WO2017116368A1

WO2017116368A1 - Customized arch wire shaping method and appropriated bracket transfer apparatus therefor

Info

Publication number: WO2017116368A1
Application number: PCT/TR2016/050547
Authority: WO
Inventors: Ali Arslan NAZAN
Original assignee: Nazan Ali Arslan
Priority date: 2015-12-30
Filing date: 2016-12-28
Publication date: 2017-07-06

Abstract

The invention is related to customized arch wire shaping method in which the positioning the brackets as near as possible to the teeth for increasing the patient comfort can be carried out by 1., 2 and 3. order bends by accepting the ideal set-up geometry of the patient as reference and then in which the treatment is separated into phases and the wire geometry is obtained in the virtual environment.

Description

CUSTOMIZED ARCH WIRE SHAPING METHOD AND APPROPRIATED BRACKET TRANSFER APPARATUS THEREFOR

Related Technical Field of the Invention:

The invention is related to positioning of the brackets as near to teeth as possible by using the cad-cam technology and to a method of shaping (such as bending, twisting) customized arch wire special for the patient according to this positioning.

Also, the invention is related to bracket transfer apparatus developed and produced in accordance with the disclosed method of the invention for positioning the brackets aligned in the computer environment into the mouth of patient according to the design in the computer environment.

Prior Art:

The brackets are very hard to be attached directly as are to the tooth in the lingual orthodontics. Because the lingual surface morphologies of teeth have more inclination and different anatomical structure in comparison with their labial surface morphologies, the brackets are transferred to teeth indirectly. Because it is almost impossible that the person who applies the treatment attaches the lingual bracket to the lingual surface of the tooth at the correct position by direct method and manages the treatment. Therefore, various techniques are developed for attaching the brackets to the teeth indirectly. In the brackets applied with these techniques, the distances between the teeth and brackets are increased and then these distances are filled with specific materials (such as adhesive, resin etc.).

In the orthodontic set-up or laboratory applications performed by using the present laboratory devices and techniques; bracket positionings (class, best... etc.) done by hands (manually) are insufficient at the recent conditions mostly depending on the care and experience of the person applying the treatment, they result in negative consequences affecting the treatment process directly. On the other side; due to the fact that the lingual tooth surface morphologies show a large variety, the orthodontic wires used in the straight archwire technique and therefore brackets are quite hard to be positioned such that they are at the nearest position to the tooth with the manual set-up techniques. For example; the preference of reaching of the canine and lateral brackets to each other in the anterior with a circular wire geometry instead of with a diagonal wire geometry increases the base thickness radically. In addition, the preformed arch wires used in the prior art are perfectly symmetrical. However, patients having such a symmetrical chin structure are not encountered very often when all possibilities are considered (mesiodistal diameters, crown lengths, torque, angulation etc.) in the real life. The aggressive offset bends given in the conventional mushroom arch type mostly cause bleeding in the tongue continuing from canine to premolar or from premolar to molar.

The disadvantage of the standard orthodontic wire geometries used in the straight arch technique is increasing of bracket base thickness due to the usage of wire as straight as possible and therefore, by moving away from the center of resistance of the tooth, orthodontic strength losses, not coming of teeth to the desired position, the treatment process' taking longer, the treatment decreasing comfort and injury/ailments forming in the tongue. For applying the treatment; the orthodontist should arrange the position of the teeth which is crooked in consequence of the treatment, determine the places where the brackets need to be positioned and position the brackets onto the crooked teeth according to this arrangement by going back to the first place again.

In the state of the art, positioning the brackets onto the teeth in the lingual orthodontics depends on that rule; all brackets are positioned onto the teeth from a plane such that all brackets are on the same plane and as a general rule which passes from the incisal edge with 1/3 ratio in the anterior region and from the posterior region with 1/2 ratio and at the same time this plane is positioned parallel to the occlusion plane. Due to the effort of positioning on the same plane; the orthodontic wire geometry used for reaching the desired set-up final may cause a situation different from the designed treatment format, causes unexpected tooth movements, losses in the transmission of the orthodontic strength, decreases patient satisfaction and causes longer treatment time periods.

When the other present technologies of computer aided design and production are analyzed; the effort of positioning the brackets to the teeth on the same plane in the orthodontic diagnosis and treatment periods continues. Although it enables the doctor to make less bends in the treatment, the thicknesses of the bracket base increase and the treatment comfort decreases.

In the patent document of US2008261166, a method and system in which the bracket alignment is made with the conventional straight arch technique for positioning the brackets correctly are mentioned.

In the patent document of US5863198, a transfer apparatus (jig) and method for positioning the brackets to teeth are mentioned. In this invention by using the computer scanning techniques; computer modelling of each tooth, each jig's sizing and shaping costumized for patients with CAD/CAM. In this invention also, each jig is shaped specially for each tooth with the CAD/CAM application.

In the patent document of US2008261166, a method and system for positioning the brackets correctly are mentioned. In the said document, it is said that the brackets are manipulated by changing their torque, angulation and vertical positionings.

In the patent document of US2015182304, an orthodontic bracket system and method are mentioned. In this invention, it is mentioned that the numeric notation of each bracket can be obtained.

In the patent document of US20050003324, a device for positioning the brackets onto the lingual surface of teeth is mentioned. It is stated that torque, vertical and horizontal values can be determined for each bracket. Brief Description of the Invention:

The aim in the disclosed method of the invention is to perform the transfer of brackets to the teeth correctly such that they are at the nearest position by using computer aided design and manufacturing technologies (cad-cam) especially in the lingual orthodontics and to obtain customized arch wires and to decrease the base thicknesses with these wires, therefore to realize keeping the patient comfort at the maximum level.

In the disclosed method of the invention; the positions of the crooked teeth in consequence of the treatment are aligned by using computer aided design and manufacturing technologies (cad-cam), the places where the brackets need to be positioned are determined and positioning the brackets onto the crooked teeth is performed according to this alignment by going back to the first place again.

