作用的元件。进一步公开了一种系统及治疗方法。托槽可以针对个体患者进行定制。(An orthodontic bracket is disclosed. The orthodontic bracket is formed such that the body and web portion are integrally formed as one piece, and the flank mounting surface includes an adhesive element having a chamfered angle relative to the mounting surface. The adhesive element may further comprise a geometry that facilitates spreading of the adhesive material. In some aspects, the bracket may also include elements for wire mounting and aligner tray interaction. Further disclosed are a system and a method of treatment. The brackets may be customized for individual patients.)

1. An orthodontic system comprising:

a plurality of customized orthodontic brackets, each customized orthodontic bracket configured for attachment to a tooth, wherein at least some of the customized orthodontic brackets comprise:

a mounting portion and a treatment portion integrally formed as one component;

wherein the mounting portion comprises a mounting surface for attachment to a tooth and at least one adhesive element configured to receive an adhesive material;

wherein the treatment portion comprises at least one wire mounting element; and is

Wherein the at least one adhesive element is disposed at a chamfer angle relative to the mounting surface.

An archwire or one or more transparent alignment brackets;

a 3D scanner configured to scan a patient's teeth to create a computer model of the patient's current dentition;

a computer processor configured to:

modeling an ideal bite for the patient's teeth based on the patient's current dentition;

determining an initial alignment stage of a current dentition;

simulating virtual movement of the patient's teeth from the initial alignment stage to the ideal bite in incremental steps;

designing the plurality of customized orthodontic brackets to arrange the patient's teeth in the desired bite; and

a three-dimensional (3D) printer configured to produce each of the plurality of customized orthodontic brackets by an additive manufacturing process.

2. The system of claim 1, wherein the at least one adhesive element is a plurality of adhesive elements.

3. The system of claim 2, wherein the plurality of adhesive elements are formed as protrusions above the mounting surface.

4. The system of claim 2, wherein the plurality of adhesive elements are formed as recesses below the mounting surface.

5. The system of claim 3 or 4, wherein the adhesive element is square shaped with a side length in the range of 200-400 μm and a depth in the range of 100-350 μm.

6. The system of claim 3 or 4, wherein the mounting surface comprises a plurality of grooves to facilitate spreading of the adhesive material.

7. The system of claim 1, wherein at least one of the customized orthodontic brackets comprises:

a mounting portion and a treatment portion integrally formed as one component;

wherein the mounting portion comprises a mounting surface for attachment to a tooth and at least one adhesive element configured to receive an adhesive material;

wherein the treatment portion comprises a first tubular wire mounting element and a second tubular wire mounting element disposed at an angle relative to the first tubular wire mounting element; and is

Wherein the at least one adhesive element is disposed at a chamfer angle relative to the mounting surface.

8. The system of claim 7, wherein the second tubular wire mounting element is an alternate path to the first tubular wire mounting element for an archwire to pass therethrough.

9. The system of claim 8, wherein the first and second tubular wire mounting elements share a common entrance and separate exits, wherein an archwire is configured to pass through the entrance.

10. The system of claim 9, wherein the angle is in the range of 10 ° -45 °.

11. The system of claim 1, wherein the mounting portion is formed with a lobe and is configured to mount to a lingual side of a tooth.

12. The system of claim 1, wherein the computer processor is configured to:

creating an incremental alignment step for moving the patient's teeth from the coarsely aligned model to the ideal bite model from the coarsely aligned model obtained by rescanning the patient's teeth using the 3D scanner; and

designing the one or more transparent alignment trays; and is

Wherein each of the one or more transparent alignment trays is designed for a corresponding one of the incremental alignment steps.

13. The system of claim 1, wherein:

at least some of the plurality of customized orthodontic brackets include a through-hole located between the mounting portion and the treatment portion and disposed transverse to an exterior surface of the mounting portion; and is

The archwire is configured for insertion into the through holes of the at least some of the plurality of customized orthodontic brackets to align and level a patient's teeth.

