(12) United States Patent
`Rubbert et al.
`
`(10) Patent N0.:
`(45) Date of Patent:
`
`US 6,632,089 B2
`Oct. 14, 2003
`
`US006632089B2
`
`(54)
`
`(75)
`
`(73)
`(*)
`
`(21)
`(22)
`(65)
`
`(63)
`
`(51)
`(52)
`(58)
`
`(56)
`
`ORTHODONTIC TREATMENT PLANNING
`WITH USER-SPECIFIED SIMULATION OF
`TOOTH MOVEMENT
`
`Inventors: Riidger Rubbert, Berlin (DE); Thomas
`Weise, Berlin (DE); Rohit Sachdeva,
`Plano, TX (US); Hans Imgrund, Berlin
`(DE); Peer Sporbert, Berlin (DE);
`Mario Leichner, Hohen Neuendorf
`(DE); Jens Troeger, Berlin (DE);
`Dimitrij Kouzian, Berlin (DE);
`Stephan Maetzel, Berlin (DE)
`
`5,975,893 A 11/1999 Chishti et al. ............... .. 433/6
`6,227,850 B1
`5/2001 Chishti et al. .............. .. 433/24
`6,227,851 B1
`5/2001 Chishti et al.
`433/24
`6,299,440 B1
`10/2001 Phan et al. .... ..
`433/24
`6,318,994 B1
`11/2001 Chishti et al. .... ..
`433/24
`6,334,853 B1
`1/2002 Kopelman et al. ........ .. 600/590
`6,371,761 B1
`4/2002 Cheang et al. .............. .. 433/24
`6,386,878 B1
`5/2002 Pavlovskaia et al. ..... .. 433/215
`2002/0025503 A1
`2/2002 Chapoulaud et al. ....... .. 433/24
`2002/0028417 A1
`3/2002 Chapoulaud et al. ....... .. 433/24
`
`FOREIGN PATENT DOCUMENTS
`
`EP
`
`0 250 993
`
`* 6/1987
`
`Assignee: OraMetrix, Inc., Dallas, TX (US)
`
`* cited by examiner
`
`Notice:
`
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`U.S.C. 154(b) by 187 days.
`
`Appl. No.: 09/834,412
`Filed:
`Apr. 13, 2001
`
`Prior Publication Data
`
`US 2002/0010568 A1 Jan. 24, 2002
`
`Related US. Application Data
`
`Continuation-in-part of application No. 09/560,640, ?led on
`Apr. 28, 2000, which is a continuation-in-part of application
`No. 09/451,609, ?led on Nov. 30, 1999, now Pat. No.
`6,250,918.
`
`
`
`Int. Cl.7 US. Cl. ............... ..
`
`Field of Search
`
`A61C 3/00
`
`............... .. 433/24
`
`433/24, 25, 72,
`433/213; 700/98
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`5,011,405 A
`5,338,198 A
`5,447,432 A
`5,879,158 A
`
`
`
`4/1991 Lemchen 8/1994 Wu et al. .... ..
`
`433/24
`433/213
`
`433/24
`9/1995 Andreiko et al. .
`3/1999 Doyle et al. ................ .. 433/24
`
`Primary Examiner—Todd E. Manahan
`(74) Attorney, Agent, or Firm—McDonnell Boehnen
`Hulbert & Berghoff
`(57)
`
`ABSTRACT
`
`An interactive, software-based treatment planning method to
`correct a malocclusion is described. The method can be
`performed on an orthodontic Workstation in a clinic or at a
`remote location such as a lab or precision appliance manu
`facturing center. The Workstation stores a virtual three
`dimensional model of the dentition of a patient and patient
`records. The virtual model is manipulated by the user to
`de?ne a target situation for the patient, including a target
`archform and individual tooth positions in the archform.
`Parameters for an orthodontic appliance, such as the location
`of orthodontic brackets and resulting shape of an orthodontic
`archWire, are obtained from the simulation of tooth move
`ment to the target situation and the placement position of
`virtual brackets. The treatment planning can also be
`executed remotely by a precision appliance service center
`having access to the virtual model of the dentition. In the
`latter situation, the proposed treatment plan is sent to the
`clinic for revieW, and modi?cation or approval by the
`orthodontist. The method is suitable for other orthodontic
`appliance systems, including removable appliances such as
`transparent aligning trays.
