NO20150861A1

NO20150861A1 - Multi Loop Palatal Arch

Info

Publication number: NO20150861A1
Application number: NO20150861A
Authority: NO
Inventors: Maria Lucete Martinho Fernandes Færøvig
Original assignee: Maria Lucete Martinho Fernandes Færøvig
Priority date: 2012-12-04
Filing date: 2015-07-03
Publication date: 2015-07-14
Also published as: WO2014088422A1

Description

MULTI LOOP PALATAL ARCH

The present invention relates generally to orthodontic appliances to move teeth. More specifically the invention relates to an orthodontic fixed removable palatal appliance for applying corrective forces in all three dimensions: horizontal, sagittal and vertical, to expand or contract the upper dental arch or otherwise move any desired teeth in the upper jaw including teeth that have not erupted naturally. The device according to the present invention comprises the features that are defined in the patent claims, and specifically a device or assembly comprising a wire material for moving in all three dimensions any desired teeth in the upper dental arch including teeth that have not erupted naturally relative to a pair of substantially transversally opposed upper teeth without the reaction forces on this pair of teeth causing unwanted movement of said pair of teeth, wherein said orthodontic device includes a palatal arch wire section adapted to fit between the mentioned pair of transversally opposed teeth and to be placed adjacent the palate comprising a multi-loop spring, said multi-loop spring corresponding to one third to one half of the palatal arch wire section width and when placed at some distance from the palate forming a bed for tongue pressure creating intrusive corrective forces on said pair of teeth., the orthodontic device further including extension spiral-formed bows with adaptation loops extending laterally from the transversal palatal arch for applying corrective forces to one or more teeth anterior or posteriorly placed in relation to the said pair of teeth, said palatal arch section being constricted to receive the reactive forces of the extension spiral-formed bows and applying this force to the pair of teeth cancelling out any reactive forces transmitted to the said pair of teeth. Furthermore the present invention includes the use of such a device for moving/adjusting the location, tilt, rotation and/or orientation of any tooth in the upper dental arch, and optionally including at least one unerupted tooth.

Background of the invention

Orthodontics is a field of dentistry in which the position of teeth is physically moved relative to one another and relative to the maxilla and mandible in order to achieve a proper relation to one another and to the facial skeletal structure of the patient. Expansion (movement in a buccal direction) or contraction (movement in a lingual direction), tipping, rotation and/or torqueing (movement along the longitudinal axis) of one or more teeth, usually molars in the upper jaw are common corrective tooth movements in the field of orthodontics. Equally common is the stabilization and maintenance of the molar teeth in a correct position while the molars are used as force-reaction anchors during corrective force application of other teeth in the patient's mouth. Such tooth movements can be carried out by using an orthodontic appliance referred to as Palatal Arch which comprises a wire attached to two transversally opposed teeth in the upper jaw. This wire is shaped and fitted in such a manner that after attachment to the teeth, it will remain under mechanical stress. This stress produces movement corrective forces to the teeth and is gradually reduced as correction of the tooth position progresses. The direction in which tooth movement occurs is determined by the direction of the corrective force which is determined by the shape and placement of the source of the corrective force section of the orthodontic device.

Prior art

Stainless steel palatal arenes as those shown in U.S. Pat. 3,792,529 and 4,592,725 invented by Robert A. Gosgharian are applied to a pair of opposed teeth in the upper dental arch, usually the maxillary first permanent molars for expanding, de-rotating and/or torqueing these teeth to a desired position. A single open loop is the only regulating region of the device and the opposed teeth where the device is inserted are the only teeth that benefit from the correction.

Other palatal arenes using stainless steel materials as those shown in U.S. Pat. 4,815,968, invented by Duane Keller can move other teeth of the upper arch than only the teeth where the appliance is inserted. However all these palatal arches present a single open loop as a mean of producing the corrective force to move teeth.

In CN utility model 201542766 U, a central Q -shaped loop with a U-shaped loop apart on each side is the main corrective force source of the device. However all these 3 loops are separated from each other with some length of straight (not bent) wire.

In WO 2013/040144 Al is disclosed an orthodontic device for moving teeth comprising a palatal arch with a middle portion which configuration is a triple loop comprising a central Q -shaped loop and a U-shaped loop on each side. These loops are the source of the corrective force to the teeth. However, this triple loop portion of the palatal arch is positioned towards the anterior aspect of the teeth to which the device is inserted (usually the upper first molars). This results in that the applied corrective expansion, derotation or torque forces are exerted from the anterior aspect of the center of resistence of the teeth reducing their effect. On the other end the long arm that lies between the source of the corrective force (the triple loop) and the teeth, creates a moment of the force with consequent unwanted rotational effect of the teeth to be moved.

In WO 2009/150634 A2, the Transpalatal Members of the device may include different shaped loops which main purpose are not to create the corrective force to other teeth then the anchor teeth.

Other palatal arches are fabricated with a combination of wire sections made from nickel-titanium alloys which is a superelastic material with shape-memory properties, and wire sections made from steel.

The palatal arches shown in U.S. Pat. 5,399,087 and in U.S. Pat. 5,816,800, have their central section fabricated of a superelastic material with the purpose to provide a lower and more uniform corrective force throughout the treatment period without the need to remove the appliance to add further activations.

These features are improvements to the stainless steel type palatal arch devices. However these appliances have limitations because once the device is installed in the mouth, it cannot be adjusted further and also because the amount of desired corrective forces is different from patient to patient and from the right to the left side in the same patient. In addition when a big amount of expansion movement is needed, several appliances may need to be used in sequence.

In the palatal arch shown in US 2004/0048222 Al, the superelastic material is present only in two small sections lateral ly placed in relation to the central normal elastic section. This central normal elastic section has a single loop.