14. The system of claim 1, wherein the plurality of customized orthodontic brackets are lingual brackets and the mounting portion for each lingual bracket is shaped for attachment to a lingual surface of one tooth of the patient.

15. The system of claim 1, wherein the mounting portion and the treatment portion of each of the plurality of customized orthodontic brackets are made of metal.

16. A method of orthodontic treatment, the method comprising:

scanning the patient's teeth with a 3D scanner to create a computer model of the patient's current dentition;

modeling, using a computer processor, an ideal bite based on the current dentition;

determining an initial alignment stage of a current dentition;

performing a computer simulation to virtually move the patient's teeth in incremental steps from the initial alignment stage to the ideal bite;

designing, using a computer processor, a plurality of customized orthodontic brackets configured to arrange a patient's teeth in the desired bite, wherein at least some of the plurality of customized orthodontic brackets comprise:

a mounting portion and a treatment portion integrally formed as one component;

wherein the mounting portion comprises a mounting surface for attachment to a tooth and at least one adhesive element configured to receive an adhesive material;

wherein the treatment portion comprises at least one wire mounting element; and is

Wherein the at least one adhesive element is disposed at a chamfer angle relative to the mounting surface;

manufacturing the plurality of customized orthodontic brackets using an additive manufacturing process implemented by a three-dimensional (3D) printer such that the mounting portion and the treatment portion are integrally formed as one component;

bonding each of the plurality of customized orthodontic brackets to a patient's tooth;

inserting at least one archwire into the plurality of orthodontic brackets to align and flatten a patient's teeth;

rescanning the patient's teeth to create a coarsely aligned model;

performing computer simulation to create an incremental alignment step to move the patient's teeth from the coarsely aligned model to an ideal bite model;

designing, using a computer processor, one or more transparent alignment trays for each incremental alignment step; and

fabricating the one or more transparent alignment trays.

17. The method of claim 16, wherein the at least one archwire is removed prior to inserting a first one of the one or more transparent alignment trays into the patient's oral cavity.

18. The method of claim 16, wherein:

the at least one archwire is a round superelastic archwire;

the at least one archwire is formed of a shape memory alloy material; or

The at least one archwire is formed using an additive manufacturing process.

19. The method of claim 16, wherein the at least some of the plurality of customized orthodontic brackets include a through hole positioned between the mounting portion and the treatment portion and disposed transverse to an exterior surface of the mounting portion;

the method includes inserting an archwire into the through holes of the at least some of the plurality of customized orthodontic brackets to align and level a patient's teeth.

20. The method of claim 16, wherein the at least one customized orthodontic bracket comprises:

a mounting portion and a treatment portion integrally formed as one component;

wherein the mounting portion comprises a mounting surface for attachment to a tooth and at least one adhesive element configured to receive an adhesive material;

wherein the treatment portion comprises a first tubular wire mounting element and a second tubular wire mounting element disposed at an angle relative to the first tubular wire mounting element; and is

Wherein the at least one adhesive element is disposed at a chamfer angle relative to the mounting surface.

21. The method of claim 20, comprising:

attaching each customized orthodontic bracket of the second plurality of customized orthodontic brackets to a molar tooth of the patient; and

inserting an archwire through the second cannulated wire mounting element of one or more of the second plurality of customized orthodontic brackets to create a distal coronal moment in each molar tooth to which the one or more customized orthodontic brackets are attached.

22. A method according to claim 20 or 21, wherein the second tubular wire mounting element is an alternative path to the first tubular wire mounting element for an archwire to pass therethrough.

23. The method of claim 22, wherein the first and second tubular wire mounting elements share a common entrance and separate exits, wherein an archwire is configured to pass through the entrance.