`
`45 Claims, 28 Drawing Sheets
`
`3SHAPE EXHIBIT 1013
`3Shape v. Align
`
`

`

`U.S. Patent
`
`0a. 14, 2003
`
`Sheet 1 0f 28
`
`US 6,632, 089 B2
`
`FIG. 1
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`Oct. 14, 2003
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`U.S. Patent
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`0a. 14, 2003
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`Sheet 4 0f 28
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`Sheet 28 of 28
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`US 6,632,089 B2
`
`1
`ORTHODONTIC TREATMENT PLANNING
`WITH USER-SPECIFIED SIMULATION OF
`TOOTH MOVEMENT
`
`CROSS-REFERENCE TO RELATED
`APPLICATIONS
`
`This application is a continuation-in-part application of
`the following pending U.S. patent applications:
`Ser. No. 09/560,640 filed Apr. 28, 2000 pending, whichis
`a continuation in part of Ser. No. 09/451,609 filed Nov.
`30, 1999 now US. Pat. No. 6,250,918. The entire
`contents of each of the above-reference patent appli-
`cations is incorporated by reference herein.
`
`NOTICE REGARDING COPYRIGHT
`
`A portion of the disclosure of this patent document
`contains material which is subject to copyright protection.
`The copyright owner has no objection to the facsimile
`reproduction by anyoneofthe patent disclosure, at it appears
`in the Patent and Trademark Office files or records, but
`otherwise reserves all copyright rights whatsoever.
`
`BACKGROUND OF THE INVENTION
`
`A. Field of the Invention
`
`This invention relates generally to the field of computer-
`interactive methods for diagnosis, care and treatment
`planning, therapeutics and treatment monitoring in the medi-
`cal arena, including orthodontics. The invention also relates
`to real-time computer-interactive communication between a
`medical practitioner and his or her patient regarding
`diagnosis, care and treatment planning,
`therapeutics and
`treatment monitoring, and between a medical practitioner
`and a remotely located entities regarding these matters.
`In the illustrated embodiment, the invention relates to a
`computerized and interactive method of planning orthodon-
`tic treatment for a patient suffering from a malocclusion. In
`the method,the patient’s teeth are represented in a computer
`as three-dimensional virtual objects. The orthodontist may
`simulate various types of tooth movement and appliances,
`analyze the simulation, and thereby explore possible treat-
`ment options and appliance designs,prior to initiating treat-
`ment.
`
`B. Description of Related Art
`In orthodontics, a patient suffering from a malocclusionis
`typically treated by bonding brackets to the surface of the
`patient’s teeth. The brackets have slots for receiving an
`archwire. The bracket-archwire interaction governs forces
`applied to the teeth and defines the desired direction of tooth
`movement. Typically, the bends in the wire are made manu-
`ally by the orthodontist. During the course of treatment, the
`movement of the teeth is monitored. Corrections to the
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`bracket position and/or wire shape are made manually by the
`orthodontist.
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`55
`
`The key to efficiency in treatment and maximum quality
`in results is a realistic simulation of the treatment process.
`Today’s orthodontists have the possibility of taking plaster
`models of the upper and lower jaw, cutting the model into
`single tooth models and sticking these tooth models into a
`waxbed,lining them up in the desired position, the so-called
`set-up. This approach allowsfor reaching a perfect occlusion
`without any guessing. The next step is to bond a bracket at
`every tooth model. This would tell
`the orthodontist
`the
`geometry of the wire to run through the bracket slots to
`receive exactly this result. The next step involvesthe trans-
`fer of the bracket position to the original malocclusion
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`65
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`2
`model. To make sure that the brackets will be bonded at
`exactly this position at the real patient’s teeth, small tem-
`plates for every tooth would have to be fabricated that fit
`over the bracket and a relevant part of the tooth and allow
`for reliable placement of the bracket on the patient’s teeth.
`To increaseefficiency of the bonding process, another option
`would be to place each single bracket onto a model of the
`malocclusion and then fabricate one single transfer tray per
`jaw that covers all brackets and relevant portions of every
`tooth. Using such a transfer tray guarantees a very quick and
`yet precise bonding using indirect bonding.
`However,it is obvious that such an approach requires an
`extreme amountof time and labor and thusis too costly, and
`this is the reason whyit is not practiced widely. The normal
`orthodontist does not fabricate set-ups; he places the brack-
`ets directly on the patient’s teeth to the best of his
`knowledge,uses an off-the-shelf wire and hopesfor the best.
`There is no way to confirm whether the brackets are placed
`correctly; and misplacement of the bracket will change the
`direction and/or magnitude of the forces imparted on the
`teeth. While at the beginning of treatment things generally
`run well as all teeth start to move at least into the right
`direction, at the end of treatment a lot of time is lost by
`adaptations and corrections required due to the fact that the
`end result has not been properly plannedat any pointof time.