With the disclosed method of the invention;

- As a result of decreasing the base thickness (tooth-bracket distance); decreasing the orthodontic strength losses to the minimum level by approximating to the center of resistance of the tooth, becoming the treatment period shorter by using the orthodontic strength which moves the teeth with maximum control and decreasing injury and/or diseases it forms in the tongue to the minimum level (1. Order- Improvements)

- Decreasing the negativity of disturbing the patient by the bracket hooks used in the lingual orthodontics (2. Order- Improvements)

- Especially in the anterior region; the distance between the bracket and tooth is decreased by increasing the torque angle of the bracket. (3. Order-Improvements)

- Positioning the brackets to the tooth at the nearest position according to the intraoral model of the patient instead of positioning the brackets on a single plane

(1., 2. and 3. Order bends)

- Formation of customized arch wires with bends in 3 dimensions is provided in consequence of these bracket positionings.

In the disclosed method of the invention, also the transfer of the brackets to the mouth of patient is performed expediently for the purpose like it is simulated in the computer. The technique does not work as desired in case that the brackets are not transferred to the mouth of patient at the positions designed in the computer environment and therefore, the bracket transfer apparatus are inseparable parts of this method.

For the disclosed arch wire shaping method of the invention; teeth set-up with the method mentioned in our patent application of TR 2015/04349 whose application has been filed before are used. The crooked teeth are aligned and final set-up teeth model (aligned teeth model) is formed with some references taken in the method mentioned in said patent document. In this disclosed method of the invention, the apparatus used for the transfer of the brackets to the mouth model of the patient in the aligned teeth by using the aligned teeth model are design in the computer environment, are produced in the professional 3d printer. The arch wire is shaped according to the nearest positionings of these brackets to the teeth.

The shapings given to the arch wire in the disclosed method of the invention are 3. order bends (torque, inclination bends) except of 1. order (bends made at the horizontal axis) and 2. order (bends made at the vertical axis) bends, they can be changed to maximize the comfort of the patient. Therefore, this method does not require the brackets to transfer on the same plane via the changeable order bends differently from the straight wire technique (positioning the brackets to the set-up teeth on a plane). Also, the desired bracket system can be used including straight arch wire and edge wise brackets because of the advantages we have mentioned in this method. Therefore, positioning the brackets as near as possible to teeth is provided because it is not necessary that the brackets are transferred to teeth on a single plane. Due to this positioning, the thicknesses of distances between the brackets are thinned and the comfort of patient is increased especially in the lingual orthodontics. Consequently; customized arch wire/wires are positioned after the performed bracket transfer process.

Detailed Description of the Invention: Description of the Figures

Figure 1-1: It is the view of the prefabricated arch wire used in the state of the art and of the brackets positioned to teeth according to this wire.

Figure 1-2: The arch wire used in the state of the art

Figure 2-1: It is the view of the customized arch wire obtained with the disclosed method of the invention and of the brackets positioned to teeth according to this wire.

Figure 2-2: The customized arch wire obtained with the disclosed method of the invention

Figure 3-1, 3-2, 3-3, 3-4: It is the view of the positionings of the brackets.

Figure 4-1, 4-2, 4-3: It is the representational view of joining of two separate wires passing through any two brackets and of the angle values between the wires.

Figure 5-1, 5-2: It is the representational view of the brackets positioned to teeth with the known laboratory techniques and of transferring the brackets to teeth on a single plane.

Figure 5-3: It is the view of the nearest positioning process that can be performed by changing the torque angles of the brackets with the disclosed method of the invention. Figure 6-1: It is the representational view of the arch wire when any changes in the torque angles of the bracket are not made in the straight wire technique.

Figure 6-2: It is the representational view of the "torque" bends which need to be made on the wire in consequence of "the nearest" positioning process performed by changing the torque angles.

Figure 7-1: It is the view of the situation in which the bracket hooks disturb the patient. Figure 7-2: It is the view of the situation in which the bracket hooks disturb the patient in the straight wire technique.

Figure 7-3: It is the view of the wire geometry formed due to being able to perform the positioning freely at the 2. order (the bends made at the vertical axis) bend direction in the bracket positions.

Figure 8-1, 8-la: It is the top and side view of the arch wires designed for an arch case tried to be managed with the mode-1 phase.

Figure 8-2, 8-2a: It is the top and side view of the arch wires designed for an arch case tried to be managed with the mode-2 phase.

Figure 8-3, 8-3a: It is the top and side view of the arch wires designed for an arch case tried to be managed with the mode-3 phase.

Figure 9: It is the flow diagram of the disclosed method of the invention.

Description of the references in the figures:

The meanings of the short codes of the parts in the attached figures are given below for understanding the invention.

D: Tooth

16: Sixteenth tooth

15: Fifteenth tooth

16m: Mesial point for sixteenth bracket

16d: Distal point for sixteenth bracket

15m: Mesial point for fifteenth bracket

15d: Distal point for fifteenth bracket

Last position of the distal point of fifteenth bracket

Last position of the mesial point of sixteenth bracket

B: Bracket BS: Bracket slot

AT: Arch wire

KOAT: Customized arch wire

K: Base thickness

H: Bracket hooks

Forming customized arch wire (KOAT) geometry and determining tooth movements for every phase by separating the treatment into phases, obtaining 3D geometry of the arch wire (AT) which provides the determined tooth movements and managing the treatment are impossible in the manual laboratory and set-up steps. Similarly, manual operations do not have the technology which can form customized arch type for the mouth geometry of the patient and which puts this into use in the treatment plan. In addition, there are not any devices or ancillary equipment providing the slot angles to be changed in the operations performed manually.

In the disclosed arch wire shaping method (100) of the invention, the first order bends from shapings given to the arch wire (AT) are the bends made at the horizontal axis according to the tooth (D). The second order bends from said shapings are the bends made at the vertical axis according to the tooth (D). Also, the third order bends from said shapings are the bends where the arch wire (AT) is twisted and the torque of the bracket (B) is adjusted.