24. The method of claim 22, wherein the angle is in the range of 10 ° -45 °.

25. The method of claim 20, comprising:

attaching each customized orthodontic bracket of the second plurality of customized orthodontic brackets to a molar tooth of a patient; and

inserting an archwire through the second cannulated wire mounting element of one or more of the second plurality of customized orthodontic brackets to create a distal coronal moment in each molar tooth to which the one or more customized orthodontic brackets are attached.

26. The method of claim 16, wherein,

the plurality of customized orthodontic brackets are all lingual brackets; and is

Each lingual bracket is attached to a lingual surface of one of the patient's teeth.

27. The method of claim 16, comprising sequentially inserting each of the one or more transparent alignment trays into the patient's mouth to engage the plurality of customized orthodontic brackets, which creates a force on the patient's teeth until a desired bite is achieved.

28. The method of claim 16, wherein the at least one adhesive element is a plurality of adhesive elements.

29. The method of claim 28, wherein the plurality of adhesive elements are formed as protrusions above the mounting surface.

30. The method of claim 28, wherein the plurality of adhesive elements are formed as recesses below the mounting surface.

31. The method of claim 29 or 30, wherein the adhesion element is square shaped with a side length in the range of 200-400 μ ι η and a depth in the range of 100-350 μ ι η.

32. The method of claim 29 or 30, wherein the mounting surface comprises a plurality of grooves to facilitate spreading of the adhesive material.

33. The method of claim 16, wherein the mounting portion and the treatment portion of each of the plurality of customized orthodontic brackets are made of metal.

Technical Field

The present application relates to the field of orthodontics.

Background

Orthodontic systems and methods have been used for many years to correct tooth alignment. Orthodontic devices may be used for medical and/or aesthetic reasons, and interventions may range from minimally invasive to long-term combination therapy. Conventional methods typically begin by adhering a composite material to the surface of the tooth and using various means to facilitate tooth movement. One such method involves bonding a metallic bracket to the outside of a composite material at a prescribed angle and attaching the bracket to a tensioning wire (referred to as an "archwire") to create an alignment force.

Although this treatment has proven to be very effective, there are some drawbacks. For example, conventional metallic brackets are typically constructed in a multi-process method. The method may include molding the front bracket portion and stamping or sintering a separate "web" or mounting area to the tooth side of the bracket. Due to the small dimensions of the components, it is difficult to produce a reproducible, high quality bracket with tight tolerance specifications. A common production problem is the variation in the size of the slot for receiving the archwire. This can negatively impact the resulting alignment force, causing the bracket to move the tooth in an unintended manner. Furthermore, the slots for the wire typically have a flat base, while the wire attempts to follow a curved path around the patient's teeth. This results in friction between the wire and the bracket slot, which may lead to binding or denting of the wire. This can reduce the effectiveness of the treatment.

The main limitation of conventional lingual brackets is that it is very difficult and time consuming to engage the archwire into the bracket. Similarly, a limitation of using only transparent aligners is the efficacy and accuracy of the alignment phase. The composite attachment for the transparent aligner is very sensitive to the application technology. Due to errors made during application to the teeth, they do not always fit the aligner, resulting in an undesirable final tooth position. When the final tooth position is not ideal, a "finishing" phase must be started, which requires a new scan, a new attachment, and a new aligner.

In addition, orthodontic brackets may be applied to the facial or lingual surfaces of teeth. While it is sometimes desirable to use a lingual attachment for aesthetic reasons, placement and comfort of this type of bracket presents challenges. Thus, there is a need for improved geometry, manufacturing reproducibility, and placement accuracy and ease for facial and lingual brackets.

Disclosure of Invention

The subject matter disclosed herein relates to orthodontics, and in particular to a method of producing metallic brackets for use therein, brackets produced by the method, and systems and methods for using such brackets in orthodontic treatment. With orthodontic brackets as disclosed herein, improved elements for facial and lingual brackets are provided. The integrally formed configuration allows for the use of smaller, lower profile brackets that are more comfortable for the patient, while still providing multiple treatment features and retaining elements.

