HK1118003B - A dental orthotic device - Google Patents

Description

Dental correcting device

Cross reference to related applications

The present invention claims priority from australian provisional patent application no 2005900090 filed on 10.1.2005, the contents of which are incorporated herein by reference.

Technical Field

The present invention relates to a dental appliance and a method of using a dental appliance. In particular, the present invention relates to a method and apparatus for maintaining the mandible in a protracted condition.

Background

During normal breathing, air flows through the nasal cavity and flexible structures behind the throat, such as the soft palate, uvula, and tongue. When a person is awake, some muscles keep the airway open, but during sleep they relax, which can cause problems. It is believed that: such sleep disordered breathing, such as snoring, Upper Airway Resistance Syndrome (UARS), and sleep obstructive apnea (OSA), occurs when the airway is at least partially occluded, often in conjunction with the tongue. During OSA, the tongue is sucked against the back of the throat, completely blocking the flow of air. When the oxygen concentration in the brain becomes low enough, the sleeper will wake up half and the muscles contract to reopen the airway. This circulatory airway occlusion can have serious consequences, including the induction of cardiovascular disease, which has the potential to lead to cardiac arrest and death.

There are several alternative treatment options, including: surgery, nasal Continuous Positive Airway Pressure (CPAP), and the use of orthotic devices. Because orthotics are generally small, easy to wear, and relatively inexpensive, there is an increasing tendency to select a method of orthotics. Another benefit of the orthotic device is that this treatment is reversible and non-invasive.

Mandibular Advancement Device (MAD), an orthotic device used to hold the mandible in a protracted position, has proven effective in treating sleep disordered breathing. It has been found that: keeping the lower jaw in the advanced position clears the airway, reduces the possibility of the tongue blocking breathing, and helps control symptoms associated with sleep disordered breathing.

The boiled and occluded MAD is pre-fabricated and lined with a soft thermoplastic material molded over the patient's teeth in the patient's home. The MAD is engaged with the mandible primarily at the incisors, and thus, it only uses a pair of teeth to apply a force that pulls forward. Although these MADs are relatively inexpensive and easy to use, they suffer from the following disadvantages: for some patients, it may exert too much force on the underlying anterior teeth, which can cause discomfort, loosening of the teeth, and problems with too long a time to fit the device. Another potential problem is: once these devices are molded for a particular patient, they are not adjustable, limiting the possibility of applying these devices to a wide range of patient groups. In addition, some patients may not have good conditions for the gums and teeth in both the upper and lower jaws, and may not be able to support the MAD securely in the mouth.

Another example of a MAD is one produced in a laboratory, which requires a dentist to participate in the manufacture, who obtains an impression of the mouth, which is used to make a model of the teeth and gums. These models are then used to create dental overlays for covering all of the teeth in the upper and lower portions and to extend the mandible to help clear the airway. Laboratory fabricated MADs may also exert too much force on the teeth, resulting in pain and tooth loosening. Furthermore, such laboratory-made MADs are problematic in meeting the patient's specific dental needs, as they require that both the gums and teeth be healthy.

The discussion of documents, acts, materials, devices, articles or the like which has been included in the present specification is solely for the purpose of providing a context for the present invention. It is not to be taken as an admission that all or a portion of these matters form part of the prior art of the present invention and are not considered as: it is common general knowledge in the field relevant to the present invention, as it exists before the priority date of the various claims of this application.

Throughout this specification, the word "comprise", or variations thereof, shall be understood to mean: including those elements, integers, or steps mentioned or groups of elements, integers or steps, but not excluding any other elements, integers or steps, singly or in any combination.

Disclosure of Invention

According to a first aspect, the present invention provides a dental appliance for holding the lower jaw of a patient in a protracted position, the dental appliance comprising:

an intraorally located anterior mandibular abutment surface that prevents the patient's mandible from retracting rearwardly by abutting the gingiva overlying the mandible;

an extramaxillary anterior maxillary abutment surface on which the intraoral anterior mandibular abutment surface rests;

a posterior maxillary abutment surface located intraorally to prevent rotation of the dental orthotic device caused by interaction of the intraoral anterior mandibular abutment surface with the external maxillary anterior abutment surface.

In another aspect, the invention provides a method for maintaining a patient's mandible in a protracted position, the method comprising the steps of:

preventing retraction of the mandible by abutting the intraoral anterior mandibular abutment surface against the gingiva covering the mandible;

supporting the intraoral anterior mandibular abutment surface against the extramaxillary anterior maxillary abutment surface; and

rotation caused by the interaction of the intraoral anterior mandibular abutment surface and the extramaxillary anterior maxillary abutment surface is prevented by the intraoral posterior maxillary abutment surface.

In a further aspect, the invention provides a kit of parts comprising an intraoral anterior mandibular abutment surface, and/or an extramaxillary anterior abutment surface, and/or an intraoral posterior maxillary abutment surface.

In one embodiment of the invention, the anterior maxillary abutment surface is concave, preferably the anterior maxillary abutment surface is shaped to comfortably fit and conform to the shape of the tissue covering the maxilla. In another embodiment of the invention, the anterior maxillary abutment surface is extraoral and pushes against the soft tissue covering the subnasal maxillary bone.