No previous palatal arches have been designed for dragging not erupted teeth out of the bone and move them to their alignment in the dental arch or otherwise move any desired teeth in the upper dental arch without unwanted reactive forces on anchor teeth. In addition no previous palatal arches have been designed for intrusion of the teeth to which the appliance is anchored.

Description of the invention

The appliance according to the present invention comprises a wire formed from material with a mean cross section in the interval 0, 8 to 0, 9 mm. This cross section is preferably circular, although other cross sectional shapes may be contemplated such as square. The wire included in the appliance according to the present invention is preferably formed of 0,036 inch (0,91440 mm) diameter stainless steel wire spring - hard resilient although other diameter sizes and other alloys håving similar properties that comprise carbon, chromium, cobalt, nickel, manganese and stainless steel can be utilized. Metal alloys such as cobalt-chrome-nickel or titanium-molybdenum (3 - titanium) alloys can be utilized. The material to be chosen should have an elastic modulus that allows a rigid wire span where it is required. The material should also have high formability in order to sustain a big amount of permanent deformation without breakage. It should be adjustable and should reta in its shape after being bent in order to provide corrective forces. It is also recommended that the material is solderable and/or weldable.

The present appliance assembly comprises the following sections:

A palatal arch section (CS) that is crossing the palate between two opposed molars (MR (right molar), ML (left molar)) and has an arching towards the palate which

approximates the concave shape of the palatal arch (Fig. 10). In the central part of this palatal arch section (CS) (Fig. 1-9) there is a compressive multi Q -loop spring system (LSI) that is oriented towards the distal aspect of the upper teeth to which the device is inserted (usually the upper first molars) (figs. 1-10). The number of loops in the multi Q -loop system of the central section in the device according to the present invention is normally 3 or 5. Since the loops are always multiple and doubled back onto themselves the number of loops is an uneven one (3 or 5 ) for extending securing ends evenly across the palate to opposing molars, although an even number (2, 4 or 6) of loops may extend the securing ends to non-opposing molars or other teeth in need of correction. According to the present invention can in one embodiment the number of loops in the multi Q -loop system of the central section in the device accommodate 3 or 5 loops.

In the five Q -loop system embodiment (LSI, Fig. 1-7) three loops are opening towards the anterior aspect and two loops are opening towards the posterior aspect. In case of a narrow palate a three Q-loop (LS2) (Fig. 8) palatal arch can replace the five Q -loop palatal arch and in this case two loops are opening towards the anterior aspect and one loop is opening towards the posterior aspect. This multi Q -loop spring system placed in the central part can be replaced by a helical loop spring system (LS3) (Fig. 9) where the loop in the middle (LS3M) is a helical loop for more effective corrective contraction (opposite to expansion) forces on the molars.

Two attachment sections (ISR, ISL) (Fig. 1-9), one in each side end of the palatal arch section. These attachment sections are intended to fix the palatal arch assembly to the upper opposed molars (both first molars, both second molars or one first molar and one second molar). Each of these attachment sections has one end that is bent over double to form rectangular shaped end inserts (Figs. 11, 12). These rectangular - shaped end inserts resemble U-shaped integral compressive loop projections with two being pa ra I lei leg segments for a convenient insertion into the lingual sheaths (LS) of pre-fitted upper molar bands (MB). These compressed loop projections are long (Fig. 12-13) in order to fasten the appliance securely without the need to be tied in with ligatures. The increased length of these end attachments also make the insertion of the appliance inside the sheath easier and provides more corrective derotation and torque forces on the molars.

Two extension bows laterally placed one in each side (LSR, LSL) (Fig. 1-6) and extending anteriorly for a distance from the palatal arch (CS). Each lateral extension bow in one embodiment (ARI, ALI) (Fig. 1-3) has a triple helical loop (HLR,HLL) in its middle part which is vertically or horizontally oriented depending on the direction of the activation desired. Each lateral extension bow (AR1,AL1) with a helical loop (HLR,HLL) works as a cantilever arm and is designed for traction of not erupted teeth (NETR, NETL)(Fig.l) or otherwise movement of any desired tooth in the upper dental arch (Fig. 2,3). Each lateral extension bow (ARI, ALI) with the helical spring has a proximal end (PER, PEL) and a distal end (DER,DEL)

(Fig. 1). Each distal end has a small hook for possibility of ligation to the attachment of the tooth to be moved. Each proximal end has a U-shaped loop for sagittal, transversal or vertical adjustments of the extension bow in the mouth and to avoid impingement on the palatal mucosae (Fig. 1 -6). These lateral extension bows can also be adjusted for lateral expansion/contraction in the canine and premolar region (AR2,AL2) (Fig. 2)and frontal expansion/ contraction (AR3, AL3)

(Fig. 3). In another embodiment each extension bow can be adjusted for anchorage control only (AR4, AL4, AR5, AL5, AR6, AL6) (Figs. 4-6) and in this case it does not incorporate any helical loop in order to increase stiffness of the extension.