In one aspect, an orthodontic bracket as disclosed herein may have a mounting portion and a treatment portion integrally formed in one piece, wherein the mounting portion has a mounting surface for attachment to a tooth and at least one adhesive element configured to receive an adhesive material, and the treatment portion has at least one wire mounting element, wherein the at least one adhesive element is disposed at a re-entrant angle relative to the mounting surface.

According to another aspect of the subject matter disclosed herein, a method of orthodontic treatment using the disclosed one-piece bracket is described. The method is adapted to utilize the lingual surface of the teeth and is a combination of a transparent aligner and an archwire treatment.

The method disclosed herein overcomes the obstacles of the prior art. For example, replacing a composite attachment with a custom metal attachment not only reduces user error during application; also, since the attachment is in place at the time of scanning, the fit with the aligner is perfect. The provider can easily engage the lingual archwire with the custom metal attachments and by combining the archwire alignment with the transparent aligners will increase the efficiency and effectiveness of the treatment time and make it easier to achieve the desired effect.

While some aspects of the subject matter disclosed herein have been set forth above, and these aspects are achieved in whole or in part by the presently disclosed subject matter, other aspects will become apparent when described in conjunction with the attached drawings as best described below.

Drawings

FIG. 1A is a front view of an orthodontic bracket according to the disclosure herein;

FIG. 1B is a cross-sectional side view taken along line A-A of FIG. 1A;

FIG. 1C is a top view of an orthodontic bracket according to the disclosure herein;

FIG. 2 is a rear isometric view of an orthodontic bracket according to the disclosure herein;

FIG. 3 is a rear oblique view of an orthodontic bracket according to the disclosure herein;

FIG. 4 is another isometric view of an orthodontic bracket according to the disclosure herein;

FIGS. 5A-5B are isometric views of another embodiment of an orthodontic bracket according to the disclosure herein;

FIG. 6 is a view of the placement of orthodontic brackets according to the present disclosure;

7A-7E are various views of another embodiment of an orthodontic bracket according to the disclosure herein;

fig. 8 and 9 are placement views of orthodontic brackets according to the disclosure herein;

10-12 are top isometric views of an orthodontic system for teeth according to the disclosure herein;

fig. 13 is a schematic view of an orthodontic treatment method according to the disclosure herein; and

fig. 14 is a flow chart of a method of orthodontic treatment according to the disclosure herein.

Detailed Description

The subject matter disclosed herein addresses the problems encountered in conventional orthodontic treatment methods using conventional brackets. By providing integrally-made orthodontic brackets having the features disclosed herein, orthodontic treatment can be customized for each individual patient. Customized orthodontic brackets and attachments improve orthodontic results and reduce treatment time by optimizing the interaction between the brackets, wires and teeth.

Referring to fig. 1A-1C, an orthodontic bracket of an exemplary embodiment, generally designated 100, is shown, wherein the bracket 100 is configured for attachment to a portion of a tooth (e.g., lingual or facial attachment) that completely surrounds the tooth or does not completely surround the tooth. The orthodontic bracket 100 has two general areas: a treatment portion 110 and a mounting portion 120. The treatment portion 110 is also commonly referred to as a body. The mounting portion 120 generally corresponds to a conventional "mesh" portion of an orthodontic bracket, which is generally manufactured as a separate part from the body and subsequently joined to the body. According to the present disclosure, the orthodontic bracket 100 is formed as a single component with the treatment portion 110 and the mounting portion 120 integrally joined. The treatment portion 110 has features for attaching a treatment device, such as bosses, hooks, and slots. The mounting portion 120 has a buccal mounting surface 122 that features to facilitate attachment to the tooth with an adhesive material (e.g., a curable composite material). The mounting portion 120 further includes at least one adhesive element, which may be in the form of a protrusion or a recess (e.g., 124, 126). The protrusion or recess is arranged at least partially at an undercut angle (undercut angle) relative to the mounting surface to form an undercut such as undercut 130. In other words, the adhesive element joins the mounting surface at an angle less than perpendicular. These features will be discussed in more detail below.