The prefabricated arch wires (AT) used in the state of the art are shown in the Figure 1-1 and 1-2. An example of the customized arch wire (KOAT) obtained with the disclosed method (100) of the invention is shown in the Figure 2-1 and 2-2. The customized arch wires (KOAT) are more twisted than the prefabricated arch wires (AT) as seen from the figures.

All steps of the arch wire shaping method (100) explained below are carried out by a control unit which is in the virtual environment. Also, the control unit is an operator in the preferred embodiment of the invention.

In the invention, a teeth model whose set-up is performed (aimed teeth model) by using the method mentioned in the patent application of TR 2015/04349 is used. In the disclosed arch wire shaping method (100) of the invention, the arch wire is shaped via the computer aided design and manufacturing program (cad-cam) according to the method steps below:

Obtaining the customized set-up geometry (0)

Carrying out the orthodontic wire position in the virtual environment with the predetermined lengths from the mesial and distal parts of all brackets (B) used such that the bracket slots (BS) are assumed as center (101)

Carrying out the alignment of brackets (B) and positioning the arch wire (AT) connections; if necessary, revising the bracket (B) position (Figure 3-4) (102)

Alignment of the other residual brackets (B) to the final- setup (teeth after treatment) teeth (D) and making the connections (Figure 3-1, Figure 3-2, Figure 3-3) (103)

Calculating the angles and distances between the connection points in consequence of connecting of the arch wires (AT) to each other; if necessary, manipulating the wire lengths passing through the slots and the connection points (Figure 4-2, Figure 4-3) (104)

- Controlling and if necessary revising the connection points of 1. order bends made at the horizontal axis according to the tooth (D) (105)

Controlling and if necessary revising the connection points of 2. order bends made at the vertical axis according to the tooth (D) (106)

Controlling and if necessary revising the connection points for twisting the arch wire (AT) via the 3. order bends and adjusting the torque of the bracket (B) (107)

Going back of all teeth (D) together with the brackets (B) on them to their positions when they are crooked (malocclusion) right after positioning the brackets (B) on the teeth (D) virtually (108)

Separating the treatment into phases (109)

- The operations performed for obtaining the wire geometry via the control unit for mode-1 which is one of the phases of the treatment (110)

Applying the optimum tooth movements for mode-1 (110-a)

- Determining the geometry of the arch wire (AT) passing through the bracket slots (BS) on the teeth at the present position for mode-1 (110-b)

- Controlling the arch wire (AT) connection algorithms for mode-1 (110-c)

- Obtaining the geometry of arch wire (AT) for mode-1 (110-d) Operations performed for obtaining the wire geometry via the control unit for the mode-2 which is one of the phases of the treatment (111)

Applying the optimum tooth movements for mode-2 (111-a)

- Determining the geometry of the arch wire (AT) passing through the bracket slots (BS) on the teeth at the present position for mode-2 (111-b)

- Controlling the connection algorithms of the arch wire (AT) for mode-2 (111-c)

- Obtaining the arch wire (AT) geometry for mode-2 (111-d)

- Operations performed for obtaining the wire geometry via the control unit for mode-3 which is one of the phases of the treatment (112)

- Applying the optimum tooth movements for mode-3 (112-a)

- Determining the geometry of arch wire (AT) passing through the bracket slots (BS) on the teeth at the present position for mode-3 (112-b)

- Controlling the connection algorithms of the arch wire (AT) for mode-3 (112-c)

- Obtaining the arch wire (AT) geometry for mode-3 (112-d)

Generally, some difficulties are experienced as a result of being wide/narrow of the patient arch while the bracket (B) positionings are carried out. In the 101. step, positioning a wire length of 4 mm at the maxilla is carried out normatively as follows; the position of orthodontic wire which fits into the bracket slot (BS) at 2 mm to the mesial direction and 2 mm to distal direction by taking the bracket slot (BS) as the center is determined in the computer environment. While this length is taken as 4 mm for every bracket for the maxilla, positioning wires which are shorter than this length is carried out for the mandibula in the computer environment, for example 3 mm for every bracket. In the mandibula, positioning a wire length of 3 mm is carried out at 1.5 mm to the mesial direction and 1.5 mm to the distal direction. Because of the smaller distance between brackets (B) in the mandibula, the determined arch wire (AT) length is shorter than the maxilla. These values determined for each bracket (B) may be changed by the control unit as a result of allowance by the arch width especially in the mandibula.

In another embodiment of the invention, positioning of the wire into the bracket slot (BS) may be carried out by the control unit in the computer environment taking the wire length determined from the mesial point (MN) and the distal point (DN) by taking the bracket slot (BS) as center in 101. step for positioning a wire length of 2 to 5 mm fitting into the bracket slot (BS) in the maxilla.

Positioning of the wire into the bracket slot (BS) may be carried out by the control unit in the computer environment taking the wire length determined from the mesial point (MN) and the distal point (DN) by taking the bracket slot (BS) as center in 101. step for positioning a wire length of 2 to 4 mm in the mandibula.

In the 102. step; positioning the brackets (B) to all teeth (D) (Figure-2) is carried out not by going through any reference plane, by aligning the brackets (B) one by one generally to the exact middle point of the clinical crown at the nearest position to the teeth (D) and then revisions which increase the comfort of patient and effectiveness of the treatment are carried out by the control unit. The most important point considered in this part is the rule that the brackets (B) are not very close to the direct gingival parts or incisor parts of the tooth.

The steps applied in the disclosed method (100) of the invention are shown in the Figure- 3-1, 3-2, 3-3 and 3-4. The first stage is shown with the step of 3-1 and the last stage is shown with the step of 3-4. The steps of the Figure 3-1, 3-2 correspond to the 102. step of the disclosed method (100) of the invention and Figure 3-3 corresponds to the 103. step of it. The Figure 3-4 corresponds to the 102. step of the method (100).

