EP3793475A1

EP3793475A1 - Method for producing bite splints

Info

Publication number: EP3793475A1
Application number: EP19723825.6A
Authority: EP
Inventors: Elisabeth Meyer; Joachim Weber
Original assignee: Individual
Current assignee: Individual
Priority date: 2018-05-18
Filing date: 2019-05-17
Publication date: 2021-03-24
Also published as: WO2019219937A1; EP3569187A1; DE102019207271A1

Abstract

The present invention relates to a method for producing bite splints and series bite splints for use in the treatment of a patient having at least one disease, which originates from a functional disorder of the organ of mastication, in particular craniomandibular dysfunctions, as well as to bite splints and series bite splints which are produced according to said method.

Description

Method for producing bite splints

The present invention relates to a method for producing occlusal splints and follow-on splints for use in the treatment of a patient with at least one disease resulting from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions, as well as bite splints and subsequent bite splints be prepared by this method.

Background of the invention

Patients with illnesses of the chewing organ represent an essential part of the dental treatments, in particular orthodontic treatments. A frequently occurring illness in the dental everyday life, which emanates from a functional disturbance of the chewing organ, is the so-called craniomandibular dysfunction (Cranium = cranium; Mandibula = Lower jaw) or myoarthropathy, which is referred to below as CMD. CMD is characterized by musculoskeletal pathologies of a patient's craniomandibular system. A temporomandibular joint essentially consists of a condyle (condyle with caput mandibulae) of the lower jaw, which is movably arranged in a fossa (Fossa articularis) of the temporal bone. The lower jaw is suspended by a complex system of cartilage, muscles and ligaments, especially the bilaminar zone on the skull, whereby the position of the temporomandibular joint and the occlusion, i. the final bite of the teeth of the upper and lower jaw, influence each other in statics and dynamics. An ideal occlusion is when the teeth are in a physiological position and the jaw can maintain its physiological position.

The Kaumuskellage is essentially involved in the head posture in statics and dynamics. The head posture in turn has a significant influence on the entire posture. This often results in interactions of the muscular mass with the appendage in the neck area, while the latter interacts with the entire body statics.

The frequently occurring craniomandibular dysfunction is a pathological and thus non-physiological position of the condyle in the joint pit and a concomitant over- or Fehlbelastung the entire anatomical structures involved, such as ligaments, cartilage, muscles, teeth and temporomandibular joints. As a rule, this leads to painful tension in the masticatory muscles leading to permanent damage to ligaments, tendons and cartilage and to the destruction of bony structures involved. Symptoms of CMD include headache, ear or face pain, as well as nocturnal crunching and grinding of the teeth. In addition, other complaints that are not directly related to the causal system, such as tinnitus, visual disturbances, sleep disorders or balance disorders, or Problems in the area of the spine and the entire musculoskeletal system, such as the hip, the legs, the knees, the feet and the shoulder area occur.

In the treatment of CMD bite splints, hereinafter also referred to as a splint or dental splint, are frequently used. The aim of the use of such Aufbiss rails is to prevent the patient from a pathological occlusion and / or chewing or wean him. As a result, the physiological center of the rod ends in the joint pits of the temporomandibular joint to be restored. This is intended to at least partially eliminate the over- and underloading of the teeth and temporomandibular joints, which generally leads to improved positioning of the temporomandibular joints and relaxation of the jaw musculature. This can reduce inflammation, remodel bone structures and recalibrate the musculoskeletal system.

In terms of design, one generally distinguishes bite rails with unadjusted, i. occlusal surface not adapted to the chewing profile of the patient, and bite rails with adjusted occlusal surfaces. The splints may cover parts of the row of teeth (individual teeth) or extend over all the teeth of a jaw.

The prior art discloses various bite splints for the treatment of craniandibular dysfunction and corresponding methods for producing such bite splints.

The utility model DE202004020196 U1 describes a maxillary bite splint with a receiving area for maxillary teeth as well as with a lower side directed towards the lower jaw teeth in the inserted state of the bite splint, wherein the underside of the bite splint in the anterior region is formed as a plateau (anterior splint splint plateau). which prevents the complete closing of the jaws, ie leaves the jaw in a slightly open state. The receiving area for the maxillary teeth is designed such that the plateau forms an angle in the range of 0 ° to 10 ° or, in another embodiment, an angle in the range of 5 ° to 30 ° with the occlusal plane in the inserted state of the bite splint. The rails have no canine guidance and posterior contacts. The easy opening of the temporomandibular joints and the missing canine guidance and posterior contacts are intended to restore the physiological center of the temporomandibular joints (CR position) and to achieve a neuromuscular relaxation of the temporomandibular joints and jaw musculature.

The utility model DE202009003999 U1 describes a bite splint for the upper or lower jaw, consisting of a base plate with precisely fitting tooth support elements, wherein the tooth support elements have a first surface, which is occlusally adapted to the teeth, and have a second surface which is vestibular to the second Plane and ensure posterior guidance, and where In the case of the tooth support elements, a cranial concave dome shape is overall present. The bite splints may also have compensating elements which allow adaptation of the occlusion during the treatment of a patient with CMD via the course of the therapy.

DE1020131 12032A1 describes a method of constructing an adjusted bite splint for use in treating a patient having at least one craniomandibular dysfunction from an existing bite splint. This method includes the computer-assisted steps of acquiring data to uniquely define a shape of the existing bite splint, an actual morphology of the teeth of the second jaw, and a location of the second jaw, the contact area of the existing bite splint, and patient's temporomandibular joints relative to each other; Simulating an occlusion of a patient's craniomandibular system comprising the existing bite splint inserted into the patient; Identifying spurious contacts between the contact area of the existing bite rail and the teeth of the second jaw; and constructing the adjusted bite bar from the acquired data and data obtained from the simulation such that the identified interfering contacts are eliminated. Furthermore, it is proposed to repeat the above-mentioned steps in order to construct a series of bite splints for iterative approach to the physiological position of the temporomandibular joints.

The prior art methods of making occlusal splints for treating CMD typically start from an ideal bite position, i. a bite position with a dental-defined occlusion, position of the lower jaw or the rod ends as well as a tooth-defined muscular posture. This "ideal bite position" generally refers to the physiological bite position, which is also referred to as a centric condylar position or "centric relation position" (CR position) or as a "stable condyle position" (SCP). However, the ideal (physiological) bite position may change over the period of treatment of the chewing organ dysfunction. In addition, the ideal bite position can vary depending on the head and body postures or the patient's body position (eg standing, lying, sitting) and whether the patient is in a resting position or in motion (statics versus dynamics), ie Depending on the individual application areas of the bite splints by the patient, several ideal bite positions may exist.