The treatment portion 110 may further include an archwire slot 112 and tie wings 118 to which elastomeric ligatures may be mounted to retain the archwire. The geometry of the archwire slot 112 can be customized to accommodate a variety of archwires. In the exemplary embodiment of the orthodontic bracket 100, the slot 112 has tapered walls 114. However, other profiles are contemplated, for example, the wall 114 may have a rectangular or arcuate profile to match the geometry of a particular archwire. Further, the base of the slot 112 is preferably formed in a longitudinal arc in the linear direction to follow the curvature of the patient's dentition. The orthodontic bracket 100 may further optionally include additional features 116 in the form of bosses, slots, etc., which may be used for functions such as bracket orientation and engagement of additional treatment devices.

Fig. 2 is an isometric view of the orthodontic bracket 100 from the tooth-facing side, wherein the bracket 100 is configured for attachment to a portion of a tooth that completely surrounds the tooth or does not completely surround the tooth. As shown here, the orthodontic bracket 100 has a plurality of adhesive bases 124 disposed at a level above the mounting surface 122. In this example embodiment, the bonding bases 124 are arranged in a grid array; however, other configurations are possible, such as a circular or random pattern, or even a single element. Each adhesive base 124 is preferably attached to the mounting surface 122 at an angle of less than 90 ° relative to the mounting surface 122 to form an undercut 130. In the embodiment shown in fig. 1B-1C, the adhesive base 124 has an undercut 130 on all four sides of the base. However, the base may have the undercut 130 on one side, two sides, or three sides. This geometry provides improved engagement between the bonding material and the bracket by providing increased volume of composite material for influx as compared to conventional brackets. This can also help prevent separation from the teeth after the composite has hardened by creating a mechanical interlock.

Fig. 3 illustrates an alternative embodiment of an orthodontic bracket 100 (generally designated 100'), wherein the bracket 100' is configured for attachment to a portion of a tooth that completely surrounds the tooth or does not completely surround the tooth. In this embodiment, the adhesive elements of the mounting surface 122 are in the form of adhesive recesses 126. The bonding recess 126 is disposed at an angle relative to the mounting surface 122 to form an undercut 130. That is, in embodiments using an adhesive recess 126, the lower or inner surface of the recess has a larger area than the outer surface of the recess. Just like the bonding base 124, the bonding recess may have an undercut 130 on one side, two sides, three sides, or all four sides. For both the bond base 124 and the bond recess 126, the bond element may be square in shape with an outer edge length of about 200-. It should be understood that other shapes are possible.

To achieve the undercut 130 in the bonding base 124 or bonding recess 126, the orthodontic bracket 100 may be produced by various suitable methods known to those skilled in the art. Current methods include additive manufacturing processes such as powder bed fusion, such as Selective Laser Sintering (SLS) and Direct Metal Laser Sintering (DMLS), and powder feeding, such as Directed Energy Deposition (DED). This configuration allows for the inclusion of features in the bracket that are difficult to obtain using conventional techniques. This also allows orthodontic brackets to be designed and built at the point of service (i.e., "chair side") and customized for individual patients. An additional benefit of the single component configuration is that designing and manufacturing the brackets at the chair side reduces the high tooling and manufacturing costs typically associated with bracket design changes. Still further advantages of the brackets disclosed herein are improved dimensional tolerances, faster production, and more desirable aesthetics.

Fig. 4 illustrates another alternative embodiment of an orthodontic bracket 100, generally designated 100 ", wherein the bracket 100" is configured to be attached to a portion of a tooth in a fully encircling or a partially encircling manner. In addition to the bonding recesses 126, the orthodontic bracket 100 "also has optional grooves 128. The groove 128 may be disposed longitudinally and/or laterally with respect to the horizontal plane of the bracket. The grooves 128 provide additional paths for evenly distributing the bonding material in the bonding recesses 126.