`For the orthodontist
`this is still preferable over the lab
`process described above, as the efforts for the lab process
`would still exceed the efforts that he has to put in during
`treatment. An the patient has no choice and does not know
`the treatment time could be significantly reduced if proper
`planning was done.
`U.S. Pat. No. 5,431,562 to Andreiko et al. describes a
`computerized, appliance-driven approach to orthodontics. In
`this method,
`first certain shape information of teeth is
`acquired. A uniplanar target arcform is calculated from the
`shape information. The shape of customized bracket slots,
`the bracket base, and the shape of the orthodontic archwire,
`are calculated in accordance with a mathematically-derived
`target archform. The goal of the Andreikoet al. methodis to
`give moe predictablity, standardization, and certainty to
`orthodontics by replacing the human elementin orthodontic
`appliance design with a deterministic, mathematical com-
`putation of a target archform and appliance design. Hence
`the °562 patent teaches away from an interactive, computer-
`based system in which the orthodontist
`remains fully
`involved in patient diagnosis, appliance design, and treat-
`ment planning and monitoring.
`More recently,
`in the late 1990’s Align Technologies
`began offering transparent, removable aligning devices as a
`new treatment modality in orthodontics. In this system, a
`plaster modelof the dentition of the patent is obtained by the
`orthodontist and shipped to a remote appliance manufactur-
`ing center, where it is scanned with a laser. A computer
`modelof the dentition in a target situation is generated at the
`appliance manufacturing center and made available for
`viewing to the orthodontist over the Internet. The orthodon-
`tist indicates changes they wish to maketo individual tooth
`positions. Later, another virtual model is provided over the
`Internet and the orthodontist reviews the revised model, and
`indicates any further changes. After several such iterations,
`the target situation is agreed upon. A series of removable
`aligning devices or shells are manufactured and delivered to
`the orthodontist. The shells,
`in theory, will move the
`patient’s teeth to the desired or target position.
`The art has lacked an effective, computer-based interac-
`tive orthodontic treatment planning system that provides the
`necessary tools to allow the orthodontist to quickly and
`
`

`

`US 6,632,089 B2
`
`3
`efficiently design a treatment plan for a patient. The art has
`also lacked a treatment planning system in which the
`orthodontist-derived parameters for the treatment can be
`translated into a design of an orthodontic appliance in real
`time, while the patient is in the chair. Real-time appliance
`design as described herein also allows for real-time com-
`munication of the treatment plan or appliance design to
`occur with the patient, or transmitted over a communications
`link and shared with a colleague or remote appliance manu-
`facturing facility. Alternatively, the treatment planning can
`be performed remotely and a digital treatment plan sent to
`the orthodontist
`for review,
`interactive modification, or
`approval.
`
`SUMMARYOF THE INVENTION
`
`4
`tooth objects. A method of obtaining the tooth objects from
`a scan of teeth, and obtaining other virtual objects of
`associated anatomicalstructures, e.g., gums, roots and bone
`is described. When the teeth are separated from each other
`and from the gums, they can be individually manipulated.
`Thus,
`the individual
`tooth objects can be individually
`selected and movedrelative to other teeth in the set of virtual
`tooth objects. This feature permits individual, customized
`tooth positioning on a tooth by tooth basis. These position-
`ing can be in terms or angular rotation about three axis, or
`translation in transverse, sagittal or coronal planes.
`Additionally, various measurementfeatures are provided for
`quantifying the amount of movement.
`Oneof the primary tools in the treatment planning appa-
`15
`ratus is the selection and customizationor a desiredortarget
`Inafirst aspect of the invention, apparatus for treatment
`archform. Again, because the teeth are individual
`tooth
`planning for an orthodontic patient is provided. The appa-
`objects, they can be moved independently of each other to
`ratus can be considered an interactive, computer-based com-
`define an ideal arch. This developmentofthe target archform
`puter aided design and computer aided manufacturing
`could be calculated using interpolation or cubic spline
`(CAD/CAM) system for orthodontics. The apparatus is
`algorithms. Alternatively, it can be customized by the user
`highly interactive, in that it provides the orthodontist with
`specifying a type of archform (e.g, Roth), and the tooth are
`the opportunity to both observe and analyze the current stage
`moved onto that archform or some modification of that
`of the patient’s condition and develop and specify a target or
`desired stage. A shortest direct path of tooth movement to
`the target stage can also be determined. Further, the appa-
`ratus provides for simulation of tooth movement between
`current and target stages.