In this connection, it would be desirable to have a method for producing bite splints for the treatment of CMD with which several bite splints, each of which are optimally adapted to the various relevant body postures of the patient or intended use, can also be produced - For example, a rail for the day and one for the night). In addition, in the case of the methods known from the prior art, which assume an ideal (physiological) bite position, examination findings from orthodontics It has not or only insufficiently taken into account in various medical fields, although it may have a significant impact on the successful treatment of a condition that results in a functional disorder of the masticatory organs, in particular craniomandibular dysfunctions.

It is therefore the object of the present invention to provide a method for the production of occlusal splints and follow-on splints for use in the treatment of a patient with at least one disease originating from a functional disorder of the chewing organ, in contrast to those known in the art Method a faster, more effective and more individual, ie especially for the interdisciplinary findings and for different relevant body postures of the patient or the individual purposes of use, treatment of craniomandibular dysfunctions.

This object is achieved according to the invention by a method for the production of bite splints and follow-on bite splints for use in the treatment of a patient with at least one disease which is based on a functional disorder of the chewing organ, in particular craniomandibular dysfunctions, as in the patent claims and in US Pat The following will be described in detail.

The inventive method is characterized in particular by the fact that due to the consideration of several bite positions bite splint (s), which largely eliminate or at least reduce the complaints of the patient, can be found faster and more effectively. The consideration of different patient-specific head and body postures or body positions in statics as well as in dynamics also makes it possible to treat the CMD specifically tailored to the individual needs of the patient. By including findings from medical fields other than dentistry and orthodontics, the result of the treatment can be further improved, i. the patient's complaints are reduced even more efficiently and far-reaching. Last but not least, the bite splints can be produced inexpensively and reproducibly with the method according to the invention. With the method according to the invention, it is also possible to return to previous bite splints at any time during the therapy, if the desired improvement can not be achieved with any subsequent bite splint. It can also respond quickly and effectively to both desired changes (e.g., compensatory processes) and unwanted changes (e.g., decompensatory processes) during treatment of CMD.

Summary of the invention

The present invention relates to a method of making occlusal splints for use in the treatment of a patient having at least one disease, starting from a functional disturbance of the chewing organ, in particular cranio-mandibular dysfunctions, comprising the following steps: a) gathering data on the position of the jaws, the temporomandibular joints, the movement paths of the lower jaw and the current morphology of the patient's teeth (starting point); State),

b) determination of two or more than two different bite positions of the patient, whereby the determination of the bite positions takes place with different head and body postures in statics and dynamics,

c) computer-assisted merging of the data acquired in step a) (initial state) and the bite positions (target states To) determined in step b) for calculating in each case a temporary model of a bite rail for two or more than two of the steps in step b ) certain bite positions,

d) Generation of one bite splint each for two or more than two of the bite positions determined in step b), based on the temporal models calculated in step c).

Furthermore, the invention relates to a method for the production of follow-on bite bars, comprising the steps a) to d) as described above and below, the method additionally comprising the following steps: e) checking the bite positions determined in step b),

f) selecting one or more of the bite positions determined in step b) or rejecting all bite positions determined in step b),

g) Generation of consecutive bite splints.

Furthermore, the present invention relates to occlusal splints and follow-on splints for use in the treatment of a patient with at least one disease that results from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions obtainable by a method as described above and below.

A further aspect of the invention relates to bite splints for use in the treatment of a patient with at least one disease which is based on a functional disorder of the chewing organ, in particular craniomandibular dysfunctions, comprising a receiving area for receiving teeth of a first jaw of the patient and a contact area for Contacting teeth of a second jaw of the patient opposite the first jaw, the at least one receiving area having at least one means for guiding the teeth and being profiled so as to ensure a sufficiently secure hold of the rails even under load, and wherein the contact area is only slightly profiled, characterized that the configuration of the means for guiding the teeth and the profiling of the contact areas of the bite splints and follow bite rails at bite positions with different head and body postures in statics and dynamics oriented, and that the distance of the receiving area or contact area for the first jaw to the receiving area or contact area for the second jaw of the bite splints and subsequent bite splints opposite the first jaw on the therapeutically desired bite increase (jaw opening) with different head and body postures in statics and dynamics and / or on one or more examination findings ( en) from medical fields other than orthodontics.

Further, the present invention relates to a set of occlusal splints for use in the treatment of a patient having at least one disease emanating from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions consisting of two or more than two occlusal splints as before and within As defined below, each of these two or more bite splints is used in a different head and posture in statics and dynamics.

Detailed description of the invention

The terms "bite splint" and "subsequent bite splint" used here designate a means for biting off the upper jaw and / or lower jaw, the at least one receiving area for receiving the teeth of the upper jaw and / or lower jaw and / or at least one contact area for contacting the teeth of the upper jaw and / or the lower jaw. A "follow-on bite splint" can actually follow as a replacement for the first splint in the sense of a total replacement of the first splint, for example if the first splint has been modified for therapeutic reasons or had to be completely discarded. However, the term "follow-on bite splint" is also used for tracks which follow in production, but which at the same time come into therapeutic use, for example in combinations such as day / night splints, sports / work splints, hard - / soft rails and the like.

The receiving area of the bite splints and the subsequent bite splints can not be profiled, ie not adapted to the respective tooth morphology (chewing profile) of the patient, slightly profiled, ie slightly or roughly adapted to the respective tooth morphology of the patient, or else strong profiled, ie be fully adapted to the particular tooth morphology of the patient. The contact area, in turn, can either not be profiled, ie not adapted to the respective tooth morphology (chewing profile) of the patient, so that a complete freedom of movement of the jaws to each other in the maximum contact position remains, or slightly profiled, ie slightly or roughly to the be adapted to the particular tooth morphology of the patient, so that the freedom of movement of the jaw to each other in the final Bite position is restricted. For example, both occlusion splints, such as equilibration rails, reduction rails, vertical rails, decompression rails and protrusion rails; as well as reflex rails, z. B. with bilateral bite or anterior bite.

