`

`US 7,156,655 B2
`Page 2
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`U.S. PATENT DOCUMENTS
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`200210064748 Al"
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`512002 Chishti et al. ... ....... ...... 433124
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`812002
`6,431,870 Bl
`6,457,972 Bl* 10/2002
`1012002
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`6,471,512 Bl
`10/2002
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`Sachdeva .... ................ 4331213
`Chishli el al.
`... ... .. ..... ... 433124
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`.. ........... 433/24
`Sachdeva et al ......... ..... 433124
`Sachdeva .... .............. .. 7021167
`Sachdeva et al . ........ ... .. 433/24
`Sachdeva .................. .. ... 705/1
`Miller et al. .. ............... . 433/24
`Eiffcrt et al. .............. . 6001300
`Rubber! et al. ........... .... 433/24
`Rubber! et al. .... ....... .. .. 433/24
`Chapoulaud el al . ..... .... 433/24
`
`OTHER PUBLICATIONS
`
`Voker Blanz, et al., A Mo1phab/e Model For the Synthesis of 3D
`Faces , amax-Planck-lnstitut fiir biologische Kybernetik, Tiibingen,
`Germany, 1999.
`S.M. Yamany and A.A. Farag, "A System for Htunan Jaw Modeling
`Using Intra-Oral Images" in Proc. IEEE Eng. Med. Biol. Soc.
`(EMBS) Co11f, vol. 20, Hong Kong, pp. 563-566, Ocl. 1998.
`S.M. Ya.many, A.A. Farag, David Tasman, A.G. Farman, "A 3-D
`Reconstruction System for the Human Jaw Using a Sequence of
`Optical Images," IEEE Tra11saclio11s on Medical Imaging, vol. 19,
`No. 5, pp. 538-547, May 2000.
`* cited by examiner
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`U.S. Patent
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`Jan. 2, 2007
`
`Sheet 13 of 115
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`US 7,156,655 B2
`
`FIG.11A
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`U.S. Patent
`
`Jan.2,2007
`
`Sheet 16 of 115
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`US 7,156,655 B2
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`FIG.16A
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`U.S. Patent
`
`Jan.2,2007
`
`Sheet 76 of 115
`
`US 7,156,655 B2
`
`FIG. 59
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`~ I 1. Open note editor
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`m 3. Aesthetic occlusal plane lower Jaw
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`2. Display lower jaw
`3. Front view
`4. Left view
`5. Topview
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`7. Right view
`8. Back view
`9. Right lingual view
`10. Left lingual view
`11. Display tooth models of setup
`12. Display tooth models of malocclusion
`13. Display gingiva models of setup
`14. Display gingiva models of malocclusion
`15. Display treatment occlusal plane
`16. Display graph paper plane
`17. Display clipping plane
`18. Display ideal contact points
`19. Display marginal ridges
`20. Display lateral ceph image
`21. Display slide line (Setup arch form)
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`us 7,156,655 82
`
`1
`METHOD AND SYSTEM FOR
`COMPREHENSIVE E\".ALUATION OF
`ORTHODONTIC TREATMENT USING
`UNIFIED WORKSTATION
`
`RELATED APPLICATIONS
`
`'
`BACKGROUND OF THE INVENTION
`
`50
`
`TI1is is a continuation-in-part of application Ser. No.
`10/428,461 filed May 2, 2003, which is a conlinualion-in(cid:173)
`part of application Ser. No. 09/834,412, filed Apr. 13, 2001,
`now issued as U.S. Pat. No. 6,632,089. TI1e entire contents
`of both related applications are incorporated by reference
`herein.
`
`2
`short-cut, relying predominantly on their intuition to select
`a treatment plan. for example, the diagnosis and treatment
`planning is often done by the practitioner on a sheet of
`acetate over !he X-rays. All of these factors frequently
`5 contribute towards trial and error, hit-and-miss, lengthy and
`inefficient treatment plans that require numerous mid-course
`adjustments. While at the beginning of treatment things
`generally run well as all teeth start to move at least into the
`right direction, al lhe end of!rea!menl a lo! of lime is los! by
`1 o adaptations and corrections required due to the fact that the
`end result has not been properly plaimed at any point of time.
`By and large, this approach lacks reliability, reproducibility
`and precision. More over, there is no comprehensive way
`available lo a practitioner lo stage and simulate the treatmenl
`15 process in advance of the actual implementation to avoid the
`often hidden pitfalls. And the patient has no choice ai1d does
`A. Field of the Invention
`not know that treatment time could be significai1tly reduced
`TI1is invention relates to the field of computerized tech(cid:173)
`if proper plaiming was done.