Brief description of the drawings

Fig. 1 is a plan view of the upper dental arch i Hustra ting an orthodontic appliance of the present invention with lateral extension bows to pull the not erupted teeth (NETR, NETL) out of the bone and move them into proper position in the dental arch. Fig. 2 is a plan view of the upper dental arch illustrating orthodontic appliance of the present invention with the lateral extension bows for lateral expansion/ contraction movements in the canine and premolar region. Figs. 3 is a plan view of the upper dental arch illustrating an orthodontic appliance of the present invention with the lateral extension bows for expansion/ contraction movements in the incisor region (front segment). Figs. 4,5 are plan views of the upper dental arches illustrating orthodontic appliances of the present invention with the lateral extension bows for anchorage control purposes in canine and premolar region. Fig. 6 is a plan view of the upper dental arch illustrating an orthodontic appliance of the present invention with the lateral extension bows for anchorage control purposes in the incisor region (front segment). Fig. 7 is a plan view of the upper dental arch illustrating an orthodontic appliance of the present invention with the palatal arch (CS) with five loops (LSI). In this embodiment the extension bows were cut off for expansion and rotation corrective movements of only the attached opposed molars. Fig. 8 is a plan view of upper dental arch illustrating and orthodontic appliance of the present invention with a palatal arch with 3 loops (LS2). Fig. 9 is a plan view of the upper dental arch illustrating an orthodontic appliance of the present invention with a palatal arch with a helical loop (LS3M) in the loop system (LS3) for contraction corrective forces. Fig. 10 illustrates a perspective frontal view of the orthodontic appliance of the present invention showing the position of the device with respect to the concavity of the palate in the upper jaw. Fig. 11 is a perspective view showing in detail the attachment insert on the right side (ISR) of the palatal arch of the present invention, which is to be inserted in the lingual sheath (LS) of the molar band (MB). Fig. 12 is a side lingual view showing in detail the doubled over "U-shaped" attachment insert of the right side (ISR) inserted into the lingual sheath (LS) of the molar band (MB). Fig. 13 is a top view showing in detail the doubled over "U-shaped" attachment insert on the right side (ISR) inserted into the lingual sheath (LS) of the molar on the right side (MR). Fig. 14 A is a plane view of the orthodontic appliance of the present invention. By bending the terminal doubled-over attachment insert ends at a horizontal angle relative to the entrance angle of the lingual sheath of the molar band, a corrective rotational force is applied to the molars in the horizontal plane (B). The resultant spreading or compressing of the central multi-loop system of the palatal arch section when the appliance in inserted in the mouth produces the desired spring corrective force. With additional activation of the multi-loop system of the palatal arch section by the orthodontist before the appliance is inserted in the mouth the applied corrective rotational force can be selectively directed to either the anterior aspect or to the posterior aspect of the crown of the molar teeth (C). Fig. 15 A is a lingual view of the attachment end insert (ISL) inserted on the lingual sheath of the left upper molar. By bending the terminal doubled-over attachment end inserts at a vertical sagittal angle relative to the entrance angle of the lingual sheath of the molar band, a corrective force is applied to the inclination of the molars in the sagittal plane (B). The resultant spreading or compressing of the central multi-loop system of the palatal arch section when the appliance in inserted in the mouth produces the desired spring corrective force. With additional activation of the multi-loop system of the palatal arch section by the orthodontist before the appliance is inserted in the mouth the applied corrective force can be selectively directed to either the anterior aspect or to the posterior aspect of the crown of the molar teeth (C). Fig. 16 A is a perspective lingual view of the attachment end insert (ISL) inserted on the lingual sheath of the left upper molar. By bending the terminal doubled-over attachment end inserts at a vertical transversal angle relative to the entrance angle of the lingual sheath of the molar band, a corrective force is applied to the inclination of the molars in the transversal plane. The resultant spreading or compressing of the multi-loop system of the palatal arch section when the appliance in inserted in the mouth produces the desired spring corrective force. With additional activation of the multi-loop system of the palatal arch section by the orthodontist before the appliance is inserted in the mouth the applied corrective force can be selectively directed to either the crown or the roots of the molar teeth

(B).

Fig. 17 illustrates an example of an embodiment of an orthodontic appliance of the

present invention as disclosed supra for expansion and torque of the upper molars from a frontal view. The device according to this example comprises a palatal arch section (CS) with a five Q-loop stainless steel wire with an even cross section of 0,036 inches (0,91440 mm). The total width of the device is adjusted to span the hard palate across the sagittal midline plane of the subjecfs mouth. At the terminals of each end of the palatal arch section (CS) there is an attachment insert (IS) for insertion to the relevant molar (MR,ML). The device may be positioned in the mouth by inserting the attachment end into the lingual sheath on the molar crown band on one side first and then on the other side by compressing the device through the activation of the triple loops of the palatal arch section (CS). The compressed multi loop system will create corrective expansion forces and press against said molar crowns. If it is necessary to additionally correct the inclination of the molars in the 3 different planes, the device can be preactivated in the attachment end insert sections by introducing bends in the double-over terminal ends. The device will e.g. correct the tilt of the relevant molars to a more up righted tilt while being expanded. The device may be further activated by opening the loops with a plier.

Fig. 18 A illustrates an example of an embodiment of a orthodontic appliance of the present invention as disclosed supra for traction of impacted teeth from a perspective horizontal view. The device according to this example comprises a palatal arch section (CS) with a five Q-loop stainless steel wire with an even cross section of 0,036 inches (0,91440 mm). In this embodiment the fifth Q-loop section represents one third of the total width of the central section. One attachment insert in each end of the palatal arch section for insertion to the relevant molar (MR, ML) sheath. From the attachment end on the right side there proceeds an extension bow (ARI) with a helical loop (HPR) that is ligated on its terminate end to an attachment previously bonded to a nonerupted canine by a surgeon. This extension bow is intended for traction of the not erupted teeth (NETR). From the attachment end insert on the left side there proceeds an extension bow that extends anteriorly to the canine on that side this one naturally erupted and is adjusted for anchorage control only. In Fig 18 B the canine on the right side has been forced to erupt by the device and the same extension bow that pulled the tooth out is now used to press the canine out into alignment with the other teeth before any fixed appliances are bonded to the upper dental arch.