`In its broader aspects, the apparatus comprises a work-
`station having a processing unit and a display, and a memory
`storing a virtual, complete three-dimensional model repre-
`senting the dentition of a patient. The virtual
`three-
`dimensional model can be obtained from one of several
`possible sources; in the preferred embodimentit is arrived at
`from a scanning of the dentition. The apparatus further
`includes software executable by the processing unit that
`accesses the model and displays the model on the display of
`the workstation. The software further includes navigation
`tools, e.g., typed commands,icons and/or graphical devices
`superimposed on the displayed model, that enables a user to
`manipulate the model on the display and simulate the
`movementof at least one tooth in the modelrelative to other
`teeth in the model in three-dimensional space, and quantify
`the amount of movementprecisely. This simulation can be
`used, for example, to design a particular target situation for
`the patient.
`The development of a unique target situation for the
`patient has utility in a variety of different orthodontic
`appliances, including an approach based on off-the-shelf or
`generic brackets and a custom orthodontic archwire. The
`scope of the inventionis sufficient to encompass other types
`of appliances, such as an approach based on customized
`brackets, retainers, or the removable aligning devices men-
`tioned earlier. In a bracket embodiment, the memory con-
`tains a library of virtual,
`three-dimensional orthodontic
`brackets. The software permits a user to access the virtual
`brackets through a suitable screen display, and place the
`virtual brackets on the virtual model of the dentition of the
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`patient. This bracket bonding position can be customized on
`a tooth by tooth basis to suit individual patient anatomy.
`Because the tooth models, brackets and archwire are indi-
`vidual objects, and stored as such in memory, the treatment
`planning apparatus can simultaneously display the virtual
`brackets, the archwire and the virtual model of the dentition,
`or some lesser combination, such as just the brackets, just
`the dentition, or the brackets and the archwire but not the
`teeth. The same holds true with other appliance systems.
`In a preferred embodiment,
`the virtual model of teeth
`comprises a set of virtual,
`individual
`three-dimensional
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`archform. The archform can be shaped to meet the anatomi-
`cal constraints of the patient. After the initial archform is
`designed,
`the user can again position the teeth on the
`archform as they deem appropriate on a tooth by tooth basis.
`The treatment planning software thus enables the movement
`of the virtual tooth objects onto an archform which may
`represent,at least in part, a proposed treatment objective for
`the patient.
`Numerous other features are possible with the treatment
`planning software, including movement of the teeth with
`respect to the other teeth in the archform, changing the
`position of the virtual brackets and the teeth with respect to
`each other, or opposing teeth with respect to the selected
`archform. Custom archwire bends can be simulated to
`provide additional corrections. Bonding corrections at the
`bracket-tooth interface are also possible.
`In another aspect of the invention, a method is provided
`for digital treatment planning for an orthodontic patient on
`a workstation having a processing unit, a user interface
`including a display and software executable by the process-
`ing unit. The method comprises the steps of obtaining and
`storing a three-dimensional virtual model of teeth represent-
`ing the dentition of the patient in a current or observed
`situation. The virtual modelis displayed on the display. The
`method further includes the step of moving the position of
`teeth in the virtual model relative to each otherso asto place
`the teeth of the virtual model into a target situation and
`displaying the virtual model with the teeth moved to the
`target situation to the user. Parameters for an orthodontic
`appliance to move the patient’s teeth from the current
`situation to the target situation can be derived from the
`virtual model andthe target situation. For example,if virtual
`brackets are placed on the teeth, their location in the target
`situation can dictate the design of an archwire to move the
`teeth to the target situation.
`In a preferred embodiment, the method includes the step
`of providing screen displays on the display enabling a user
`of the workstation to operate the user interface so as to place
`virtual three-dimensional objects representing orthodontic
`appliances, e.g., brackets, onto the surface of teeth in the
`virtual model. A library of the virtual brackets can be stored
`in memory and a landmarking procedure used to place the
`brackets on the teeth at the desired location. Anatomical
`considerations may dictate movementof the brackets from
`their originally selected position to a new position.
`
`

`

`US 6,632,089 B2
`
`5
`tools
`the software provides navigational
`Accordingly,
`enabling a user to changethe position of the brackets relative
`to the teeth.
`
`The treatment planning system is based on individual
`tooth objects which can be moved to any position in three
`dimensional space. They can be moved in several ways—by
`direct user specified movement, and by adding an object
`comprising an orthodontic appliance and changing the con-
`figuration of the appliance to cause the teeth to move. For
`example brackets can be virtually bondedto the teeth and the
`position of the brackets changed in three dimensions to
`move the teeth. Alternatively, an archwire shape can be
`defined which fits into the slots i the brackets. Movementof
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`the archwire can be simulated, resulting in a simulation of
`tooth movement.