After this stage, the connections of the arch wire (AT) are made in the 103. step. The control unit may take measures for the arch wire (AT) geometry by making revisions right in the first time through the bracket (B) heights and angles (torque/angulation) with this geometry which may confront in a complex structure with the control unit in this stage.

The closing relation of maxilla and mandibula is examined carefully although the occlusion is increased by the person applying the treatment in the 103. step; the positions of the brackets (B) must be revised by the control unit if there is a possibility that these brackets (B) hit any tooth especially in the mandibula. In this stage, the control unit makes decision by acting together with the person applying the treatment.

It can be shown in the screen how many mm of bends are present with how many degrees and where it is present due to making connections and becoming the connections defined in the 103. step. In the Figure 3-1, the image that is attached as an example for how the operation starts and in which a wire length of 4 mm is positioned through a bracket (B) attached onto the sixteenth tooth (16) is present. In the Figure 3-2, there is another image in which a wire length of 4 mm is positioned through a bracket (B) attached onto the fifteenth tooth (15). During these operations continuing consecutively, the geometrical connection of the wire passing through the brackets (B) attached to the sixteenth (16) and fifteenth teeth (15) shown in the Figure 3-2 may be arranged by the control unit according to the elements indicated below.

The sketch properties shown in the Figure 4-2 are used for looking at the geometrical references of the wire at the present situation (Figure 4-1) in the 104. step. In this geometry that can be defined as zigzag or Z-bend, the wire connected with the angle of Z: 60.53 degrees is connected with the distal point (15d") of the fifteenth bracket obtained by decreasing the length determined for the distal point (15d) of the fifteenth bracket from 2 mm to 1.6 mm by the control unit as shown in the Figure 4-3 with a wider angle such as Z: 70 degrees on condition that the mesial point (15m) of the fifteenth bracket remains fixed. In other words, the connection of the wire geometry positioned with specific lengths and passing through the bracket slot (BS) is carried out by manipulating it as mentioned above.

Similarly, the connection of the wire is possible to be carried out by the control unit with an angle of 70 degrees with the mesial point (16m") of the last position of the sixteenth bracket obtained by changing the size (wire length) of the mesial point (16m) of the sixteenth bracket on condition that the distal point (16d) of the sixteenth bracket remains fixed.

After the bracket positioning is completed, the arch wire is defined by the control unit numerically in the x-y-z coordinates such that how many mm of the arch wire (AT) is positioned for each bracket slot (BS) and its connection to each other is carried out with how many degrees of Z bends in an arch wire (AT) geometry shown in the Figure 2-2 and this data can be exported from the system in the extensions of ".csv, .xlsx, .xla, .xml, .dif ' by the control unit.

For example, the data of an arch wire geometry determined by the control unit which are defined numerically on the x-y-z axes: Position X Position Z Position Y

1

-15,5683 1,578378 -8,29512

2

-14,6258 1,600953 -4,40782

3

-15,1823 1,49742 -0,63433

4

-13,5779 1,805459 3,016857

5

-12,5814 1,671933 7,287489

6

-11,5665 1,698009 11,15651

7

-13,9992 1,222655 14,37348

8

-11,7268 1,968943 17,57958

9

-11,7486 1,415407 20,77471

10

-8,32593 2,04878 22,74562

11

-6,96929 1,320726 24,26267

12

-3,03081 1,524518 23,5942

13

2,357302 1,69812 24,13267

14

6,270101 2,357333 23,62724

15

6,677204 2,832629 22,92388

16 9,815662 2,192036 20,52811 17

9,772638 2,802454 18,03641

18

11,56789 1,437107 14,73294

19

10,36317 1,87973 11,80643

20

11,39597 1,870428 7,942078

21

12,56952 1,969527 4,366049

22

13,93135 1,615214 0,621735

23

14,26403 1,835013 -4,85892

24

15,60388 1,828626 -8,62785

Table- 1: The data of the determined wire geometry which are defined numerically on the x-y-z axes

Despite all of the controls, 1-2-3. order bends are looked at respectively for a last time for completing the operation on the purpose of control. As listed below, controls of 1., 2. and 3. order bends may be performed by a control unit.

In the connection control mentioned in the 105., 106 and 107. steps; 1. order controls, 2. order controls and 3. order controls are performed and if necessary, a revision may be carried out.

While 1. order bends are made by the control unit in the 105. step, the controls of being connected of the arch wire (AT) geometry to each other continuously are also carried out at the same time. If the angles between the mesial point (MN) and distal point (DN) are very sharp, the angle values are decreased as far as possible in the process of calculation of the values of angles mentioned in the 104. step for example if the translation angles of canine-premolar or premolar- molar are bigger than 90 degrees. Another approach is that the wire geometry is manipulated by approximating the bracket (B) to the tooth (D) or moving the bracket (B) away from the tooth (D) on the horizontal axis.

If a case with extraction is treated and a bodily movement is defined to the tooth (D), it is concerned to be in a suitable geometry with the principles of sliding mechanics. So, the condition of positioning at the nearest place to the tooth (D) is changed with the condition of being straight of the wire also including the teeth (D) at the ends of the tooth (D) which is moved.

As a result of decreasing the base thickness (K) in the 105. step, it is possible by making 1. order bends by the control unit that the orthodontic strength losses are decreased to the minimum level by approaching to the resistance center of the tooth (D) and the period of the treatment becomes shorter by using the orthodontic strength moving the teeth (D) with maximum control and the injury and/or diseases it forms in the tongue are decreased to the minimum level.