Terms used in this context "slightly profiled" or "slightly or roughly adapted to the dental morphology of the patient" mean that the profiling does not represent a form-fitting negative image (impression) of the contact areas of the teeth with the bite splint, but rather that the profiling consists of Surface of the bite splint to extended wells or pits and / or ramps in the contact area of the teeth is (occlusal impressions). In other words, these are smoothed impressions of the contact areas of the teeth. The smoothing of the contact areas can be more or less pronounced, depending on how large the desired freedom of movement of the jaw in the final bite position should be.

Analogously, the expressions "strongly profiled" or "completely adapted to the dental morphology of the patient" mean that the profiling represents an essentially positive negative impression (impression) of the contact area of the teeth of the patient, which determines the freedom of movement of the jaw in the end Bite severely restricts or even completely inhibits.

The at least one receiving area for receiving the teeth of the upper jaw and / or lower jaw preferably has a low to strong profiling. Particularly preferably, the at least one receiving area is strongly profiled, i. completely adapted to the respective tooth morphology (chewing profile) of the patient.

The receiving area may additionally comprise means for guiding the teeth. Preferably, the receiving area has at least one means for guiding the teeth. The means for guiding the teeth may, for example, be anterior tooth guidance, canine guidance, group guidance (for example in the case of malocclusions), balanced occlusions (for example in dentures) or posterior guidance and combinations thereof. The means for guiding the teeth is preferably selected from a front tooth guide, canine guide and a front canine guide, in particular a front canine guide.

Preferably, the contact region has a slight profiling, i. the contact area is slightly or roughly matched to the particular tooth morphology of the patient. This will allow the jaws to be directed to a desired position in the end bite position.

Preferably, the bite rails and subsequent bite splints obtainable by the method according to the invention have a receiving area for receiving Teeth of a first jaw of the patient and a contact area for contacting teeth of the first jaw opposite arranged second jaw of the patient. The receiving area of these bite splints and subsequent bite splints is profiled in such a way that a sufficiently secure hold of the splints is ensured even under load (eg biting, speaking, bruxism). Optionally, the support of the rails can be improved with conventional holding means (eg button anchors). The contact area is preferably slightly or roughly adapted to the particular tooth morphology of the patient. Furthermore, these bite rails and follower bite rails preferably have means for guiding the teeth, as defined above, eg a front canine guide.

The strength of the bite splint or follower splint, i. The distance of the receiving area or area of contact for the first jaw to the receiving area or contact area for the second jaw opposite the first jaw can vary widely and is based on the extent of the therapeutically desired bite increase through the jaw opening or mouth when needed with or without change of position by eg Protrusion and / or laterotrusion.

The term "end bite position", also referred to as centric occlusion, refers to the end point of the jaw closure movement with maximum multi-point contact of the teeth with the opposing teeth or the material to which the teeth bite. Ideally, in the end bite position both rod ends should sit centrally in the respective joint pits. The left and right temporomandibular joint should each be centrically located in their joint pits, the masticatory muscles should have physiological tension and length on both sides, and the rows of teeth in the lateral tooth area should show uniform multi-point contacts on the right and left. These parameters are unconsciously, z. B. when swallowing checked by the brain. If there is a lack of stress, an involuntary compensation mechanism via neurological reflex trajectories sets in, so that the person shifts the lower jaw until, on the other hand, he feels multiple point contacts on the teeth. However, the symmetry and the bilateral uniform tension of the musculature is lost, which, for. B. leads to bruxism and craniomandibular dysfunctions.

As used herein, the term "jaw position" refers to a position of the mandible and maxilla with respect to one another, encompassing both physiological and pathologic positions. Pathological jaw positions may be primarily or secondarily caused by other disorders, e.g. a malposition of the teeth.

The terms "initial state" and "actual state" as used herein refer to the measured or actual anatomical positions of the jaws, temporomandibular joints and the present tooth morphology. The term "desired state" as used herein denotes a desired anatomical position of the jaws, the temporomandibular joints and the present the tooth morphology z. B. corresponds to the physiological state. The desired state can be calculated from the anatomical conditions of the patient, for example based on tabular values (eg cephalometric measurements, building material tables, gnatological standard values, etc.) or also determined clinically and empirically as explained below.

In order to be able to handle the high volumes of data, which are caused, inter alia, by the inclusion of different examination findings (possibly from different fields) and the iterative character of the method, and the associated complexity of the present method, the individual method steps for the production the bite splints and follow-on bite splints are computer-supported, if possible, using suitable computer programs (software) for this purpose.

Step a):

In a first step of the method according to the invention, data on the position of the jaws, temporomandibular joints, trajectories of the lower jaw and the current morphology of the teeth of the patient are recorded.

In principle, all methods known in the state of the art for acquiring anatomical data which can be read in by computer programs, visualized or graphically displayed and processed are suitable for this purpose. The acquisition of the data preferably takes place by means of three-dimensional imaging methods. In this context, the term "three-dimensional imaging method" refers to any pictorial representation of a real object in three to four dimensions, e.g. By x, y, z and time coordinates. Three-dimensional imaging methods include, for example, three-dimensional X-ray, magnetic resonance tomography or magnetic resonance tomography (MRT), three-dimensional computed tomography (CT) or digital X-ray tomography and / or surface scanning by incident light scanning. The image data can be reproduced both analog and digital, e.g. by individual or commercially available computer programs, e.g. DiCom (OFFIS e.V., Oldenburg, Germany). The term "three-dimensional imaging method" also encompasses superimposing and processing of image data, eg. By means of computer programs such as coDiagnostiX @ (Chemnitz, Germany), Onyx-Ceph (Image Instruments GmbH), 3shape (3Shape, Copenhagen, Denmark) or implant3D (med3D GmbH, Heidelberg, Germany). From the image data, actual values can be measured as coordinates, length, volume and angle dimensions.

In addition, the skilled person has specific methods for describing the positional relationship of the anatomical structures in statics and dynamics (eg, detection of the trajectories of the lower jaw by the occlusion analysis and achsiographic examination methods), which make up for the temporomandibular joints and the temporomandibular joints Trajectories of the mandible relevant biomechanical parameters, such as the hinge axis, centric, Kondylenbahnneigung, Bennett angle or Bennett movement can be determined. In principle, all methods known in the state of the art for detecting the pathways of the lower jaw, which supply data on the trajectories in digital form, which can be read in by computer programs, displayed graphically or graphically and optionally digitally processed, are suitable for the method according to the invention , Commercially available systems for detecting the trajectories of the lower jaw are, for example, the Zebris JMAnalyser + system, the DDI Group's Freecorder® BlueFox system or the Ignident DMD system.