Fig. 19 illustrates an example of an embodiment of an orthodontic appliance of the present invention as disclosed supra for traction of impacted teeth from a perspective side view on the labial side. A labial impacted maxillary canine on the left side with an attachment bonded to its crown is being pulled down into place by means of an extension bow with a helical spring (ALI). The mechanics chosen to erupt an impacted canine should make the tooth erupt if possible in the center of the alveolar ridge in order to produce a normal labial gingival relationship over the erupted tooth. With this technique is possible to avoid the traction of the tooth out towards labial therefore reducing the risk of producing a bony dehiscence with consequent migration of the labial gingival margin, which results in labial recession and increase crown length of the impacted tooth when compared with the non-impacted one. Fig. 20 A illustrates an example of an embodiment of an orthodontic appliance of the present invention as disclosed supra for contraction of the first molar teeth from a perspective horizontal view. The device according to this example comprises a palatal arch section (CS) with a three- loop stainless steel wire with an even cross section of 0,036 inches (0,91440 mm). At the terminals of each end of the palatal arch section (CS) there is an attachment insert (IS) for insertion to the relevant molar (MR,ML) sheath. Both first molars (MR, ML) in the upper dental arch are over expanded and need to be contracted and the left molar also needs correction of the rotation in the horizontal plane. For this purpose the loop spring system in the palatal arch section (LS3) comprises three loops where the loop in the middle is replaced by a helical loop (LS3M). Anti-rotation force movements is provided by the open loop on the left side laterally placed to the middle helical loop. Fig. 20 B illustrates the result of the corrective contraction and rotation forces delivered by the appliance on the first molars. Fig. 21 A illustrates an example of an embodiment of an orthodontic appliance of the present invention as disclosed supra for unilateral expansion from a perspective horizontal view. The device according to this example comprises a palatal arch section (CS) with a five Q-loop stainless steel wire with an even cross section of 0,036 inches (0,91440 mm). At the terminals of each end of the palatal arch section (CS) there is an attachment insert section (IS) for insertion to the relevant molar (MR,ML) sheath. From the attachment insert section on the right side there proceeds an extension bow that extends anteriorly until the canine of the same side and is positioned so that more teeth are in contact with the appliance on this non-expansion side for anchorage control. Unilateral expansion and derotation of the molar on the left side can be achieved by cutting away the extension bow of the left side so that the expansion and rotation forces produced are exerted mostly on the left molar (B). Fig. 22 A illustrates an example of an embodiment of an orthodontic appliance of the present invention as disclosed supra for bilateral asymmetric expansion from a perspective horizontal view. Fig. 23 Illustrates an example of an embodiment of an orthodontic appliance of the present invention as disclosed supra for intrusion of the upper molars from a perspective frontal view. Both upper molars (MR, ML) are overextruded (A) and need to be intruded. By adapting the device in the mouth of the patient so that there is some distance between the palatal arch section and the hard palate of the patient's mouth, the tongue may exert a pressure upwards on the multi loop system of the palatal arch (B) which is transmitted in the form of corrective intrusive forces to the upper molars (C).

Applications

The invention is related to an improved fixed-removable and adjustable palatal arch that has the following applications:

A. Traction of unerupted teeth in the upper jaw.

B. Expansion of the palatal arch.

C. Contraction of the palatal arch.

D. Rotation of the upper molar teeth.

E. Intrusion of the upper molar teeth.

F. Torquing of the upper molar teeth.

G. Anchorage of the upper molar teeth.

A.

In the first main application the conventional traction of a tooth that did not erupt (meaning that it did not come out of the bone by itself), the aim is to drag the tooth out of the bone and move it to its right position in the dental arch. Moving an impacted tooth into the dental arch is a difficult, lengthy and challenging task. An unerupted tooth is an extreme example of an asymmetric tooth alignment problem because the tooth is far from the line of occlusion. The movement of an unerupted tooth to the correct position is usually accompanied with unwanted side effects as unnecessary movements of neighbor teeth.

After an attachment has been bonded to the crown of an unerupted tooth by a surgeon, the orthodontist begins to drag this tooth to the proper place by means of a device according to the present invention. An extension bow (ARI, ALI)) with a helical loop (HLR, HLL) is ligated to the attachment of the unerupted tooth and works as a cantilever arm for traction of the tooth. The same extension bow is connected to a rather rigid anchor palatal arch (CS) to allow stabilization of the rest of the dental arch.

With this appliance a multi-axis displacement of the not erupted tooth is possible to perform due to the possibility of activating the extension bow (ARI, ALI) (Fig. 5) in the three planes of the space: vertical, transversal and sagittal. Without this appliance a precise guidance of the movement of the tooth on its path from its starting position inside the bone to its final correct position in the upper dental arch is very difficult due to the need of different vectors of traction forces of the tooth during the course of treatment. This is because of the big variation in its original position inside the bone and the presence of neighbor anatomic structures. It is important to note that the tooth to be moved is not visible until it is out of the bone and throughout the mucosa and for a good treatment result the tooth should erupt as close as possible to its final correct position in the dental arch in order to have a healthy paradont which will hold the tooth in the bone for the rest of its life. At the same time it is very common that the crown of the impacted canine is in intimate contact with the roots of the central and lateral incisors. In these situations it is important to keep the tooth away from the neighboring teeth on its path out of the bone to avoid pressure on these teeth because this increases the risk for damaging their roots (root resorption of the neighbor teeth).

A common not erupted tooth in the upper jaw is the canine. An impacted canine can be placed on the labial, in the center or on the palatal side of the alveolus. About one third of the impacted canines are positioned labially or within the alveolus and two thirds are located palatally. The mechanics chosen to erupt an impacted canine should make the tooth erupt if possible in the center of the alveolar ridge in order to produce a normal labial gingival relationship over the erupted tooth. This is particularly important in high labially impacted canines. Mechanics that draw the tooth out labial should be avoided because it can produce a bony dehiscence with consequent migration of the labial gingival margin, which results in labial recession and increase crown length of the impacted tooth when compared with the non-impacted one. In addition it may also increase the tendency for this canine to re-intrude after orthodontic treatment is finished.