While 2. order bends are made in the 106. step, controls of being connected of the arch wire (AT) geometry to each other continuously are performed by the control unit also in the 2. order bends. Instead of positioning the brackets (B) on the same plane; similarly in the Figure 7-1 and 7-2, the bracket hooks (H) are moved away from the gingiva by making 2. order bends in the bracket (B) positions on the purpose of preventing the disturbance which is given to the patient by the bracket hooks (H) due to the hook problems in the set- up model or the spee curve of the seventh and sixth molars. Therefore, the feeling of disturbance which the bracket hooks (H) create in the patient disappears by moving them away from the part of gingival they touch due to moving the brackets (B) in the vertical direction. The wire geometry formed by the positioning made in this manner is shown in the Figure 7-3. If self ligating brackets are not used in the sixth and seventh molar, the bends bigger than 10 degrees are not made on the purpose of providing convenience for the doctor in the transfer of the arch wire (AT).

In the 107. step; although the brackets (B) are tried to be positioned as near as possible to teeth (D), torque may be given to the bracket (B) similarly for positioning the bracket (B) to the tooth (D) at a predetermined distance for example a distance of 0.01-0.05 mm due to the lingual surface morphologies of the teeth (D). The effort of positioning of the bracket (B) by giving torque at a nearer point is provided by twisting the arch wire (AT). The image of the brackets (B) positioned to the tooth (D) by the known laboratory techniques is shown in the Figure 5-1. Also, the section of the arch wire (AT) passing through the bracket slot (BS) is shown in the image similarly. As a result of positioning the bracket (B) as in the Figure 5-1, any twisting process is not performed on the geometry of the wire passing through the bracket slot (BS) as shown in the Figure 6-1. (Prior art) The image showing the plane determined for positioning the brackets in the straight wire technique is attached in the Figure 5-2. Also, the base thickness (K) positioned for straight wire technique is seen in the Figure 5-1. It is seen that the base thickness (K) in the Figure 5-1 is much more than the base thickness (K) in the Figure 5-3. It is shown in the Figure 5-3 that the base thickness is decreased by giving torque onto the bracket (B) with the disclosed method (100) of the invention. While the torque is given to the bracket (B), the orthodontic wire with rectangular or square section passing through the bracket slot (BS) also needs to be twisted as shown in the Figure 6-2 because of changing the angle of the bracket slot (BS) already. While 3. order bends are made, the controls of being connected of the arch wire (AT) geometry continuously to each other are carried out by the control unit.

In the 107. step, decreasing the base thickness (K) especially in the anterior region by increasing the torque angle of the bracket (B) becomes possible by making 3. order bends by the control unit. Increasing the torque angle of the bracket (B) by the twisting movement given to the arch wire (AT) in the 107. step may be carried out by the control unit again.

For coming of the teeth to the desired positions in the invention by starting from a teeth model (aimed teeth model) whose set-up is made by using the method mentioned in the patent application of TR 2015/04349, the table of final set-up total tooth movements showing how many mm and degrees the teeth is required to replace is shown in the Table- 2.

Rotation 7 11.5 8 10 4

limit:degree

o

Table-2: Final Set-Up Total Tooth Movements Table

The movement limit which is one of the definitions mentioned in the Table 2 is used for Intrusion, Extrusion, Mesialization and Distalization movements.

The rotation limit (degree) which is another definition mentioned in the Table 2 is used for: Torque (Inclination), Tipping (Angulation), Rotation movements.

The base thickness (K) is closed in the virtual environment in a model with malocclusion which is mentioned in the 108. step and the model with brackets (B) can be printed from a professional 3d printer and used for transferring the brackets (B) to the patient. After this stage, the treatment is separated into phases (109. step).

Separating the treatment into phases mentioned in the 109. step is realized in 3 phases as mode 1 (module-1), mode 2 (module-2) and mode 3 (module-3). These modes define the arch wires which the patient needs to use for each stage. In all modules (module 1, 2 and 3) and for each module; the geometry of the arch wire (AT) passing through the bracket slots (BS) is formed, connection algorithms are controlled and the arch wire (AT) geometry is determined for each stage by using the teeth at the present position by applying optimum teeth movements after malocclusion. Also, how many mm/degree wire needed to be used is determined for each stage and the arch wires (AT) are defined. Therefore, how many stages in which the treatment is finished in the phases given as mode-1, mode-2, mode-3 is determined. In each module (mode 1, mode 2 and mode 3), optimum teeth movements are determined by repeating the steps from 0. step to 104. step. The wire geometry is determined for each stage (Figure 8-1, 8-2, 8-3) by adjusting optimum forces and optimum teeth movements for every phase coordinately with the doctor for obtaining final set-up teeth (ordered teeth) from malocclusion (crooked teeth) with the separation of the treatment into phases in the 109. step.

In the 109. step; the optimum teeth movements of the stages of mode 1, mode 2 and mode 3 which are appropriate for sex and age of the patient may be defined to teeth by the control unit.

The values of mode 1, mode 2 and mode 3 defined in the 109. step are constant values predetermined according to the age and sex. After the step in which the treatment is separated into phases (109. step), the arch wire (AT) geometry is determined for each mode according to the steps below.

In the prior art; round sectioned Ni-Ti (Nickel-Titanium) wires are used at the beginnings of the orthodontic treatments, however; these cause very small movements in the teeth (D). The treatment is generally started by using .012 inch of Ni-Ti or .014 inch of Ni-Ti and alignment of the teeth (D) is tried to be provided in this stage. Then, the force given by .016 inch or .016x.016 inch of Ni-Ti or CuNi-Ti starts to increase slowly also by growing of the section of the arch wire (AT). After the end of levelling/alignment, the rectangular wires take place and special duties are defined on the wire (such as detailing, changing the torque angles of the teeth). An orthodontist/dentist who starts the treatment with .014 inch of Ni-Ti hopes the teeth movements to form by using this wire for a predetermined time, for example between 4-6 weeks, however; he does not have any data regarding how much teeth movements the wire he uses forms in the patient. He cannot determine how much the teeth move for every stage clearly. Instead of this, the dentist tries to manage the treatment completely in the way expressed as "try-see". Here, the biggest fear is death of the tooth (necrosis) and generally because of this concern, the treatment is finished in a longer time than the time determined at the beginning.