The data collected in step a) serve as the basis for the construction of the bite rail and follow-on bite bar according to the method of the invention. From this it is possible to calculate the parameters that are essential for the therapy, which must be taken into account in the construction of the splints, such as the material thickness, type of material, surface structure in adaptation to the jaw position in statics and dynamics and the like. For subsequent rails, the exact metric change required can be calculated from the output rail (initial rail).

If the patient already has an existing bite splint, the shape of the existing bite splint and the contact area of the teeth with the bite splint are additionally recorded in step a) of the method according to the invention by means of the methods described above. These data are taken into account in the design of the new bite bars and follower bite bars.

Step b):

In a next step of the method according to the invention, two or more than two different bite positions of the patient are determined, whereby the bite positions are determined with different head and body postures in statics and dynamics.

In this context, the terms "bite position" or "therapeutic bite position", which are used interchangeably here, refer to a disease relevant for the therapy of the disease (in particular craniomandibular dysfunctions) resulting from a functional disorder of the chewing organ. potentially / presumably relevant position of the maxilla and mandible relative to each other. The bite position thus represents a desired state, ie, a desired anatomical position of the jaws and temporomandibular joints. The term "bite position" as used herein is to be distinguished from the term "ideal bite position" as defined above. The bite positions determined in step b) can contain the ideal (physiological) bite position, but also include other bite positions, which generally differ from the ideal bite position. For example, due to different body positions and body positions in statics and dynamics and / or by the inclusion of examination findings from different from orthodontics medical areas.

The determination of these bite positions relevant for the therapy of the disease resulting from a functional disorder of the chewing organ can take place in various ways.

In a first embodiment of the method according to the invention, the determination of the bite positions relevant to a disease that results from a functional disorder of the chewing organ takes place in step b) using the methods described above under step a), and via further empirical and clinical methods.

If the methods described above under step a) are used for the determination of the relevant bite positions, the determination of the bite position is made for the body positions that are relevant for the patient, i.e. in different head and body postures in statics as well as dynamics (such as standing, sitting, lying but also running, walking, etc.). For example, with the aid of magnetic resonance imaging (MRI), different bite positions can be determined, which from an anatomical or biomechanical point of view should have positive effects on the patient's complaints (for example relief of inflammatory areas, sufficiently large temporomandibular joint width, etc.).

In addition to the methods used in step a), further empirical and clinical methods can be used to determine the relevant bite positions. According to this, the determination of the bite positions is carried out, for example, by inserting spacers or partial rails between the upper and lower jaw, support partial rails, which can possibly be slipped over (any) existing initial rail (s) for a short time, or with the aid of (bite). Registrations that temporarily fix the jaws in a specific position that at least partially reduces patient discomfort. This empirical determination also takes place in the case of different head and body postures or at different body positions in statics and dynamics (such as standing, sitting, lying, but also running, walking, etc.).

This empirical and clinical determination of the bite position is particularly suitable for complaints or symptoms that can be after an at least partial correction of the cause quickly, eg within a few minutes to a few hours, diminish or largely disappear and are objectively measurable. These complaints or symptoms may be, for example, the following symptoms: Balance disorders, such as vertigo, caused by the interaction of the collarbone group with the neck muscles and cervical spine load, which are objectively determined by measuring and analyzing body fluctuations, eg with posturography equipment (eg the Tetraax posturography machine from BeamMed Ltd., Israel) to let;

Tinnitus or blood flow sounds in patients suffering from nocturnal teeth or crunching (bruxism); objectively determinable by measuring the brain waves;

Visual disturbances that can be objectively determined by appropriate eye tests; Muscle tension, such as tension in the muscles of the muscles, neck or back muscles, which can be objectively determined by measurements of muscle tone.

In addition, examination results from orthodontics of various medical fields can be included in the determination of the bite positions relevant for the therapy of the functional disease of the masticatory organ. As a result, the complaints of the patient caused by the CMD can usually be treated even more purposefully and effectively.

In a preferred embodiment of the method according to the invention, the determination of the bite positions in step b) therefore takes place with inclusion of one or more examination findings from medical fields that are different from orthodontics.

These findings can be weighted differently depending on the relevance, i. to a greater or lesser extent in determining the bite positions relevant to the treatment of the functional disease of the masticatory organ.

These examination findings can in principle be drawn from all orthodontics-related medical disciplines, such as, for example, orthodontics. ENT (in particular the equine organs) or ophthalmology and / or from all medical fields dealing with head and posture in statics and dynamics, such as osteopathy, physiotherapy, orthopedics, sports medicine, speech therapy, manual therapy, Chi Therapy, and the like, come.

In the examination findings from medical fields other than orthodontics, which may be included in the determination of the bite positions relevant for the therapy of the functional disease of the chewing organ, these may be, for example, the examination findings listed below.

For example, osteopathic whole body findings can be used to determine the bite position relevant for the treatment of the functional disease of the chewing organ. be involved. For this purpose, the osteopathic view of favorable overall body posture are recorded while controlling the jaw. For example, in particularly relaxed head and body positions and / or in a block-needle-like overall body posture, one or more bite positions can be ascertained. The optimal jaw position for total body posture determined from the osteopathic point of view is registered and included in the determination of the bite positions relevant for the therapy of the functional disease of the chewing organ.

Furthermore, whole body orthopedic findings can be included in the determination of the bite positions relevant for the treatment of the functional disease of the chewing organ. For this purpose, the orthopedic whole body findings, for example by means of treadmill analysis, analysis of posture such as with the Diers device technology or by means of X-ray, CT, MRI, recorded while controlling the jaw. In this context, relevant conditions for the total body posture, such as joint and postural changes in the context of rheumatic diseases, foot vaulting disorders, spinal column deficiencies and the like, as well as planned and / or existing therapies or interventions, such as, for example, the construction of shoe inserts, planning of posture when inserting artificial joints or scoliosis therapy included. The optimal jaw position for total body posture determined from an orthopedic point of view is registered and included in the determination of the bite positions relevant for the treatment of the functional disease of the masticatory organ.

Furthermore, ENT whole body findings can be included in the determination of the bite positions relevant for the treatment of the functional disease of the chewing organ. The interaction between the functional disease of the chewing organ and the ENT medical area often results in the above-mentioned symptoms or symptoms such as tinnitus, blood flow noise or balance disorders. For this, the ENT whole-body findings are recorded, while the jaw position is checked. The optimum jaw position determined from the ENT-medical point of view is registered and included in the determination of the bite positions relevant for the therapy of the functional disease of the chewing organ.