After reaching the desired position of the impacted tooth, the extension bow (cantilever arm) can then be positioned in order to move other maxillary teeth of the upper dental arch (AR2, AL2, AR3, AL3) (Figs. 2,3) or simply cut just shorter and in this last case the shorter bow may lay passively for anchorage purposes (AR4, AL4, AR5, AL5, AR6, AL6) (Fig. 4-6).

The most common unerupted tooth is a maxillary canine but it can be necessary to bring other unerupted teeth into the arch and the same techniques apply for incisors and premolars.

B.

The second main application is the conventional expansion of the upper molars. The palatal arch section of the device has in its central part a spring-operated expansion system. This spring operated expansion system exhibits a 3 or 5 Q- shaped loop spring form that produces the expansion force by permitting the relative distance of both ends to one another to be varied. Because the device crosses the palatal vault directly from one molar on one side straight to the molar on the other side , the vector of force passes close to the center of resistance of the molars reducing the unwanted tooth movements that result when the force is applied far from the center of resistance of the tooth.

The main group of appliances used today for that purpose that are fabricated in steel materials have a single big loop in the middle of the section that crosses the palate from molar to molar. Due to the triple or fifth loop design of this invention, bigger amount of activations for expansion can be made without increasing the immediate forces to the molars and without making the insertion of the appliance into the molar sheaths more difficult. In addition, the multi loop design of the spring makes it possible to activate the spring unilaterally producing different expansion forces from one side to the other or producing expansion forces in one side and rotation/torque forces in the other side. In addition, as the appliance expands the upper molars, the multi loop spring of the palatal arch section moves occlusally. This will produce tongue pressure on the appliance. This tongue pressure reduces tipping movements of the abutment teeth as they are expanding and produces intrusion force movements on these teeth.

Unilateral expansion may be produced by cutting away the extension bow of the side we want to have more expansion so that more teeth are in contact with the appliance on the non-expansion side.

C.

Another main application is contraction of the upper molars. For this purpose the loop spring system in the palatal arch section (LS3) (Fig. 9) comprises three loops where the loop in the middle is replaced by a helical loop (LS3M). This appliance is effective in contraction the upper molars in cases of overexpanded arches or scissor crossbites. Anti-rotation force movements can be provided by the open loops laterally placed to the middle helical loop in order to prevent the upper molars from rotating as they are being contracted.

D.

When only expansion/ rotation/ contraction movement of the attached molars is desired, the extension bows of the device may be cut off and the device has no lateral arms (Figs. 7-9 ).

Due to the triple of fifth Q-loop design of the spring section of the palatal arch (CS), this appliance allows for bigger activations for molar corrective movements in each visit to the orthodontist without increasing the immediate force movements to the molars. This leads to fewer visits to the orthodontist. The long attachment end inserts (ISR, ISL) of the appliance also allows for an easier insertion into the molar sheaths with bigger activations for molar derotation.

E.

Due to the big size of the loops of the palatal arch section, their number and their placement in the molar region of the upper jaw, this section of the appliance can be adjusted so that it lies occlusally towards the tongue. With this type of adjustment, the palatal arch section of the appliance according to this invention functions as a bed for the tongue to exert pressure upwards creating intrusion force movements to the upper molars.

F.

A common undesirable side effect of the expansion force movements is the tendency for the teeth to which the appliance is attached (the opposed upper molars) to tip in an outwards direction (Fig. 17). This tipping of the teeth makes the desired translation movement difficult to achieve and has to be corrected or prevented from the start of the expansion movements. By introducing torqueing bends in the rectangular- shaped ends of the attachment inserts that are inserted into the molar lingual sheaths, the tendency of the expansive forces to tip the molars can be counteracted.

G.

It is possible to use the extension bows to additionally anchor the arch on neighboring teeth (AR4, AL4, AR5, AL5, AR6, AL6) (Figs. 4-6). When no additional anchoring is needed, the orthodontist may cut off the extension bows (Figs. 7-9).

Conclusion:

The present invention represents an improvement to previous palatal orthodontic arches for the following reasons: No prior art devices or techniques are capable of producing traction movement of unerupted teeth without producing unwanted movements of neighboring teeth. The solid anchorage obtained with de structure of the appliance according to the present invention makes it an improved appliance to efficiently bring unerupted maxillary teeth out of the bone and move them to their final position as well as to solve other asymmetric alignment situations in the upper dental arch. With the device according to the present invention it is possible to make the traction of a tooth that did not erupt naturally without the need to put fixed appliances in the maxillary dental arch. The risk for undesirable side effects like loss of anchorage and deterioration of arch form is therefore reduced with the appliance of the present invention. - In situations where a not erupted tooth in the upper jaw has to be pulled out of the bone and moved into proper position in the dental arch, the use of the device according to the present invention allows for an overall shorter treatment time. In addition, the fact that part of the treatment can be done without the need to place fixed appliances on the teeth of the upper jaw, reduces the risk for root resorption of the front teeth.

In situations as set fortn in the above indicated items, the device according to the present invention has the advantage of being an effective, yet invisible orthodontic appliance when the patient is viewed from the front. With the increasing demand for invisible orthodontic appliances, the device according to the present invention makes it considerably easier to keep all the steps of the orthodontic treatment invisible when the orthodontist chooses a lingual fixed or removable approach to treatment. - The Q-shaped loops present in the appliance according to the present invention have the advantage of incorporating the same length of wire as in U-shaped loops although being smaller in size thus occupying less space anterior-posteriorly in the palate of the patient. This makes the Q-loop sections of the device slimmer and therefore less intrusive to the patient.