For example; total teeth movements between the final set-up and beginning states are concerned for a case in which only the movements of the teeth with the numbers of 13-12- 11-21-22 are provided.

As carried out in the disclosed method (100) of the invention, the dentist is required to separate the treatment into the phases by acting coordinately with the control unit. Deciding how many stages the treatment is finished in depends on some factors such as the sex, age and genetics of the patient. Here, the most important part that needs to be concerned is to lose the tooth (necrosis) in case of giving aggressive teeth movements. While giving 1 mm of teeth movement in a single stage does not cause any problem in a female patient aged about 15, giving 1 mm of teeth movement in a single stage may cause tooth loss (necrosis) in a female patient aged about 45.

As an example for separation of the treatment into phases, the teeth movement macro defined to the teeth only in the anterior region by the control unit for a female aged about 30 is as follows. Mode: 1 These values are constant values predetermined according to age and sex.

Table-3 Mode 1 numerical va ues

Generally for mode 1; .012 inch of Ni-Ti or .014 inch of Ni-Ti arch wire is used for the most effective result. As of the malocclusion (108), the teeth movements are formed as the optimum values defined in the table above. Also the brackets (B) on the teeth (D) go to their new positions together with the teeth (D) so an arch wire (AT) geometry giving the desired movements to the teeth is formed. The connections of the formed geometry are controlled. This formed geometry is defined numerically on the x-y-z axes and this data may be exported from the system by the operator in the extensions of ".csv, .xlsx, .xla, 0 .xml, .dif (Figure 8-1). In the mode-1; making modifications which cause changes in the length of arch wire (AT) passing through the bracket (B), therefore in the wire (AT) geometry is possible similarly as shown in the Figure 4-2, Figure 4-3.

Mode:2 These values are constant values predetermined according to age and sex.

Table-4 Mode 2 numerical values

5 Generally for mode 2; .016 inch or .016x.016 Ni-Ti/SS (Stainless Steel) orthodontic wire is used for the most effective result. In the teeth positions remaining from the mode-1, the teeth movements are formed as the optimum values defined above. Also the brackets (B) on the teeth (D) go to their new positions together with the teeth (D) so an arch wire (AT) geometry giving the desired movements to the teeth (D) is formed. The connections of the 0 formed geometry are controlled. This formed geometry is defined numerically on the x-y- z axes and this data may be exported from the system by the operator in the extensions of ".csv, .xlsx, .xla, .xml, .dif. (Figure 8-2) In the mode-2; making modifications which cause changes in the wire (AT) geometry is possible similarly as shown in the Figure 4-2, Figure 4-3.

Mode 3 These values are constant values predetermined according to age and sex.

Table-5 Mode 3 numerical values

Generally for mode 3; .016x.022 Ni-Ti/SS (Stainless Steel) or .016x.018 Ni-Ti/SS (Stainless Steel) orthodontic wire which is expressed as finishing wires or detailing wires is used for the most effective result. In the teeth positions remaining from the mode-2, the teeth movements are formed as the optimum values defined above. Also the brackets (B) on the teeth (D) go to their new positions together with the teeth (D) so an arch wire (AT) geometry giving the desired movements to the teeth (D) is formed. The connections of the formed geometry are controlled. This formed geometry is defined numerically on the x-y- z axes and this data may be exported from the system by the operator in the extensions of ".csv, .xlsx, .xla, .xml, .dif (Figure 8-3). In the mode-3; making modifications which cause changes in the wire (AT) geometry is possible similarly as shown in the Figure 4-2, Figure 4-3.

The arch wire (AT) used in the disclosed method (100) of the invention may be round or rectangular sectioned.

The disclosed method (100) of the invention does not require the brackets (B) to be transferred on the same plane due to the changeable order bends differently from the straight wire technique. Therefore, the brackets (B) are provided to be positioned as near as possible to the teeth (D) because transferring the brackets (B) to the teeth (D) on a single plane is not necessary. Due to this positioning; the base thickness (K) is thinned and damaging or disturbing of the brackets (B) to the tongue is prevented. Forming customized arch wire geometry and determining tooth movements for every phase by separating the treatment into phases, obtaining 3D geometry of the arch wire (AT) which provides the determined tooth movements and managing the treatment in the manual laboratory and set-up stages are provided by the invention. Similarly, the technology forming customized arch type for the patient's mouth geometry and putting this into use in the treatment plan is provided by this invention.

To summarize; the ideal set-up geometry of the patient (final set-up geometry) is accepted as reference and the brackets (B) can be positioned as near as possible to the teeth (D) for increasing the patient comfort by using the Cad-Cam technology in the disclosed method (100) of the invention. This nearness, namely; the base thickness (K) may change between 0,01 and 0,05 mm according to the embodiments of the invention. In the method, the base thickness (K) can be obtained numerically due to the operation of "the nearest positioning". Consequently; the torque (inclination, 3. order bends) and also 1. and 2. order bends can be given freely due to the reference angle freeness in the brackets which do not have to be positioned on the same plane and these can be defined numerically. Therefore, the base thickness (K) formed in consequence of the differences resulting from the morphologies of the teeth can be decreased in this manner and the patient comfort is maximized. With the disclosed method (100) of the invention; the customized arch wire (KOAT) geometry can be defined numerically and the wire can be shaped according to this.

The success of the treatment period defined in the virtual environment is closely related to how much consistency the designed bracket (B) positions are actually transferred to the patient with. In respect to this, the bracket transfer apparatus are inseparable parts of this invention.