In addition, whole body findings from other medical fields that deal with posture in statics and dynamics, such as findings in sports medicine, physiotherapy, speech therapy, manual therapy, chiropractic and the like in the determination relevant for the treatment of functional disease of the chewing organ Bite positions are involved.

The registration of the jaw position can be achieved by conventional dental methods for producing impressions by means of registries, such as waxes, silicone bites (for example of vinylpolysiloxane), fast-curing polymer foams and the like. In addition, three-dimensional imaging methods, as defined above, can also be used. In particular, surface rastering of the oral cavity by incident light scanning, be used for registration of the jaw position.

Preference is given to examination findings from medical fields that differ from orthodontics, which can be included in the determination of the bite positions in step b), selected from the optimal head and body position from an osteopathic point of view,

optimal posture from the orthopedic point of view,

from the ENT perspective optimal head posture and jaw position,

Optimal head and posture from an ophthalmological point of view.

The above methods of determining the relevant bite positions can be combined as desired. For example, the ideal bite position, which has been determined from a biomechanical point of view, and which has been determined by means of imaging methods, can be combined with empirically and clinically determined bite positions from a medical range different from orthodontics.

In a second embodiment of the method according to the invention, the bite positions relevant for the therapy of the functional disease of the chewing organ are calculated from the data acquired in step a), such as, for example, cranial CT, DVT, MRT. It is not necessarily assumed that a very specific ideal bite position, which usually corresponds to the biomechanically ideal bite position, exists, but rather on the basis of various medical assumptions (eg about the height of the bite splint or the form of the impressions) For example, based on the experience of the treating physician, several possible bite positions relevant to the therapy are calculated exclusively. Also in this second embodiment of the method according to the invention different head and body postures or different body positions are taken into account.

The particular bite positions thus determined in step b) of the present invention represent a bite library of the patient. Each individual bite position from this bite library determined for a specific head and body posture in terms of statics and dynamics can be used as a starting point for the production of an or several Aufbissschie- nen be used for a particular purpose. In addition, further bite positions from this bite library, which were determined in statics and dynamics for head and body postures deviating therefrom, can be used to produce so-called "companion rails" for further purposes or to produce a set of bite splints for respectively different ones Uses (day rail, night rail, work rail, sports rail, etc.) can be used.

The central approach used in the present method, in the treatment of craniomandibular dysfunctions of multiple patient-specific bite sites allows a holistic and highly patient-specific treatment of the CMD. This approach proves to be particularly advantageous in cases where a different form of dynamics is required than in statics (especially sport);

in the case of changes in position (standing, sitting, lying down) another form is required (for example individualized snore or apnea rails) for aesthetic reasons other designs are required (for example mini-rail without front teeth increase for tags);

divergent indications for the optimal position are available from various disciplines (test tracks);

Diverging therapy tasks are available from different disciplines (for example training tracks in different forms for logo, physiotherapy, ergothera- py and the like).

Overall, all factors can also be taken into account in the manufacture of orthodontic correction rails (aligners).

Step c):

In a next step of the method according to the invention, the computer-assisted merging of the data acquired in step a) and the bite positions determined in step b) takes place for calculating a temporary model of a bite rail for two or more more than two of the bite positions determined in step b).

For this purpose, the data acquired in step a) and the bite positions determined in step b) are depicted using suitable computer software. In principle, all programs with which three-dimensional (image) data can be processed, ie displayed, processed and calculated, such as, for example, programs for computer-aided design or computer-aided manufacturing (CAD / CAM - Programs). In the imaging, both surface and volume data of the skull incl. The teeth of the patient and motion paths or movement clouds of the lower jaw (initial state) and the determined in step b) bite positions (target states T _o ) in an overall view together - led, such. B. by the superimposition of image data. This overlay can be performed manually by the attending physician or with the help of suitable software (virtual matching). Abnormalities of the teeth, the jaw and the jawbone are visualized by the imaging and can be quantified using anatomical fixed points, which serve as reference points. Subsequently, the bite positions (desired states To) determined in step b) are compared with the initial state to provide a measure of a deviation of the actual state from the respective desired desired states and thus a measure of a therapeutic repositioning into the respective desired target To determine conditions.

In this case, two or more bite positions which are based on different examination findings, e.g. based on various examination results from medical fields other than orthodontics, are brought together to form a bite position. In this case, the merged bite positions can be weighted equally (averaging) or, depending on relevance, to different degrees.

The dimensions of the deviations obtained from the analyzes of the desired states and the actual state are transferred in the correct position to a virtual articulator, on the basis of which temporary models of a bite splint are calculated for each of the desired bite positions (desired states) that the jaw in Reposition the desired layers. A virtual articulator is synonymous with software that processes 3-dimensional data.

If desired, it is of course also possible to transfer the desired bite positions to a physical articulator. For this purpose, the temporary models, which represent negative images of the desired bite positions, for example, by means of 3D printing process printed and attached to the physical articulator in the correct position.

Step d):

Subsequently, a bite splint is respectively generated for two or more than two of the bite positions determined in step b), based on the temporal models calculated in step c).

Usually, a bite rail is generated for each of the bite positions determined in step b).

The dispensing of the bite splints is advantageously done with 3D forming equipment, such as e.g. 3D printers and 3D milling units. When using 3D printers and 3D milling units, the procedure is usually to first print a positive model of the dental morphology with the temporary ideal positions of the jaws and temporomandibular joints, from which then the rails, for example by deep drawing of a suitable polymer material , can be made.

With the bite splints thus produced, the patient's discomfort can be quickly and effectively reduced, or even largely eliminated, and thus advantageous in the treatment of diseases that emanate from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions.

In the treatment of diseases that result in a functional disorder of the kaurorgan, such as the craniomandibular dysfunctions, the patient is accustomed to a new muscular movement pattern, which leads to a therapeutically favorable position of the jaw and temporomandibular joints. This habituation is a continuous process and takes place over a longer period, usually over several months, in which the body reacts in the sense of a control loop. Therefore, it is useful or even necessary to check the originally determined bite position in the treatment of diseases that are based on a functional disorder of the chewing organ, such as craniomandibular dysfunctions, in order to draw conclusions about the effectiveness of the created bite splints If necessary, it is possible to redefine and initially determine bite positions that have been determined in order to be able to create correspondingly improved follow-on bite bars.