`niques for orthodontic treatment planning for human
`Jn recent years, computer-based approaches have been
`patients. More particularly, the invention is directed to an
`20 proposed for aiding orthodontists in their practice. However,
`interactive workstation and associated computerized tech(cid:173)
`these approaches are limited to diagnosis and treatment
`niques for facilitating integration of various tasks performed
`plam1ing of craniofacial structures, including the straighten(cid:173)
`in planning treatment for orthodontic patients, and more
`ing of teeth. See Andreiko, U.S. Pat. No. 6,015,289; Snow,
`particularly evaluation of a proposed treatment plan.
`U.S. Pal. No. 6,068,482; Kopelmann et al., U.S. Pal. No.
`B. Description of Related Art
`25 6,099,314; Doyle, et al., U.S. Pat. No. 5,879,158; Wu et al.,
`'l11e lradi!ional process of diagnosis and Lrealment plan(cid:173)
`U.S. Pat. No. 5,338,198, and Chisti et al., U.S. Pat. Nos.
`ning for a patient with orthodontic problems or disease
`5,975,893 and 6,227,850, the contents of each of which is
`typically consists of the practitioner obtaining clinical his(cid:173)
`incorporated by reference herein. Also see imaging and
`tory, medical history, dental history, and orthodontic history
`diagnostic software and other related products marketed by
`JO Dolphin Imaging, 6641 Independence Avenue, Cai1oga Park,
`of the patient supplemented by 2D photographs, 2D radio(cid:173)
`graphic images, CT scans, 2D and 3D scanned images,
`Calif. 91303-2944.
`ultrasonic scanned images, and in general non-invasive and
`A method for generation of a 3D model of the dentition
`sometimes invasive images, plus video, audio, and a variety
`from an in-vivo scan of t11e patient, and interactive com(cid:173)
`of communication records. Additionally, physical models,
`puter-based treatment planning for orthodontic patients, is
`such as made from plaster of paris, of the patient's teeth are 35
`described in published PCT patent application of OraMctrix,
`created from Lhe impressions taken of the patient's upper
`Inc., the assignee of this invention, publication no. WO
`and lower jaws. Such models are manually converted into
`01/80761, the contents of which are incorporated by refer(cid:173)
`teeth drawings by projecting teeth on drawing paper. Thus,
`ence herein.
`there is a large volume of images and data involved in the
`Other background references related to capturing three
`diagnosis and treatment planning process. Furthennore, the 40
`dimensional models of dentition and associated crai1iofacial
`information may require conversion from one fonn to
`structures include S. M. Yamai1y and A. A. Farag, "A System
`another and selective reduction before it could become
`for Humai1 Jaw Modeling Using Intra-Oral Images" in Proc.
`usefol. There are some computerized tools available to aid
`IEEE Eng. Med. Biol. Soc. (E1\4BS) Conj, Vol. 20, Hong
`the practitioner in these data conversion and reduction steps,
`Kong, October 1998, pp. 563-566; and M. Yamany, A. A.
`for example to convert cephalometric x-rays (i.e., 2 dimen- 45
`Farag, David Tasman, A.G. Farman, "A3-D Reconstruction
`sional x-ray photographs showing a lateral view of the head
`System for the Human Jaw Using a Sequence of Optical
`and jaws, including teeth) into points of interest with respect
`Images," IEEE Transactions on Medical Imaging, Vol. 19,
`to soft tissue, hard tissue, etc., but they are limited in their
`No. 5, May 2000, pp. 538-547. The contents of these
`functionalities and scope. Even then, there is a fairly sub(cid:173)
`references are incorporated by reference herein.
`stantial amount of manual work involved in these steps.
`TI1e technical literature farther includes a body of litera(cid:173)
`Additionally, a number of measurements, e.g., available
`ture describing the creation of 3D models of faces from
`photographs, ai1d computerized facial animation and mor(cid:173)
`space between teeth, are also often done manually. Gener(cid:173)
`phable modeling of faces. See, e.g., Pighin el al., Synthe(cid:173)
`ally, these steps are time consuming and prone to inherent
`sizing Realistic Facial Expression from Photographs, Com(cid:173)
`inaccuracies. Furthermore, the practitioner has to contend
`with the biological interdependencies within the patient, 55
`puter Graphics Proceedings SIGGRAPH '98, pp. 78-94
`(1998); Pighin et aL Realistic Facial Animation Using
`which introduces constraints eliminating certain treatment
`Image-based 3D Morphing, Technical Report no. UW-CSE-
`options that would otherwise be acceptable, between the soft
`97-01-03, University of Washington (May 9, 1997); and
`tissue, the hard tissue, and the teeth. There is lack of an
`inlegraled platform which a practitioner could utilize lo
`Blai1tz ct al., A Morphable Model.for The Synthesis of3D
`60 Faces, Computer Graphics Proceedings SIGGRAPH '99
`filter-out non-practicable treatment options.