Fig. 5A-5B illustrate another embodiment of an orthodontic bracket, generally designated 150, wherein the bracket 150 is configured for attachment to a portion of a tooth in a fully encircling or a partially encircling manner. Orthodontic bracket 150 includes a treatment portion 110, a mounting portion 120, and an adhesive recess 126 disposed at a negative or undercut angle to form an undercut 130. Instead of tie wings, the treatment portion 110 of the orthodontic bracket 150 is a tubular element 152 for insertion of an archwire. Brackets of this type are used, for example, at the end of archwires. The orthodontic bracket 150 also includes an optional second conduit 154. The second conduit 154 is preferably disposed at an angle alpha in the range of 10-45 deg. to the occlusal plane.

Fig. 6 illustrates the use of orthodontic brackets 150. The second wire tube 154 can be used as an alternative path for the archwire 160 in order to create distal coronal moments in the molars. This distal crown moment counteracts the medial crown moment that occurs when the molar teeth are extended forward and aligned with the teeth T during gap closure. The balanced moment can help to hold the molars in place while retracting the front teeth, which is a highly desirable biomechanical movement for treating patients with gaps or extractions. Although the embodiments described herein use a one-piece configuration, it is contemplated that the second conduit 154 may also be used with conventional band-like mounting types that completely encircle the teeth.

Routing the archwire through the second conduit 154 provides advantages over conventional techniques for bonding brackets at an angle to teeth. The second wire conduit 154 may allow the tooth provider to make significant adjustments to the archwire tension without having to remove and re-bond the brackets.

Fig. 7A-7E illustrate yet another exemplary embodiment of an orthodontic bracket, generally designated 200, in which the bracket 200 is configured for attachment to a portion of a tooth in a fully encircling or a partially encircling manner. The orthodontic bracket 200 has a treatment portion 210 and a mounting portion 220. While the orthodontic bracket 100 is configured such that the mounting surface 122 is substantially concave (i.e., adapted to mount on a facial surface), the orthodontic bracket 200 is configured such that the mounting surface 222 is convex in some instances and is configured for mounting on a lingual surface of a tooth. Various embodiments of the orthodontic bracket 200 may be used as a system in lingual orthodontic treatment, such as with an archwire, an aligner bracket, or a combination thereof.

Just as with the orthodontic bracket 100, the orthodontic bracket 200 is integrally formed as one piece. This advantageously allows the orthodontic bracket 200 to be manufactured with small features and overall size that provides improved comfort to the patient and facilitates insertion of an archwire by the clinician. Further, if the orthodontic bracket 200 is produced by an additive manufacturing process at a point of service, the mounting surface 222 is customized to accommodate individual tooth anatomy.

Similar to the orthodontic bracket 100', the orthodontic bracket 200 includes an adhesive element to facilitate adhesion of an adhesive material to the bracket. For example, the mounting surface 222 includes a plurality of bonding recesses 226, which may be provided with dimensions as described for the bonding recesses 126. The bonding depressions 226 may be arranged in a regular, semi-regular, or random pattern as desired to maximize bonding.

In the example embodiment shown in fig. 7A-7E, the treatment portion 210 is different from the treatment portions in the orthodontic brackets 100 and 150. In the case of orthodontic brackets 200, through holes 212 are provided. The through hole 212 is located between the mounting portion and the treatment portion and is configured to receive an archwire. The diameter of the through hole corresponds to the size of the circular arch wire used for connecting the lingual brackets. The treatment portion 210 may also be used as part of a transparent alignment treatment, which is described in more detail below.