In addition, special circumstances or changes may occur over the course of the treatment which necessitate the adaptation or rebuilding of the initially produced bite splints and / or the creation of additional bite splints, such as operations, accidents, tooth loss or illnesses which cause a direct or indirect influence on the jaw position, the tooth morphology, the head and body posture and / or the musculoskeletal system.

Therefore, a further aspect of the invention relates to a method for the production of subsequent bite bars, comprising the steps a) to d) as defined above and in the following, the method additionally comprising the following steps: e) checking that in step b ) certain bite positions,

g) Generation of consecutive bite splints.

Steps):

As a rule, the examination of the bite positions determined in step b) (also referred to below as "initial bite positions") takes place within the framework of a treatment of the CMD within a period of a few weeks to several months after the preparation of the previous bite bars.

However, special circumstances or changes may occur over the course of the treatment, which make a review of the bite positions determined in step b) (initial bite positions) recommendable or even necessary. To In addition to the above-mentioned circumstances and changes, findings from medical fields other than orthodontics, which were collected after the generation of the current bite splints, are also included.

The examination of the initial bite positions is carried out according to the methods described above under step b) for determining the bite positions with different head and posture in statics and dynamics, whereby usually the method (s) is used, with which the check is as efficient as possible according to the situation. In particular, the empirical and clinical methods described above can be used advantageously for this purpose.

In a preferred embodiment of the method according to the invention, the checking of the bite positions determined in step b) therefore takes place using empirical or clinical methods, as described above.

Step f):

Subsequently, one or more of the bite positions determined in step b) is / are selected or, if appropriate, all bite positions determined in step b) are discarded.

The selection of the bite splint (s) is usually made on the basis of the examination performed in step e), as well as on the basis of the objective patient-specific benefit and / or on the basis of the subjective sensation of the patient.

The selection of the splint (s) on the basis of the test carried out in step (e) is usually based on the following criteria:

If it is determined in step e) that a certain bite position (initial bite position) determined in step b) does not correspond or no longer corresponds to the desired therapeutic bite position for the relevant head and body posture in terms of statics and dynamics, this bite position is discarded. However, if this initial bite position still corresponds to the desired therapeutic bite position for the head and body posture concerned in statics and dynamics, or comes very close to it, the bite position is retained.

The retained bite positions are then additionally selected on the basis of the objective patient-specific benefit and / or on the basis of the subjective sensation of the patient.

The assessment of the objective patient-specific benefit is usually carried out by the orthodontist via a manual examination of findings using empirical and clinical examination methods, as described above. Additionally or alternatively, data on the current position of the jaws, temporomandibular joints and the tooth morphology can be obtained by means of three-dimensional imaging techniques. collected for the respective worn bite splints and included in the assessment of the objective patient-specific benefit. For example, the anatomical effects caused by wearing a specific bite splint, such as the relief of inflammatory areas or the temporomandibular joint width, can be specifically checked by MRI.

If findings from a medical field other than orthodontics have been included in the determination of bite positions in step b), or if such findings have subsequently been collected, the assessment of objective patient benefit may be made in conjunction with a medical practitioner.

In this assessment, however, the subjective feeling of the patient is generally decisive.

In a preferred embodiment of the method according to the invention, the selection of the bite positions or rejection of all bite positions in step f) comprises the following steps: f.1) acquisition of data for determining the current position of the jaws, the temporomandibular joints and the tooth morphology for the in Step b) certain bite positions (current as-is condition), f.2) selection of one or more of the bite positions determined in step b) or rejection of all of the bite positions determined in step b) on the basis of the test performed in step e), and on the basis of the data collected from the data acquired in step f.1) for determining specific patient-specific benefit and / or based on the subjective sensation of the patient.

The determination of the current actual state according to step f.1) is usually carried out with inserted rail. Here, the rail is used, which was previously manufactured for the relevant bite position (initial rail). Based on this data, the current position of the jaws and temporomandibular joints can be compared with the desired bite position when the splint is inserted.

In a particularly preferred embodiment of the method according to the invention, the selection of the bite splint (s) takes place predominantly on the basis of the examination made in step e) as well as on the basis of the subjective sensation of the patient, optionally including orthodontic aspects. Step g):

In step g) of the method according to the invention, successive bite splints are produced for the bite positions selected in step f). This can be done in different ways depending on the present situation and feasibility.

For example, in the event that at least one initial bite position in step f) has been found to be good and selected, one subsequent track can be generated for each of the selected bite positions. Furthermore, for certain selected bite positions, it is also possible to produce a plurality of follower rails which differ slightly from one another. These slight modifications may be in the form of the rails (eg thickness of the rail, enhancement of impressions / profiling or rail-mounted means of toothing, and the like) and / or the material of which the rails are constructed (eg, to modify bite resistance or the plasticity of the rail). The mentioned following rails can then be worn as an alternative to the previously produced rails or replace the previously produced rails. The latter applies in particular in the case of an iterative approach to a desired bite position through the use of several intermediate stages (intermediate rails). Preferably, the previously created bite bars are replaced by the follower bite bars.

In the event that all initial bite positions are discarded in step f), usually the discarded bite positions must be redetermined and / or additional bite positions must be determined which better take into account the individual needs of the patient. Based on these new bite positions, the subsequent rails are then produced.

In order to generate the follow-on bite splints, data for determining the current position of the jaw, the temporomandibular joints and the dental morphology of the patient are collected in a first step (current actual state), analogously to step a) of the method according to the invention.

In a next step, if necessary, one or more of the bite positions rejected in step f) are redetermined and / or one or more additional bite positions are determined for different head and body postures in statics and dynamics.

In principle, all methods described under step b) can be used to determine the new bite positions. For this purpose, empirical and clinical methods are preferably used.

In addition or alternatively, the new bite positions can be calculated. For this purpose, the previously collected data for determining the current position of the jaw, the Temporomandibular joints as well as tooth morphology and / or examination findings from medical fields other than orthodontics.

In a subsequent step, the data recorded at the beginning (current actual state) and the bite positions newly or additionally determined in the previous step are combined and a respective temporary model of a bite splint is calculated for the previously determined and / or calculated new bite positions. From the temporary models, the follow-up bite splints are then created. The calculation of the models or the generation of the sequence bite splints is analogous to the steps c) and d) described above.