`(August, 1999). The contents of these references are incor(cid:173)
`Consequently, the practitioner is left to mental visualiza(cid:173)
`porated by reference herein.
`tion, chance process to select the treatment course that
`'lbe presenl invention is directed lo an effective, com(cid:173)
`would supposedly work. Furthermore, lhe diagnosis process
`puter-based, integrated and interactive orthodontic treatment
`is some-what ad-hoc and the effectiveness of the treatment
`plamling system that provides t11e necessary tools to allow
`depends heavily upon the practitioner's level of experience. 65
`the orthodontist to quickly and efficiently design a treatment
`Often, due to the complexities of the detailed steps and the
`plan for a patient. The present invention also provides a
`time consuming nature of them, some practitioners take a
`0118
`
`

`

`US 7,156,655 B2
`
`3
`treatment planning system in which the orthodontist-derived
`parameters for the treatment can be translated into a design
`of the treatment. The preferred embodiment integrates 20
`and 3D images lo drive effective treatment planning. Intel(cid:173)
`ligence is built into the system whereby predefined thern(cid:173)
`peutic strategies, sucl1 as extraction, intetproximal reduc(cid:173)
`tion. distal movement of molars, can have associated value
`sets predefined by the clinician that are used to drive the
`appropriate set-up automatically. Such predefined therapeu-
`tic strategics could be entered via convenient user interface 10
`tools, such as by templates.
`TI1e treatment design as described herein also allows for
`real-time conununication of the treatment plan to occur with
`the patient, or transmitted over a communications link and
`shared with a colleague or remote appliance manufacturing 15
`facility. Alternatively, the treatment planning can be per(cid:173)
`formed remotely and a digital treatment plan sent to the
`interactive modification, or
`orthodontist
`for
`review,
`approval.
`
`SUMMARY OF THE INVENTION
`
`4
`In a related aspect, a computerized method of planning
`treatment for an orthodontic patient is provided, comprising
`the step of providing an orthodontic treatment planning
`workstation comprising a computing platform having a
`graphical user interface, a processor and a computer stornge
`medium containing digitized records pertaining to a patient.
`The digitized records including image data. TI1e workstation
`includes software instructions providing graphical user
`interface tools for access to the digitized records and for
`planning orthodontic treatment of a patient. The method
`continues with a step of using the workstation to generate a
`proposed set-up for treating the patient, the proposed set-up
`comprising a proposed three-dimensional position of the
`teeth of the upper and lower arches of the patient in a
`post-treatment condition. TI1e method further continues with
`a step of conducting an evaluation of the proposed set-up,
`the evaluation prompted by computer instmctions providing
`a series of predetermined steps for guiding a user to inter(cid:173)
`actively evaluate the proposed set-up. 'll1e predetermined
`20 steps comprise steps for 1) evaluation of said proposed
`set-up against boundary conditions for treatment of the
`patient, the boundary conditions including a least a 111.idline
`and an occlusal plane, and 2) evaluation of whether the tooth
`positions in both arches, and the inter-arch relalionship, of
`25 the proposed set-up are essentially ideal for treatment of the
`patient.
`
`In a first aspect, an orthodontic treatment planning work(cid:173)
`station is provided comprising a computing platform having
`a graphical user interface, a processor and a computer
`storage medium containing digitized records pertaining to a
`patient. TI1e digitized records include image data. The com(cid:173)
`puter storage medium further ii1cludes a set of so.fiware
`instn1ctions providing graphical llSer interface tools for
`providing a user witb access lo the digitized records for 30
`planning orthodontic treatment of a pulicnt. ·111e set of
`instructions include:
`a) treatment plan instmctions providing graphical user
`interface tools for allowing the user to interactively
`create a proposed set-up for treatment oflhe patient, the 35
`proposed set-up comprising a proposed three-dimen(cid:173)
`sional position of the teeth of the upper and lower
`arches of the patient in a post-treauuent condition; and
`b) evaluation instructions providing a series of predeter(cid:173)
`mined steps for guiding a user to interactively evaluate 40
`the proposed set-up. The predetem1ined steps comprise
`steps for 1) evaluation of the proposed set-up against
`boundary conditions for treatment of the patient, the
`boundary conditions including a least a midline, an
`occlusal plane, a fixed reference object (e.g. tooth or 45
`other anatomical structure that remains fixed) and an
`arch fonn, and 2) evaluation of whether the tooth
`positions in both arches, and the inter-arch relationship,
`of the proposed set-up are essentially ideal for treat(cid:173)
`ment of the patient, that is, correspond to the treatment 50
`goals of the patient. As used herein, the phrase "essen(cid:173)
`tially ideal for treatment of the patient" means that the
`proposed set up satisfies the practitioner's objectives or
`goals for treatment of the patient, in other words, the
`proposed set up meets the objectives for treatment of 55
`the patient, such as interarch relationship, tooth posi(cid:173)
`tion, etc., midline placement, overbite and overjet,
`whatever they may be for a given patient. TI1is inven(cid:173)
`tion recognizes that there may be more than one
`possible "ideal" setu.P for a given patient, as different 60
`practitioners may arrive at tmique solutions for treat(cid:173)
`ment for the patient, and that for any given practitioner
`there may be more lhan one proposed setup thal meets
`the objectives for treatment of the patient, any one of
`which would satisfy the term "essentially ideal for 65
`treatment of the patient." The term "ideal" is thus not
`used in an absolute sense of the word.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`Presently preferred embodiments of the invention are
`described below in reference lo the appended drawings,
`wherein like reference numerals refer to like elements in the
`various views, and in which:
`FIG. 1 is block diagram of a system for creating a
`three-din1ensional virtual patient model and for diagnosis
`and planning treatment of the patient.