The central multi Q-loop spring system of the appliance according to the present invention functions as an adjustable spring where the force incorporated into the device by compressing, expanding or otherwise bending the loops, can expand, contract, tip, rotate, intrude and/or torque the upper molars to with the device is attached. This multi Q-loop structure has the following advantages: (1) the big size of the loops, their number and position in the mouth provide the possibility for tongue pressure on the appliance; (2) the device according to the invention allows for bigger activations without increasing the immediate corrective force to the molars;

(3) the device according to the invention keeps the appliance active for a

longer period of time; (4) the device according to the invention makes the insertion of the appliance easier when pre-activated due to the long attachment end inserts; (5) the big size of the loops offer easy access to pliers which provides the possibility of activating the loops in the mouth without håving to remove the appliance; (6) less chair-time for the orthodontist; (7) less discomfort for the patient.

Another big advantage of the present multi Q-loop spring structure is that because the activation bow opens both anteriorly (in anteriorly opening Q-loops) and posteriorly (in posteriorly opening Q-loops), different directions of the correcting forces can be achieved with the same appliance.

The previous art devices are limited in producing effective contraction movements of the upper molars due to the open loop structure used. In the appliance according to the present invention the replacement of the middle Q-loop by a helical loop makes it effective in producing contraction forces on the molars.

The previous art devices are limited in producing effective intrusion forces to the upper molar teeth. With the structure of the appliance according to the present invention the tongue can be used to press the appliance up pa lata I ly which delivers effective intrusion forces to the anchor teeth. The big size of the loops, their number and position in the molar region of the upper jaw makes it to function as a bed for the tongue to put a pressure up towards the palate.

Removable palatal arches are subjected to tongue thrust which can result in loosening of the appliance from the lingual sheaths of the molar teeth. In addition it is necessary to remove the appliance to adjust it during treatment of a patient which may result in loosening of the fit of the ends with respect to the sheaths. Prior art palatal bars have been locked to the lingual sheaths or tubes by securing the bar with a ligature wire. However the ligature wire can be irritating to the patient, can come loose and accidentally swallowed by the patient and can also allow the palatal arch to loosen. In addition securing the appliance with a ligature wire requires additional time from the orthodontist and patent when inserting and/or removing the appliance for adjustment.

The present invention overcomes these problems and difficulties encountered in the previous assemblies. Each of the doubled over insertion attachment ends of the appliance according to the present invention has in one preferred embodiment a bigger length (8-10 mm) than in the previous art devices and function as compressed long loop projections that keep the palatal arch securely placed into the lingual sheaths or tubes preventing accidental dislodging of the appliance without the need of tying the appliance with a ligature wire. This is possible because due to their length, when one end tends to dislodge from the sheath, it activates the central spring section which once activated presses the end back into the sheath again.

The length of the end projections (8-10 mm) of the attachment end inserts makes the insertion of the appliance inside the sheaths easier especially when the appliance is pre-activated for rotation or torque to the molars. When these ends have been bent in order to deliver a corrective rotation or torque force to the molars it can be difficult to insert these ends into the molar sheath because of the different angle of entrance. Holding these ends with a pair of pliers in order to rotate or twist them a little while inserting them into the molar sheaths allows the orthodontist to make an easy insertion of the appliance with less discomfort for the patient. The easy insertion is possible because there is enough length in these ends to accommodate both the pliers and the receiving sheath at the same time.

In addition it is possible for the orthodontist to increase the activation for rotation or torque corrective forces in ach adjustment of the appliance because the insertion into the sheaths is made easier with the assembly according to the present invention. In situations where the neighbor tooth is so displaced palatally that makes the insertion of these attachment ends difficult, it is always possible to make a bend along the end in order to allow for the insertion of part of this end inside the sheath.

A common problem in orthodontics is to secure anchorage for the desired movement of teeth because of the fixation of the appliance to the teeth can lead to unwanted movement of the anchor teeth. The most common method of making the traction of a not erupted tooth I by using the fixed appliance as the anchorage unit for the movement of that tooth. The dental arch is used as an anchor and very often the neighboring teeth that support the reaction force to the traction undergo unwanted rotation, intrusion and tilting with consequent deterioration of the dental arch form. The present invention overcomes these problems and difficulties because of the structure of the appliance. Only the two upper opposing molars are supporting the reaction forces and due to the long extension bow of the relevant embodiment of the appliance with an incorporated helix-spring, the reaction forces of the traction of the impacted canine are distributed over the entire appliance and the risk of unwanted tilting, intrusion an rotation of the upper molars are greatly reduced. The multi-loop of the palatal arch section can be activated to cancel out the rotation forces transmitted to the pair of teeth by the extension bows. In addition all the other maxillary teeth are spared.

- The stainless steel type of wire is norma I ly and preferably selected for the wire part of the appliance according to the present invention. Its relatively high elastic modulus property may be advantageous because it can provide a more or less rigid structure and has the ability to exert a resilient springlike force when bent delivering different corrective forces by incorporating loops. In some embodiments of the device a rigid wire span is required while in other embodiments loops are incorporated in order to increase the

elasticity of the wire and reduce the high corrective forces immediately after adjustment. Its high formability ensures that the wire can sustain a big amount of permanent deformation without breakage and that is an advantage of this material because it allows customization of the appliance.

Some prior art devices are made of stainless steel wires that typically require several visits to the orthodontist throughout the treatment period so that the device can be adjusted because the forces diminish as the teeth move. After each visit the patient may experience discomfort because the corrective forces are hig hest at this point of treatment.

