Surgery – Diagnostic testing – Measuring anatomical characteristic or force applied to or...
Reexamination Certificate
2000-08-14
2003-09-02
Hindenburg, Max F. (Department: 3736)
Surgery
Diagnostic testing
Measuring anatomical characteristic or force applied to or...
Reexamination Certificate
active
06613001
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates generally to dentistry and specifically to a method, apparatus and monitoring device for the treatment of various problems related to improper use of jaw musculature and/or to monitor a patient's compliance with his or her treatment regimen.
BACKGROUND OF THE INVENTION
There are numerous dental problems that arise from improper use of jaw musculature. One of these is clenching, a condition in which a patient constantly or excessively presses his or her teeth against each other. Clenching can cause excessive wear of the teeth, headaches, and fatigue and soreness of the jaw muscles.
There are at least three schools of thought on the treatment of clenching. One traditional treatment involves placing a protective layer of acrylic material (called a splint) over the involved teeth. This acrylic layer serves to protect the teeth from direct contact, thus reducing wear, and to spread the load caused by clenching so that it is shared more equally among the neighboring teeth. This reduces wear of the teeth, but the acrylic protective layer does not address the problem of clenching, which frequently continues indefinitely. This forces the patient to wear the splint indefinitely. In some cases the urge to clench is worsened.
A second traditional treatment for clenching is occlusal adjustment. This treatment involves selective grinding of teeth so that the load on the teeth caused by clenching is carried evenly by several teeth rather than being concentrated on one or two. This technique is successful with some but not all types of clenching.
A third school of thought is that there is nothing that can be done about clenching. This approach may have heretofore had the advantage of candor, but it left patients with unnecessary discomfort. Muscle relaxants are often prescribed in these instances. This group of drugs may adversely effect performance, and therefore can in some instances only be used when the patient is at home.
A second class of dental problems relates to what are termed problems in the vertical frame of reference. Examples of these problems are: (1) Dental open bite which is characterized by contact between the posterior teeth without contact between the front teeth when the jaw is closed; (2) skeletal open bite which is characterized by a sloping mandibular plane and a long face; and (3) skeletal deep bite which is characterized by short faces and mandibular planes that are nearly horizontal or parallel with the floor. Skeletal deep bite patients also have dental deep bite which is characterized by excessive overlap of the front teeth. Treatments for problems of this type are discussed below.
One method of treating a dental open bite is to mount ceramic magnets on the rearmost molars with like poles facing each other so that the molars are slowly forced more deeply into the bone which supports them. A disadvantage to this method is that the magnets and their acrylic housing force the jaw open 5-6 millimeters in the rear and perhaps twice that at the front. This forces the patient to walk around with his or her mouth open, which is embarrassing and uncomfortable. Patients also have difficulty keeping their jaws in such a position that the repelling magnets are directly opposing one another. Thus, there is a tendency for the lower jaw to slide from side to side and not to stay centered. As a result, these patients are frequently asked to wear a chin strap and headgear apparatus to center the lower jaw. This method of treating open bites is prone to the problem of lack of patient cooperation.
Another problem associated with dental open bites is called tongue thrusting. A patient with this problem habitually presses his or her tongue forward against his or her front teeth. This problem can be addressed by placing a cage directly behind the upper or lower front teeth. This appliance restrains the tongue from coming forward where it has forced the front teeth apart. The patient is instructed to keep the tongue behind the cage without touching it and to move the tongue backward, away from the cage whenever it touches the cage. The problem with this appliance is that patients forget to remind themselves to move their tongues backward, and they rest their tongues against the cage. When the appliance comes off, the tongue frequently comes forward to rest against the front teeth again. Relapses frequently occur.
When dental open bites are present in patients in their teens, or later as an adult, the treatments for dental open bite are orthodontic treatment in combination with extractions of permanent teeth, or orthodontic treatment in combination with surgery, which usually includes extraction of permanent teeth.
Skeletal open bites are traditionally treated by orthodontists through the use of orthodontics, possibly including the extraction of teeth, and using orthopedic force in the form of headgear which imposes an intrusive force to the maxilla and maxillary teeth. Extractions help to solve the problem in a minor way and require the removal of four perfectly good teeth. The successful use of headgear is dependent upon the cooperation of the patient. The headgear includes a brace that circumscribes the head and neck, and it is cumbersome and uncomfortable. Experience has shown that cooperation in wearing the headgear is often less than complete. The use of extractions and headgear treat only the symptoms of skeletal open bites. The underlying cause of the problem which is the lack of sustained contact between the teeth is not addressed by this treatment.
Dental and skeletal deep bite are treated by orthodontists through the use of an orthodontic regimen which often includes propping the front teeth open with an acrylic bite plane. This leaves the posterior teeth apart and allows them to erupt into contact with each other. In the short run this treatment appears to be stable, but after about a year the deep bite may begin to return because the underlying cause of the problem (chronic clenching of teeth) was never addressed.
Another class of dental problems relates to what is termed problems in the horizontal frame of reference. Mandibular retrognathia is one such problem. It is characterized by the lower jaw being positioned too far behind the upper jaw in the horizontal frame of reference. This condition is conventionally treated with bulky acrylic appliances which hold the lower jaw forward and restrain the lower jaw from moving backward. These appliances have been shown to create undesirable side effects related to this restraint such as proclination of the lower anterior teeth. Other treatments have been: Orthodontics that usually includes extraction of teeth, or orthodontics that utilize orthopedic forces to push the upper jaw backward to meet the lower jaw. If the problem of mandibular retrognathia has not been treated by 12 to 14 years of age, it is often necessary to treat the problem with orthodontics in combination with surgery that is designed to bring the lower jaw forward.
Other classes of dental problems arise when patients fail to wear their dental splint, retainer or other corrective dental hardware. Patients, especially younger patients, routinely hinder their treatment program by failing to wear the prescribed dental hardware. When asked, most patients will not confess to the failure to wear their prescribed dental hardware. Accordingly, there is a need for an appliance which can monitor whether a patient is in compliance with his or her prescribed hardware regimen.
SUMMARY OF THE INVENTION
The present invention provides a new approach to treating and monitoring the dental problems discussed above. The present invention can remind the patient of unconscious, undesirable behavior every time it occurs and can help the patient to learn new habits. In addition, the present invention permits a patient's treating dentist or orthodontist to monitor the patient's progress through each patient's prescribed treatment regimen. This is accomplished by the use of electronic circuitry attached to, e.g., the
Hindenburg Max F.
Renner , Otto, Boisselle & Sklar, LLP
Szmal Brian
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