`FIG. 2 is a flow chart showing a method of three(cid:173)
`dimensional face creation from scanning systems, which
`may be executed in software in the computer system of FIG.
`1.
`
`FIG. 3 is a flow chart showing an alternative method of
`three-dimensional face model face creation using a plurality
`of possible input image or data fonnats, which may be
`executed in software in the computer system of FIG. 1.
`FIG. 4 is a flow chart showing a method of creating a
`complete textured three-dimensional model of teeth.
`FIGS. SA-SE show a technique for combining 20 color
`photographs with 30 tooth data to created textured (colored)
`30 tooth models.
`FIG. 6 is a screen shot of the user interface of FIG. 1
`showing a three-dimensional face model and a three-dimen(cid:173)
`sional tooth model, in separate coordinate systems (i.e., prior
`to registration or superposition of the two relative to each
`other). FIG. 6 also shows a plurality of icons, which, when
`activated, provide tools for manipulating the models shown
`in the Figure.
`FIG. 7 is a screen shot showing one possible method of
`placement of the lower jaw 30 data into the face data
`coordinate system using corresponding points that are com(cid:173)
`mon to each data set.
`FIG. 8 is a screen shot showing the face data and skull
`data obtained from a CT scan in a common coordinate
`system.
`FIG. 9 is a screen shot showing face data and skull data
`superimposed on X-ray data obtained from the patient.
`FIG.10 is a screen shot showing the superposition of skull
`and face data with X-Ray data.
`0119
`
`

`

`US 7,156,655 B2
`
`5
`FIGS. 11A-11E are a series of views of a digital model of
`an orthodontic patient obtained, for example from CT scan,
`photographs, or intra-oral scamling with a hand-held 3D
`scanner.
`FIG. 12 is a diagram illustrating a technique for scaling
`orthodontic data obtained from an imaging device, such as
`a camera, to the actual anatomy of the patient.
`FIG. 13 is a diagran1 showing an alternative scaling
`method similar lo that shown in FIG. 12.
`FIG.14 is an illustration of an X-ray ofa set of teeth and
`adjacent bone.
`FIG. 15 is an illustration of scaling the X-ray data of the
`tooth to the actual size of the tooth to produce a scaled digital
`model of the tooth.
`FIGS. 16A-16C arc an illustration of a method of deter- 15
`milling orientation reference points in a digital model of a
`patient.
`FIG. 17 is an illustration of a method of mapping the
`orientation reference points of FIGS. 16A-16C to a three(cid:173)
`dimcnsional coordinate system.
`FIG. 18 is an illustration of a method of mapping the
`orientation reference points of FIGS . 16A-16C to a three(cid:173)
`dimensional coordinate system.
`FIG. 19 is a more detailed block diagram of the treatment
`plaruling software executed by the workstation of FIG. 1.
`PIG. 20 is an illustration of the integration of the patient
`data acquisition, treatment planning and appliance design
`f1mctions that are facilitated by a preferred embodiment of
`the urufied workstation.
`FIGS. 21-58 illustrate screen shots from the workstation
`of FIG. 1, showing various treatment plruming fean1res that
`are provided by the treatment plamling software of FIG. 19
`in a presently preferred embodiment.
`FIG. 59 is a diagram showing the types of evahrntion that
`cru1 be performed in tills invention.
`PIGS. 60- 91 illustrate various screen shots on the work(cid:173)
`station of FIG. 1 (or on a remote workstation), showing
`various proposed set-up evaluation features that are pro(cid:173)
`vided by the evaluation instructions executed in the work(cid:173)
`station in a preferred embodiment.
`FIG. 92-94 are an index of icons that may be provided to
`the user on the dis