If, in step f), one or more of the bite position (s) determined in step b) has been selected (initial bite positions), the generation of the bite splints in step g) preferably comprises the following steps: g.1a) the collection of data for determining the current position of the jaws, the jaw joints and the dental morphology of the patient (current actual state), g.2a) possibly redetermining one or more of the bite positions discarded in step f) and / or determining one or more additional bite positions with different head and body postures in statics and dynamics, g.3a) computer-assisted merging of the data acquired in step g.1 a) (current actual state) and the one selected in step f) and optionally in step g.2a) new or additionally determined bite positions for calculating in each case a temporary model of a bite splint for two or more than two of the ones selected in step f) g.4a) Generation of a respective consecutive bite splint for two or more than two bite positions selected in step f) and possibly determined in step g.2a), based on bite positions optionally determined in step g.2a); to the temporary models calculated in step g.3a).

If none of the bite positions initially determined in step b) were found to be good and therefore discarded in step f), one or more of the bite positions rejected in step f) must be redetermined and / or one or more additional bite positions must be added Different head and body postures in statics and dynamics are determined, which better meet the requirements of the patient.

In this case, the generation of subsequent bite bars preferably comprises the following steps: g.1 b) the acquisition of data to determine the current position of the jaws, the jaw joints and the dental morphology of the patient (actual status), g.2b) redetermination of one or more of the bite poses discarded in step f) and / or the determination of one or more additional bite positions with different head and body postures in statics and dynamics, g.3b) computer-assisted merging of the data acquired in step g.1 b) (current actual state) and that in step g .2b) certain new bite positions for calculating each a temporary model of a bite splint for two or more than two of the bite positions determined in step g.2b), and g.4b) generating one subsequent bite splice for two or more than two of the ones in step g .2b) determined bite positions, based on the temporary models calculated in step g.3b).

The determination of these new bite positions in step g.2b) takes place as described above under step b). The steps g.3b) and g.4b) are carried out analogously to the above-described steps c) and d).

Iterative procedure:

As previously mentioned, CMD therapy often occurs over an extended period of time in which the body responds in the sense of a control loop, which may require multiple adjustments to the bite splint until all functional symptoms have disappeared and a stable physiological position of the condyle reached in the joint pits. Furthermore, in the context of CMD treatments, besides advances, there may always be relapses (recurrences) which may involve an adaptation of the occlusal splints, i. make subsequent bite splints, or even require a return to an initial bite splint. In addition, a change to an alternative bite position-based bite splint may be required, for example, when new findings arise over time, for example, from medical fields other than orthodontics, as discussed above, or the existing findings due to interactions in the field Change control loop.

In addition, the treatment of CMD is generally more tolerable for the patient if the approach to the respective therapeutic position (s) of the jaws and temporomandibular joints of the respective bite position (s) (therapy goal (s )) stepwise, ie on the creation of one or more, for example, about 1 to 10, so-called intermediate rails takes place. For this reason, in a preferred embodiment of the method according to the invention, steps e) to g) are repeated once or several times until one or more final bite splines are obtained, with which the therapy goal is essentially achieved or until the patient-specific ones Complaints are largely eliminated, in which case, instead of the bite positions determined in step b), the bite positions selected in step f) and, if appropriate, those newly determined in step g) occur. If, from a therapeutic point of view, a bite position is required for which no (initial) bite splint has yet been created, it can be included as a new bite position in step g) to produce a corresponding subsequent bite splint.

The steps e) to g) of the process according to the invention are preferably repeated 1 to 10 times.

A further subject of the present invention relates to occlusal splints and follow-on splints for use in the treatment of a patient with at least one disease resulting from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions produced by the process described herein ,

As already mentioned, these bite splints and follow-on bite splints are particularly suitable for the treatment of patients suffering from a disorder that results from a functional disorder of the masticatory organ, such as bruxism and craniomandibular dysfunctions. In particular, the bite splints and subsequent bite splints obtainable by the method according to the invention are suitable for the treatment of craniomandibular dysfunctions.

A further aspect of the present invention therefore relates to bite splints for use in the treatment of a patient with at least one disease which is based on a functional disorder of the chewing organ, in particular craniandibular dysfunctions, comprising a receiving area for receiving teeth of a first jaw of the patient and one Contact area for contacting teeth of the second jaw of the patient opposite the first jaw, wherein the at least one receiving area has at least one means for guiding the teeth and is profiled so that a sufficiently secure hold of the rails is ensured even under load, and wherein Contact area is only slightly profiled,

characterized,

that the configuration of the means for guiding the teeth and the profiling of the contact areas of the bite splints and follow bite rails at bite positions with different head and body postures in statics and dynamics oriented, and that the distance of the receiving area or contact area for the first jaw to the receiving area or contact area for the first jaw opposite Overlying arranged second jaw of the bite splints and subsequent bite splints on the therapeutically desired bite increase (jaw opening) with different head and body postures in statics and dynamics and / or one or more examination findings (s) oriented from orthodontics different medical areas.

These bite splints are preferably a set of two or more bite splints, each bite splint being inserted in the splint set for a different use (day rail, night rail, work rail, rail, sports rail, etc.).

Accordingly, a preferred embodiment of the invention relates to a set of occlusal splints for use in the treatment of a patient with at least one disease which is based on a functional disorder of the chewing organ, in particular craniomandibular dysfunctions consisting of two or more than two bite splints as defined above, whereby each of these two or more bite splints is used in a different head and posture in statics and dynamics.

The following figures serve to further explain the invention.

FIG. 1:

FIG. 1 shows the method according to the invention for the production of bite splints. In a first step a), data on the position of the jaws, the jaw joints, the movement pathways of the lower jaw and the current morphology of the patient's teeth are acquired (initial state). Subsequently, in a step b), two or more than two bite positions of the patient, i. for the treatment of craniomandibular dysfunctions relevant or potentially / presumably relevant positions of the maxilla and mandible relative to each other, determined in different head and body postures in statics and dynamics (target states or bite library). Subsequently, in each case one bite splint is produced from two or more than two of the bite positions determined in step b) in accordance with steps c) and d) (2 to n bite splints produced).