Other prior art devices make use of shape memory wires because they provide low but constant corrective forces throughout the treatment period and does not require as rna ny visits to the orthodontist for readjustments (to aid different bending forces). Shape memory is the ability of a material (e.g. metal or metal alloy) to return to a set shape after deformation. However, once a shape memory wire is inserted, it will provide constant corrective forces as the wire attempts to return tits original shape and not always the shape of the wire is the desired shape and there is almost always a need to correct the alignment of the molars by tipping, rotating or torquing them. It can also be necessary to correct the rotation of one molar and correct the torque of the opposed molar. Each patient requires different prescriptions for moving their teeth and the amount of desired corrective forces is left to the individual teeth. In addition when a big amount of expansion movement is needed several appliances may need to be used in

sequence.

In all the embodiments of the present invention the force-supplying part of the appliance has a configuration that is customized to the individual patient and situation by the clinician.

The design of the assembly according to the present invention, which in one embodiment is made of a normal elastic material as stainless steel, provides a mean of applying a corrective transversal force on either or both sides of the upper dento alveolar complex by expanding/contracting the lateral dental segments or otherwise moving any desired teeth in the upper jaw including teeth that have not erupted naturally. In addition the device according to the present invention allows for independent adjustments to follow different prescriptions for moving teeth.

With the appliance design according to the present invention the appliance can deliver individual corrective forces to the teeth that are relatively low and long lasting even though it is fabricated with a normal elastic material.

The device according to the present invention has been disclosed supra as being attached/secured to molars for adjusting the location, tilt, rotation, etc. of erupted or un-erupted teeth in the upper dental arch. The embodiments and examples given have shown the attachment of the device to molars and mainly for adjusting the properties of molars. However, the device according to the present invention may be used to correct the indicated properties of any tooth in the upper dental arch. Also the embodiments of the device have been shown to possess two extension bows (extending anteriorly to some distance from the palatal arch section (CS) of the device. In alternate embodiments, however, the number of lateral arms need not necessarily be restricted to two, and any number of such arms may be added to palatal arch of the device or may also be added to the lateral arms themselves.

The total width of the device according to the present invention is adjusted to fit the size of the mouth and can vary from 35 to 60 mm. The width of the palatal arch middle multiple Q-loop section can vary from 15 to 30 mm and the height 12 to 17 mm. In one particular embodiment the "normal" width may lie in the interval 35-45 mm, selected by the orthodontist from pre-fabricated devices according to the invention. The middle triple Q-loop section represents in this embodiment one third to half of the total width of the palatal arch. When selecting a width of the palatal arch (CS) with the multiple loop structure the orthodontist may consider such as the discomfort of the patient, the opportunity to inflict tongue thrust by the patient to the multi loop section (more loops providing a larger area for the tongue to exert forces upon thereby distributing the pressure forces and providing less discomfort to the patient). The extension of the multi-loop section depends on the type of corrective forces to be delivered by the appliance but should not provide unreasonable discomfort to the patient, and should not interfere too severely with the tongue of the patient (the discomfort being a subjective evaluation informed by the patient to the orthodontist). Other individual considerations when securing a correctional device according to the present invention in the mouth of a patient is inter alia if the patient experiences speech discomfort.

Also the resilient wire made preferably of a metal may have an even thickness or may alternatively comprise sections of uneven thickness for providing sections of a more rigid structure for larger corrective forces where is needed and sections of a less rigid structure for smaller corrective forces where is needed. The location of such stretches of uneven thickness of the wire may be selected by the person skilled in the art. For making the device slimmer it may also be possible to use a wire of a non-circular cross section. This to make the device less intrusive to the patient.

Different aspects of the orthodontic device according to the present invention are presented inf ra. In one aspect the device according to the present invention represents an orthodontic device or assembly comprising a wire material for moving in all three dimensions any desired teeth in the upper dental arch including teeth that have not erupted naturally relative to a pair of substantially transversally opposed upper teeth without the reaction forces on this pair of teeth causing unwanted movement of said pair of teeth, wherein said orthodontic device includes a palatal arch wire section adapted to fit between the mentioned pair of transversally opposed teeth and to be placed adjacent the palate comprising a multi-loop spring, said multi-loop spring corresponding to one third to one half of the palatal arch wire section width and when placed at some distance from the palate forming a bed for tongue pressure creating intrusive corrective forces on said pair of teeth., the orthodontic device further including extension spiral-formed bows with adaptation loops extending laterally from the transversal palatal arch for applying corrective forces to one or more teeth anterior or posteriorly placed in relation to the said pair of teeth, said palatal arch section being constricted to receive the reactive forces of the extension spiral-formed bows and applying this force to the pair of teeth cancelling out any reactive forces transmitted to the said pair of teeth.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the said palatal arch section comprises a compressive multi Q -loop spring system in the middle.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the device further includes extension bows that extend anteriorly for a distance from the palatal arch.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the orthodontic device further includes at least one attachment end insert in each end of the palatal arch section.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein said extension bows each incorporates at least one helical loop.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the compressive multi Q -loop system of the palatal arch is oriented towards the posterior aspect of the upper teeth to which the device is inserted.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the compressive multi Q -loop system of the palatal arch comprises at least one loop that is/are opening towards the anterior aspect and at least one loop that is/are opening towards the posterior aspect.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the middle loop of the compressive multi Q -loop is replaced by a helical loop spring where the loop in the middle is a helical loop for effective corrective contraction.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the said helical loops of the extension bows are vertically or horizontally oriented.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the attachment end inserts fix the palatal arch on the upper opposing or non-opposing teeth.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the attachment end inserts comprises projections that are located in the device in order to fasten the appliance securely without the need to be tied in with ligature wires.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein said projections are 8-10 mm long.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein said palatal arch section (CS) arches away from the palate for activation of the device by the tongue.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the source of the corrective force is located at the compressive multi Q -loop spring of the palatal arch, the helical loops of the extension bows and the attachment palatal arch end inserts.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the total width of the device lies in the interval 35-60 mm.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the palatal arch middle multiple ft-loop section represents one-third to half of the total width of the appliance.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the device is made of a normal elastic metal, resilient material, preferably a metal such as stainless steel wire or metal alloys with similar properties.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the stainless steel wire has a round cross section with a diameter of 0,8 to 0.91440 mm.