In a model where malocclusion is made in the 108. step; the base distance (K) is closed in the virtual environment and the model with malocclusion is exported such that it has brackets (B) on it. However, there are not any area/angle which allows putting the bracket (B) in returnings to malocclusion in the teeth (D) taking excessive rotation. In the treatment period; when the bracket (B) comes to a position where it can be positioned to the aimed tooth (D), the bracket transfer apparatus providing the bracket (B) to be transferred to the tooth (D) are used. Transferring the brackets (B) to the teeth (D) is carried out by using a dental model which has no brackets (B) in the mouth in the disclosed method (100) of the invention. In another embodiment of the invention; inside of the mouth of a patient having brackets in his mouth, namely; whose treatment is started by positioning the brackets before with the known laboratory techniques is scanned with the intra oral scanner and this patient can be treated with the disclosed method (100) of the invention by following the method (100) steps for this model by entering it into the system in .stl or any other appropriate data format.

Production of customized arch wire and bracket transfer apparatus;

In the invention; there are a scanning unit which provides the dental model to be scanned and entered into system, a data storing unit in which the patient information and dental models can be kept. There are a server unit providing the dental model and information of the patient to be transferred remotely to a memory unit and a printing unit providing the data to be processed such that there are no data loss by using necessary protocols on the information provided by the server unit and memory unit. All operations are processed on the .stl point cloud. The printing unit is a unit that can give 2d or 3d data printout in any Cad format where the coordinates of the orthodontic wire are determined.

The manufacturing of the arch wire (AT) determined for the patient is carried out by a wire bending unit. The manufacturing of the bracket transfer apparatus is carried out by the 3D printer unit.

Shaping of the arch wire may be performed also with a machine/robot for using in the arch wire bending operations and which provides the opportunity of numerical control via a post-processor (importing) by preparing (exporting) data in ".dxf ' or in "any appropriate data format" for converting of each wire geometry in the part of separation of the treatment into phases (in the mode-1, mode-2, mode-3) which is formed in the virtual environment to a physical element.

The bracket transfer apparatus can be manufactured via (e.g. Objet 30-Orthodesk) a professional 3D printer (whose layer printing sensibility is 16 micron) by exporting the model (108) which returns back to the malocclusion with brackets on it. Said model can be used for the bracket transfer operations. "Bracket transfer apparatus" developed for the transfer of brackets (B) is also an inseparable part of this method due to said customized manufacturing. In the disclosed method (100) of the invention, the bracket transfer apparatus which are the inseparable parts of the invention are designed and the brackets (B) are transferred to the mouth of the patient via these transfer apparatus. The dentist/orthodontist applying the treatment is provided to transfer the brackets (B) to the patient by giving the apparatus to this person. Due to the problems like splitting, breaking or coming loose of the parts of the bracket transfer apparatus in the literature keeping the bracket slots (BS) during the bracket transfer operation to the mouth of the patient; an arch wire (AT) with a predetermined diameter; for example 0.017x0.025 inch or 0.018x0.025 inch (especially for the bracket system), in the part where the bracket transfer apparatus join the bracket slot may be used or all of the apparatus may be manufactured from metal in the invention instead of manufacturing all of them from a plastic material. The apparatus is not shown in the figures.

How many stages the treatment is finished in is decided depending on some factors such as the sex, age and genetics of the patient according to the values in the table of "final setup teeth movements" by the control unit coordinately with the doctor.

The invention is not limited with the disclosed embodiments above, a skilled person in the art can produce different embodiments of the invention easily. They should be evaluated within the scope of invention protection demanded with claims.

Claims

1. A method (100) for positioning the brackets (B) as near as possible to the teeth (D) by using the ordered teeth model of the patient characterized by the steps of; Obtaining the customized set-up geometry (0)

- Carrying out the orthodontic wire position in the virtual environment with the predetermined lengths from the mesial and distal parts of all brackets (B) used such that the bracket slots (BS) are assumed as center (101)

- Alignment of the other residual brackets (B) to the final- setup (teeth after treatment) teeth (D) and making the connections (Figure 3-1, Figure 3-2, Figure 3-3) (103) Calculating the angles and distances between the connection points in consequence of connecting of the arch wires (AT) to each other; if necessary, manipulating the wire lengths passing through the slots and the connection points (Figure 4-2, Figure 4-3) (104)

Controlling and if necessary revising the connection points of 1. order bends made at the horizontal axis according to the tooth (D) (105)

- Controlling and if necessary revising the connection points for twisting the arch wire

(AT) via the 3. order bends and adjusting the torque of the bracket (B) (107)

- Separating the treatment into phases (109)

The operations performed for obtaining the wire geometry via the control unit for mode-1 which is one of the phases of the treatment (110)

Applying the optimum tooth movements for mode-1 (110-a)

- Controlling the arch wire (AT) connection algorithms for mode-1 (110-c)

Applying the optimum tooth movements for mode-2 (111-a)

- Obtaining the arch wire (AT) geometry for mode-2 (111-d)

- Applying the optimum tooth movements for mode-3 (112-a)

- Obtaining the arch wire (AT) geometry for mode-3 (112-d).

2. A method (100) according to claim 1 characterized in that positioning a wire length of 4 mm into the bracket slot (BS) at the maxilla can be carried out taking a wire length determined as 2 mm from the mesial point (MN) and 2 mm from the distal point (DN) by taking the bracket slot (BS) as the center by the control unit in the computer environment in the 101. step.

3. A method (100) according to claim 2 characterized in that positioning a wire length into the bracket slot (BS) at the maxilla can be carried out taking the wire length determined from the mesial point (MN) and from the distal point (DN) by taking the bracket slot (BS) as the center by the control unit in the computer environment for positioning of a wire length of 2 to 5 mm into each bracket in the 101. step.

4. A method (100) according to claim 3 characterized in that positioning a wire length into the bracket slot (BS) at the mandibula can be carried out taking the wire length determined as 1.5 mm from the mesial point (MN) and 1.5 mm from the distal point (DN) by taking the bracket slot (BS) as the center by the control unit in the computer environment for positioning of a wire length of 3 mm into each bracket in the 101. step.

5. A method (100) according to claim 4 characterized in that positioning a wire length into the bracket slot (BS) at the mandibula can be carried out taking the wire length determined from the mesial point (MN) and from the distal point (DN) by taking the bracket slot (BS) as the center by the control unit in the computer environment for positioning of a wire length of 2 to 4 mm into each bracket in the 101. step.