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`15
`
`The treatment planning software includes features
`enabling more accurate diagnosis. For one thing, the virtual
`model of the dentition can be manipulated in three dimen-
`sions at will, resulting in complete visual assessment of the
`model. Measurementtools are also provided by which the
`orthodontist can determine the distance between any two
`points on the model. This allows the user to quantify the
`patient’s morphology both at initial and at target stages.
`Thus, treatment progress, proposed changes in appliance
`design, or tooth movement can be quantified precisely. By
`measuring the differences and changes in morphology dur-
`ing the care cycle, the orthodontist can quickly and accu-
`rately assess patient treatment. Changes in treatment can be
`made early on. Theresult is shorter treatment times (and the
`ability for the orthodontist to service more patients per year).
`The treatment planning system incorporates virtual
`objects comprising orthodontic appliances that may be used
`to treat the patient. The invention provides for design of
`complete appliance systems and simulation of various appli-
`ance designs and associated tooth movement, in a computer-
`interactive fashion.
`
`These and manyother features of the presently preferred
`embodimentof the treatment planning apparatus and method
`are set forth below.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`FIG. 1 is an illustration of an orthodontic care system
`incorporating a hand-held scanner system and treatment
`planning software in accordance with a representative
`embodimentof the invention. The hand-held scanneris used
`by the orthodontist to acquire three-dimensional information
`of the dentition and associated anatomical structures of a
`
`patient and provide a base of information for interactive,
`computer software-based diagnosis, appliance design, and
`treatment planning for the patient. The scanneris suitable for
`in-vivo scanning, scanning a plaster model, scanning an
`impression, or some any combination thereof.
`FIG. 2 is a block-diagram of a scanning system, suitable
`for use in the orthodontic care system of FIG. 1.
`FIG. 3 is a perspective view of a hand-held scanner used
`to acquire information of an object under scrutiny, suitable
`for use in the orthodontic care system of FIG. 1.
`FIG. 4 is anillustration of a patient being scanned with the
`hand-held scanner of FIG. 3.
`
`FIG. 5 is a block diagram of the back office server of FIG.
`1 showing the elements used to calculate the digital model
`of the patient’s dentition and display the digital model on a
`screen display of the back office server.
`FIG. 6 is a screen shot displayed on the display of the back
`office server of FIG. 1, showing a graphical representation of
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`a three-dimensional model of a patient’s upper front teeth
`after a frame to frame registration. The user is applying
`landmarks to the teeth as a preliminary step in treatment
`planning, and as a step in registering overlapping segments
`of a scanned upper jaw relative to each other to calculate a
`complete model of the upper jaw and associated dentition.
`FIGS. 7A-7F are a series of illustrations showing the
`generation of an individual tooth model from a scanned
`tooth, shown in FIG. 7A, and a template tooth, shown in
`FIG. 7B. A library of template teeth similar to FIG. 7B are
`stored as three-dimensional computer models in computer
`memory. The individual tooth model is a three-dimensional
`tooth object having a single set of points defining the
`boundaries of the tooth. The individual tooth model reduces
`the amount of data required to represent
`the tooth, as
`compared to the data representing the tooth after a cumu-
`lative registration of a large numberof frames.
`FIG. 8 is an illustration of the tooth model of FIG. 7D
`
`positioned in the computer model of the patient’s dentition,
`surrounded by other anatomical structures.
`FIG. 9 is a screen shot from the treatment planning
`software showing some aspects of patient information that
`are stored in memory and accessed by the software, includ-
`ing photographs, patient
`information, examination notes,
`X-rays, medical and/or orthodontic or dental history, and the
`three-dimensional model of the malocclusion.
`
`FIG. 10 is an illustration of a series of icons that appear
`on a screen display that provide some tools for viewing the
`three-dimensional model of the patient’s dentition.
`FIG. 11 is an illustration of a set of icons which are part
`of the screen displays which act as a navigational tool and
`allow the user to manipulate the three-dimensional models
`of teeth and brackets on the display.
`FIG. 12 is a screen shot from the treatment planning
`software showing a set of individual tooth objects repre-
`senting the observed stage of a patient suffering from a
`malocclusion.
`
`FIG. 13 is another screen shot from the treatment planning
`software, showing the observed stage and the placement of
`virtual three-dimensional brackets on the surfaces of the
`teeth.
`
`FIG. 14is another screen shot from the trea