The overall shape of the mounting portion 220 can be produced in virtually any shape as desired to match the contours of the teeth. Fig. 8 and 9 show a possible embodiment of a lingual bracket. For example, FIG. 8 shows lingual brackets 230, 232, 234 mounted on the incisors and canines T. In this case, the mounting portion is generally convex and configured to fit the lingual surface of the teeth. On the other hand, in fig. 9, lingual brackets 236 and 238 are shown mounted on molar teeth T, and in this case, the mounting portions have a generally concave shape. It can also be seen in fig. 8 and 9 that the axes of adjacent through holes are not aligned; insertion of a lingual archwire (e.g., an archwire made of a shape memory alloy) generates alignment forces to cause movement in the teeth.

Referring now to fig. 10, a system of lingual brackets 300, including the individual brackets 240, 242, 244, 246, 248, 250, 252, 254, 256, 258 and the archwire 260, is shown in the oral cavity of a patient P. Here it can be seen that each bracket is custom made for each individual tooth T and that the brackets have a low profile. Furthermore, the lingual brackets may be quickly installed in the mouth of the patient P by using indirect adhesive brackets. Thus, the system of lingual brackets 300 may provide comfortable and minimally invasive treatment. It can also be seen in fig. 10 that some brackets (e.g., 246, 248, 250) have mounting portions with convex curvature, while others (e.g., 256, 258) have more concave forms.

Fig. 11 and 12 illustrate an alternative embodiment of a system 300, generally designated 300'. The system 300' (including brackets 340, 342, 344, 346, 348, 350, 352, 354, 356, 358, each configured for attachment to a portion of a tooth in a fully encircling or a non-fully encircling manner) provides a hybrid approach to lingual orthodontic treatment. For example, the system 300' may be applied to a tooth T, as shown in fig. 11. Each bracket includes a mounting portion having an adhesive element and a treatment portion having a through-hole. In an initial treatment stage, the brackets 340-358 may be connected, for example, using an archwire (not shown). After a certain degree of alignment is achieved, the archwire is removed and a transparent alignment treatment is initiated. As shown in fig. 12, the archwire is replaced with a transparent aligner tray 370. Typically, the transparent aligner tray interacts with ridges that adhere to the patient's teeth. The treatment portion of the lingual brackets in the system 300' replace these ridges and provide interaction with the transparent aligner tray 370 to move the teeth to the final desired position.

This general mixing method is applicable to the unique treatment methods disclosed herein and described in the schematic of fig. 13 and the flow chart of fig. 14. The treatment can achieve the desired tooth alignment in two procedural stages. The first stage (stage 1) moves the patient's teeth into partial alignment by using an orthodontic bracket system configured for lingual attachment and used with a lingual archwire (e.g., 300). In the second phase (phase 2), the alignment progress is measured and adjusted, and the brackets are used in conjunction with a transparent alignment treatment. The treatment may be performed in the upper or lower part of the jaw, or simultaneously in the upper and lower part of the jaw.

Treatment begins with an imaging scan of the interior of the patient's mouth (1001). This can be done, for example, by using a laser scanner 10. The scanned image is sent to a three-dimensional CAD program on the computer 20 where the scanned image is processed as necessary to separate the single image of the scanned tooth into individual discrete elements (1002). The processed 3D model may be referred to as an initial phase model (ISM). The dental provider then uses the skills and judgment to place the modeled dental elements in the final desired state (e.g., improved bite, straight appearance, reduced crowding, etc.) for that particular patient (1003). This final state may be referred to as ideal occlusion, and it may be based on biomechanical principles such as matching an individual malocclusion. Next, a computer algorithm may be used to define a specific path for each tooth in order to move the tooth from an initial position to a desired bite. The intermediate state along the path is selected as the end of phase 1, which may be referred to as the initial alignment phase or IAS (1004). A second simulation is then performed to move the teeth from the IAS to the ideal bite (1005). The paths are partitioned into several discrete models representing incremental states (1006). At this point, the tooth provider may reference the computer model to help design a custom lingual bracket (e.g., similar to orthodontic bracket 200) that preferably has recessed adhesive elements and through holes in the treatment portion. The custom lingual bracket (also referred to as an attachment) is configured to move the tooth from the initial alignment stage to the desired bite by means of a transparent aligner (1007).