6. A method (100) according to claim 5 characterized in that the sizes of the orthodontic wire passing through the slot are manipulated for each bracket (B) as a result of allowing of the arch width in the mandibula and maxilla, the values determined by the control unit can be changed.

7. A method (100) according to claim 6 characterized in that positioning the brackets (B) to all teeth (D) is carried out not by going through any reference plane, by aligning the brackets (B) one by one at the nearest position to the teeth (D) and then revisions which increase the comfort of patient and effectiveness of the treatment are carried out by the control unit in the 102. step.

8. A method (100) according to claim 7 characterized in that the arch wire (AT) geometry is revised by the control unit for the bracket (B) heights and angles (torque/angulation) while the connections of the arch wire (AT) are made in the 103. step.

9. A method (100) according to claim 8 characterized in that in the 104. step in the geometries that can be defined as zigzag or Z-bend, the wire connected for example with the angle of Z: 60.53 degrees can be connected with the distal point (15d") of the last position of the fifteenth bracket obtained by decreasing the length determined for the distal point (15d) of the fifteenth bracket from 2 mm to 1.6 mm by the control unit with a wider angle such as Z: 70 degrees on condition that the mesial point (15m) of the fifteenth bracket remains fixed or in other words, it is changed/manipulated in the wire geometry positioned with specific lengths as mentioned above.

10. A method (100) according to claim 9 characterized in that the connection of the wire is carried out by the control unit with the mesial point (16m") of the last position of the sixteenth bracket obtained by changing the position of the mesial point (16m) of the sixteenth bracket on condition that the distal point (16d) of the sixteenth bracket remains fixed in the 104. step with an angle of 70 degrees.

11. A method (100) according to claim 10 characterized in that positioning the brackets (B) on the same plane is not necessary differently from the straight wire technique due to the changeable order controls in the 105, 106 and 107. step and the brackets (B) are provided to be positioned as near as possible to the teeth (D) and these bends can be defined numerically by the control unit in the virtual environment.

12. A method (100) according to claim 11 characterized in that as a result of decreasing the base thickness (K) in the 105. step, 1. order bends is made by the control unit that the orthodontic strength losses are decreased to the minimum level by approaching to the resistance center of the tooth (D) and the period of the treatment becomes shorter by using the orthodontic strength moving the teeth (D) with maximum control and the injury and/or diseases it forms in the tongue are decreased to the minimum level.

13. A method (100) according to claim 12 characterized in that the controls of being connected of the arch wire (AT) geometry to each other continuously are carried out in the 1. order bends and if the angles between the mesial point (MN) and distal point (DN) are very sharp, for example 90 degrees, the angle values are decreased by the control unit in the 105. step.

14. A method (100) according to claim 13 characterized in that in the 106. step, in the 2. order bends; the controls of being connected of the arch wire (AT) geometry to each other continuously are carried out and instead of positioning the brackets (B) on the same plane, the bracket hooks (H) are moved away from the gingiva by the control unit by making the brackets (B) move at the vertical direction on the purpose of preventing the disturbance which is given to the patient by the bracket hooks (H) due to the hook problems in the set-up model or the spee curve of the seventh and sixth molars.

15. A method (100) according to claim 14 characterized in that 3. order bends are made by the control unit such that especially in the anterior region; the base thickness (K) is decreased by increasing the torque angle of the bracket (B) in the 107. step.

16. A method (100) according to claim 15 characterized in that in the 107. step in the 3. order bends; the controls of being connected of the arch wire (AT) geometry to each other continuously and giving torque to the bracket (B) are carried out by the control unit for positioning the bracket (B) to the tooth (D) at a predetermined distance for example a distance of 0.01-0.05 mm.

17. A method (100) according to claim 16 characterized for preparing the bracket transfer apparatus in that obtaining the model with malocclusion which has bracket (B) or does not have bracket and closing the base thickness (K) in the virtual environment in a model in which malocclusion is made are carried out by the control unit in the 108. step.

18. A method (100) according to claim 17 characterized in that determining how many mm/degree wire is necessary to be used for every module, defining arch wires (AT) and deciding how many stages the treatment is finished in are carried out by the control unit in the 109. step.

19. A method (100) according to claim 18 characterized in that the optimum teeth movements of the stages of mode 1, mode 2 and mode 3 which are appropriate for sex and age of the patient may be defined to teeth by the control unit in the 109. step.

20. A method (100) according to claim 19 characterized in that the values of the optimum teeth movements of the mode 1, mode 2 and mode 3 defined in the

109. step are predetermined values according to the age and sex and characterized by all macro programs or progies that can be used related to this.

21. A method (100) according to claim 20 characterized in that separation of the treatment into phases mentioned in the 109. step is carried out by the control unit acting coordinately with the doctor.

22. A method (100) according to claim 21 characterized in that how many stages the treatment is finished in is decided by the control unit depending on some factors such as the sex, age and genetics of the patient according to the values in the table of "final set-up teeth movements".

23. A method (100) according to claim 22 characterized in that inside of the mouth of a patient who has brackets (B) in his mouth, namely; whose treatment is started by positioning the brackets (B) before with the known laboratory techniques is scanned by a scanning unit (intra oral scanner) and the treatment of the patient is carried out.

24. A method (100) according to claim 23 characterized in that the dental model is entered into the system by scanning via a scanning unit, the patient information and dental models can be kept by a memory unit comprising a data storing unit, the dental model and patient information are transferred to the memory unit remotely by a server unit, the data printout as 2D or 3D in any Cad format is processed by a printing unit without any data loss by using necessary protocols on the information provided by the server unit and memory unit.

25. A method (100) according to claim 24 characterized in that the arch wire (AT) determined for the patient is manufactured by a wire bending unit.

26. A method (100) according to claim 25 characterized in that the bracket transfer apparatus are manufactured by the 3D printer unit.