In a further aspect the orthodontic device is such an orthodontic device as indicated supra, wherein the stainless steel wire has a square cross section.

In a further aspect the present invention encompasses the use of a device as disclosed supra for moving/adjusting the location, tilt, rotation and/or orientation of any tooth in the upper dental arch. Such a use includes the use wherein said any tooth includes at least one unerupted tooth.

EXAMPLES

Example 1:

This example relates to an embodiment of a correctional device as disclosed supra. The device according to this example comprises a palatal arch section (CS) made of a three-loop folded stainless steel wire with an even cross section of 0,036 inches (0,91440 mm). The total width of the device is adjusted to fit the size of the mouth, in this one particular embodiment the width is 37 mm. The palatal arch section middle triple Q-loop section represents in this embodiment one half of the total width of the appliance, thus håving a width of 16 mm, and each loop in the triple loop section has a mean width of 6 mm. At the terminals of each end of the palatal arch section (CS) there is an intermediate section (IS) for anchorage to the relevant molar (MR,ML) and from which attachment end section there proceeds one spiral-formed extension bow to terminate the ends of the device. The device may be positioned in the mouth by pressing it upwards towards the palate of the mouth and compressing it through the activation of the triple loops of the palatal arch section (CS) and placing it between relevant molars to expand and press against said molars. The device may be further anchored and secured to the relevant molars by anchoring the attachment end insert sections each to its adjacent molar (MR,ML) through inserting the U-shaped integral compressive loop ends inside each molar band sheath. The device will e.g. correct the tilt of the relevant molars to a more expanded tilt.

Claims

1. Orthodontic device or assembly comprising a wire material for moving in all three dimensions any desired teeth in the upper dental arch including teeth that have not erupted naturally relative to a pair of substantially transversally opposed upper teeth without the reaction forces on this pair of teeth causing unwanted movement of said pair of teeth, wherein said orthodontic device includes a palatal arch wire section adapted to fit between the mentioned pair of transversally opposed teeth and to be placed adjacent the palate comprising a multi-loop spring, said multi-loop spring corresponding to one third to one half of the palatal arch wire section width and when placed at some distance from the palate forming a bed for tongue pressure creating intrusive corrective forces on said pair of teeth., the orthodontic device further including extension spiral-formed bows with adaptation loops extending laterally from the transversal palatal arch for applying corrective forces to one or more teeth anterior or posteriorly placed in relation to the said pair of teeth, said palatal arch section being constricted to receive the reactive forces of the extension spiral-formed bows and applying this force to the pair of teeth cancelling out any reactive forces transmitted to the said pair of teeth.

2. Orthodontic device according to claim 1, characterized in thatthe said palatal arch section comprises a compressive multi Q -loop spring system in the middle.

3. Orthodontic device according to claim 1 or 2, characterized in thatit further includes extension bows that extend anteriorly for a distance from the palatal arch.

4. Orthodontic device according to claim 1 to 3, characterized in thatit further includes at least one attachment end insert in each end of the palatal arch section.

5. Orthodontic device according to claim 1 to 4, characterized in thatthe said extension bows each incorporates at least one helical loop.

6. Orthodontic device according to claim 2 to 5 characterized in thatthe compressive multi Q -loop system of the palatal arch is oriented towards the posterior aspect of the upper teeth to which the device is inserted.

7. Orthodontic device according to claim 2 to 6 characterized in thatthe compressive multi Q -loop system of the palatal arch comprises at least one loop that is/are opening towards the anterior aspect and at least one loop that is/are opening towards the posterior aspect.

8. Orthodontic device according to claim 2 to 7, characterized in thatthe middle loop of the compressive multi Q -loop is replaced by a helical loop spring where the loop in the middle is a helical loop for effective corrective contraction.

9. Orthodontic device according to any of the preceding claimscharacterized in thatthe said helical loops of the extension bows are vertically or horizontally oriented.

10. Orthodontic device according to claim 1 or 4, characterized in thatthe attachment end inserts fix the palatal arch on the upper opposing or non-opposing teeth.

11. Orthodontic device according to any of the claims 1 to 10,characterized in thatthe attachment end inserts comprises projections that are located in the device in order to fasten the appliance securely without the need to be tied in with ligature wires.

12. Orthodontic device according to claim 11 wherein said projections are 8-10 mm long.

13. Orthodontic device according to any of the preceding claims,characterized in thatsaid palatal arch section (CS) arches away from the palate for activation of the device by the tongue.

14. Orthodontic device according to any of the preceding claims,characterized in thatthe source of the corrective force is located at the compressive multi Q -loop spring of the palatal arch, the helical loops of the extension bows and the attachment palatal arch end inserts.

15. Orthodontic device according to any of the preceding claims,characterized in thatthe total width of the device lies in the interval 35-60 mm.

16. Orthodontic device according to any of the preceding claims,characterized in thatthe palatal arch middle multiple ft-loop section represents one-third to half of the total width of the appliance.

17. Orthodontic device according to any of the preceding claims,characterized in thatit is made of a normal elastic metal, resilient material, preferably a metal such as stainless steel wire or metal alloys with similar properties.

18. Orthodontic device according to claim 17, characterized in thatthe stainless steel wire has a round cross section with a diameter of 0,8 to 0.91440 mm.

19. Orthodontic device according to claim 17, characterized in thatthe stainless steel wire has a square cross section.

20. Use of the device according to any of the claims 1-19 for moving/adjusting the location, tilt, rotation and/or orientation of any tooth in the upper dental arch.

21. The use according to claim 20, wherein said any tooth includes at least one unerupted tooth.