One-piece custom lingual brackets are then manufactured and delivered to the tooth provider if necessary (1008). The custom lingual brackets may be produced by any suitable method (e.g., by using an additive manufacturing process on the 3D printer 30). The bracket is then loaded on the mounting feature of the attachment using an adhesive (e.g., Transbond LV). The attachment is bonded to the patient's teeth in a manner that facilitates movement of the teeth from the initial alignment stage to the desired bite (1009). A lingual archwire, preferably a shape memory alloy, is then inserted and used to align and flatten the patient's teeth for a period of time, for example 3-6 months. The lingual archwire may be produced by any suitable method, including additive manufacturing processes. The end of the time frame is the end of phase 1 (1010).

At the end of the period (e.g., 3-6 months), the patient's teeth will have moved partially toward the ideal bite. The patient's mouth is then scanned again, for example by using the laser scanner 10 (2001), and the image is imported into a three-dimensional CAD model on the computer 20 and processed to separate the teeth into individual elements (2002). The position of the teeth at this time may be referred to as a coarsely aligned model (ACM), which is targeted to be comparable to the ISM. The dental provider may then follow a process similar to stage 1 by refining the ideal bite (2003) and using computer algorithms to update and adjust the path from the ACM to the ideal bite. The path may be saved in incremental steps, also referred to as incremental step models or ICMs (2004). Each ICM defines a location for designing a series of transparent alignment brackets (2005). The transparent alignment tray may then be constructed using any suitable method, including an additive manufacturing process using a 3D printer 30 (2006), and delivered to the dental provider for continued treatment (2007). Leaving the lingual attachment in place to serve as a retention point and, together with the aligner tray, to generate forces on the teeth instead of the conventional composite attachment. The use of the treatment portion of the custom lingual brackets as a reaction point with the transparent tray may advantageously provide strong and precise movement in the tooth.

Finally, the lingual archwire may be removed and a transparent alignment treatment initiated (2008). The series of trays is used continuously until the desired bite is achieved. The progress of the patient is monitored periodically by the dental provider and, if necessary, a refined tray can be produced to correct the alignment.

Although several exemplary embodiments of the subject matter are disclosed herein, it should be understood that modifications, substitutions, and alternatives may be apparent to one of ordinary skill in the art and may be made without departing from the scope of the present disclosure. This disclosure is intended to cover any adaptations or variations of the exemplary embodiment(s). For example, although the figures show embodiments having mounting portions that do not encircle the teeth, orthodontic brackets that completely encircle the teeth according to the present disclosure may also be provided.

The subject matter disclosed herein may be implemented in or in association with software in connection with hardware and/or firmware. For example, the subject matter described herein may be implemented in software for execution by, for example, a processor or processing unit in computer 20 or associated with computer 20. In one exemplary embodiment, the subject matter described herein may be implemented using a computer-readable medium having stored thereon computer-executable instructions that, when executed by a processor of a computer, control the computer to perform the steps described. Exemplary computer readable media suitable for implementing the subject matter described herein include non-transitory devices such as disk memory devices, chip memory devices, programmable logic devices, and application specific integrated circuits. In addition, a computer-readable medium that implements the subject matter described herein may be located on a single device or computing platform or may be distributed across multiple devices or computing platforms.

Various combinations and subcombinations of the structures and features described herein are contemplated and will be apparent to those skilled in the art in view of the present disclosure. Unless stated to the contrary herein, any of the various features and elements disclosed herein may be combined with one or more other disclosed features and elements. Accordingly, the subject matter as hereinafter claimed is intended to be broadly construed and interpreted, as including all such variations, modifications and alternative embodiments, within its scope, and including equivalents of the claims.