FIG. 2:

FIG. 2 shows a preferred embodiment of the method according to the invention for producing follow-on bite splints, starting from the bite splints produced in steps a) to d) or bite positions (initial bite positions) determined for this in step b). The initial bite positions are first checked to see if they still correspond to the currently desired therapeutic bite positions (step e)). Subsequently, in a subsequent Step f) selects one or more of the bite positions determined in step b). Thereafter, if necessary, one or more of the bite positions discarded in step f) are redetermined and / or one or more additional bite positions are determined for different head and body postures in statics and dynamics (step g.2)). From this new collective of selected and newly determined bite posi- tions (new target states), the subsequent bite splints are then generated (2 to m generated consecutive bite splints). The steps e) to g) can be repeated until final bite splints are obtained with which the desired therapeutic goal is achieved.

Claims

Claims:

1 . A method of producing splints for use in the treatment of a patient having at least one disease which is based on a functional disorder of the chewing organ, in particular craniomandibular dysfunctions, comprising the following steps: a) collecting data on the position of the jaw, Temporomandibular joints, the motion pathways of the lower jaw and the current morphology of the patient's teeth (initial state),

b) determination of two or more than two different bite positions of the patient, wherein the determination of the bite positions in different head and body postures in static and dynamic,

c) computer-assisted merging of the data acquired in step a) (initial state) and the bite positions (target states To) determined in step b) for calculating a respective temporary model of a bite rail for two or more than two of Step b) certain bite positions,

d) generating in each case one bite splint for two or more than two of the bite positions determined in step b), based on the temporary models calculated in step c).

2. The method of claim 1, wherein the determination of the bite positions in step b) taking into account one or more examination findings from different from the orthodontics medical areas.

3. The method of claim 2, wherein the examination findings are selected from the osteopathic view optimal head and body posture,

optimal posture from the orthopedic point of view,

from the ENT perspective optimal head posture and jaw position,

Optimal head and posture from an ophthalmological point of view.

4. The method of claim 1, wherein the different bite positions are calculated in step b).

5. The method according to any one of the preceding claims, wherein in step a) optionally additionally the shape of an existing bite splint and the contact area of the teeth with the bite splint are detected.

6. A method for producing follow-on bite bars, comprising the steps a) to d) as defined in any one of claims 1 to 5, the method additionally comprising the following steps: e) checking the bite positions determined in step b),

f) selecting one or more of the bite positions determined in step b) or rejecting all bite positions determined in step b), g) generating subsequent bite splints.

7. The method of claim 6, wherein the checking of the bite positions in

Step e) takes place with the inclusion of one or more examination findings from medical fields other than orthodontics.

8. Method according to one of claims 6 or 7, wherein the selection of one or more of the bite positions determined in step b) or rejection of all of the bite positions determined in step b) in step f) comprises the following steps: f.1) acquisition of data for determining the current position of the jaws, temporomandibular joints and tooth morphology for the bite positions determined in step b) (current actual state), f.2) selecting one or more of the bite positions determined in step b) or rejecting all of the bite positions determined in step b ) certain bite positions on the basis of the examination performed in step e), and on the basis of the objective patient-specific benefit determined from the data acquired in step f.1) and / or on the basis of the subjective sensation of the patient.

9. The method according to any one of claims 6 to 8, wherein the generation of subsequent bite bars in step g) comprises the following steps:

Either, if in step f) one or more of the bite position (s) determined in step b) has been selected (initial bite positions), g.1a) the collection of data to determine the current position of the jaw, temporomandibular joints and the dental morphology of the patient (current as-is condition), g.2a) possibly redetermination of one or more of the bite positions discarded in step f) and / or or the determination of one or more additional bite positions with different head and body postures in statics and dynamics, g.3a) computer-assisted merging of the data recorded in step g.1a)

(current actual state) and the bite positions selected in step f) and possibly new or additionally determined in step g.2a) for calculating a respective temporary model of a bite splint for two or more than two of the ones selected in step f) and b.4a) generating one consecutive bite splint for two or more than two of the bite positions selected in step f) and possibly determined in step g.2a), based on the bite positions g. b) the acquisition of data for determining the current position of the jaws, the temporomandibular joints, in step g.3a) or, if in step f), all the bite positions determined in step b) were discarded g.2b) redetermination of one or more of the bite positions rejected in step f) and / or the determination of one or more additional ones

Bite positions with different head and body postures in statics and dynamics, g.3b) computer-assisted combination of the data acquired in step g.1 b) (current actual state) and the new bite positions determined in step g.2b) for the calculation in each case a temporary model of an occlusal splint for two or more than two of the bite positions determined in step g.2b), and g.4b) generating in each case one consecutive bite splint for two or more than two of the bite positions determined in step g.2b), based on the temporary models calculated in step g.3b).

10. A method according to any one of claims 6 to 9, wherein steps e) to g) are repeated one or more times until one or more final bite bars are achieved, with which the therapeutic goal is substantially achieved or until the patient-specific ones Complaints are largely eliminated, in which case, instead of the bite positions determined in step b), the bite positions selected in step f) and, if appropriate, those newly determined in step g) occur.

11. The method according to claim 10, wherein the steps e) to g) are repeated 1 to 10 times.

12. The method of claim 1, wherein the bite splints and follower bite splints comprise a receiving area for receiving teeth of a first jaw of the patient and a contact area for contacting teeth of a second jaw of the patient opposing the first jaw.

13. Bite splints and follow-on bite splints, for use in the treatment of a patient with at least one disease that results from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions, obtained by a method according to one of claims 1 to 12.

14. Bite splints for use in the treatment of a patient with at least one disease emanating from a functional disorder of the chewing organ, in particular craniomandibular dysfunctions, comprising a receiving area for receiving teeth of a first jaw of the patient and a contact area for Contacting teeth of the first jaw oppositely disposed second jaw of the patient, the at least one receiving area has at least one means for guiding the teeth and is profiled so that a sufficiently secure hold of the rails is ensured even under load, and wherein the contact area only slightly profiled,

characterized,

that is the configuration of the means for guiding the teeth and the profiling of the contact areas of the bite splints and subsequent bite splints Orienting bite positions in statics and dynamics with different head and body postures,

and that the distance of the receiving region or contact region for the first jaw to the receiving region or contact region for the second jaw of the bite splints and subsequent bite splints opposite the first jaw adjoins the therapeutically desired bite increase (jaw opening) for different heads. and physical postures in statics and dynamics and / or in one or more examination findings (s) from medical fields other than orthodontics.

A set of occlusal splints for use in the treatment of a patient having at least one disease which is a functional disorder of the kauro gland, in particular craniomandibular dysfunctions consisting of two or more than two occlusal splints as defined in claim 14, wherein each these two or more than two bite bars at another head and

Posture is used in statics and dynamics.