In another embodiment of the invention, the anterior maxillary abutment surface is adjustably mounted on the orthotic device so that the degree of protrusion of the mandible can be controlled.

In yet another embodiment of the invention, the orthotic device includes a tongue abutment surface that contacts the tongue when the mandible is in the advanced position. The tongue abutment surface is adapted to hold the tongue in an anterior position, and/or a depressed position, to prevent the tongue from obstructing the airway. In an alternative embodiment of the invention, the orthotic device may be shaped to leave sufficient room for the tongue to be comfortable for the patient.

In yet another embodiment of the invention, the intraoral anterior mandibular abutment surface is convex and in one embodiment is made of a resilient thermoplastic material and is shaped to fit comfortably on the gingiva covering the mandible. Preferably, the intraoral anterior mandibular abutment surface is made of silicone rubber.

In another embodiment of the invention, the orthotic device includes at least one guide surface to resist lateral movement of the orthotic device in the patient's mouth. Preferably, the orthotic device has at least two guide surfaces for positioning the orthotic device.

In yet another embodiment, the orthotic device further comprises a soft palate abutment surface adapted to support the patient's soft palate, preferably the soft palate abutment surface is shaped to conform to the surface of the soft palate.

In certain preferred embodiments, the orthotic device is provided with air holes to facilitate airflow through the device.

In one embodiment, the orthodontic device further comprises a tooth stabilizing plate adapted to be fitted to the lower dentition and/or the upper dentition.

Drawings

Examples of the invention will now be described with reference to the accompanying drawings, in which:

FIG. 1 is a perspective view of an orthotic device according to one embodiment of the present invention;

figure 2 is a perspective view of an orthotic device according to a second embodiment of the present invention;

figure 3 is a perspective view of an orthotic device according to a third embodiment of the present invention;

figure 4 is a perspective view of an orthotic device according to a fourth embodiment of the present invention;

figure 5 is a perspective view of an orthotic device according to a fifth embodiment of the present invention;

figure 6 is a perspective view of an orthotic device according to a sixth embodiment of the present invention;

figure 7A is a perspective view of an orthotic device according to a seventh embodiment of the present invention;

FIG. 7B is a front view of the embodiment taken along arrow A in FIG. 7A;

figure 8 is a perspective view of an orthotic device according to an eighth embodiment of the present invention;

figure 9 is a perspective view of an orthotic device according to a ninth embodiment of the present invention;

figure 10A is a perspective view of an orthotic device according to a tenth embodiment of the present invention;

FIG. 10B is a front view of the embodiment of FIG. 10A taken along arrow A;

figure 11 is a perspective view of an orthotic device according to an eleventh embodiment of the present invention;

figure 12 is a perspective view of an orthotic device according to a twelfth embodiment of the present invention;

figure 13 is a perspective view of an orthotic device according to a thirteenth embodiment of the invention; and

figure 14 is a perspective view of an orthotic device according to a fourteenth embodiment of the invention.

Detailed Description

In the present context, the meaning of "mandibular surface" includes all objects that belong to or are attached to the anterior part of the mandible. Non-limiting examples of anterior mandibular surfaces include bone, gingiva or gum, teeth, dentures, or other fixed or removable devices.

In the context of this document, the meaning of "maxillofacial surface" includes all objects belonging to or attached to the maxilla. Non-limiting examples of maxillary surfaces include bone, gums, teeth, dentures, or other fixed or removable devices.

Referring to the figures, the orthotic device 100 in the embodiment shown in figure 1 comprises an extraoral member 105 and an intraoral member 110, wherein the member 110 is adapted to be fitted into the patient's mouth. The members 105 and 110 are made of stainless steel. Alternatively, the intraoral and extraoral members may be made of rigid thermoplastic materials. Thermoplastic materials can be softened by heat to shape them, suitable thermoplastic materials include, for example, acrylic, duromers, polypropylene, methyl vinyl acetate, ethyl vinyl acetate, polyethylene, and rigid urethanes.

In the illustrated state, a concave anterior maxillary abutment surface 115 is mounted on member 105 by bolts 120. As shown, the anterior maxillary abutment surface 115 is slightly angled towards the lips to facilitate a more conforming contact with the tissue covering the subnasal maxillary bone. The anterior maxillary abutment surface 115 is positioned so as not to substantially obstruct or impede the flow of air in the nasal cavity.

In still other embodiments of the invention, such anterior maxillary abutment surfaces may be adjustably mounted to the orthotic device by a sliding mechanism or any other means known in the art. In other embodiments, the anterior maxillary abutment surface is permanently fixed to the body of the orthotic device.

In the embodiment of the invention shown in figure 1, the anterior maxillary abutment surface 115 is made of an elastomeric material shaped to fit comfortably over the soft tissues and skin covering the subnasal maxillary bone. Suitable thermoplastic materials include, for example, caprolactone, polycaprolactone, 1, 4-dibutylene glycol polyester, 2-oxepanone (oxepanone), or silicone rubber.

The anterior mandibular abutment surface 125 of the embodiment shown in fig. 1 is a convex slat that is connected to member 110 with member 130. The anterior mandibular abutment surface 125 presses against the gingiva covering the mandible. Such a configuration allows the orthotic device 100 to be applied to a patient who has lost one or more of the anterior mandibular teeth. In addition, by pressing against the gingiva covering the mandible, the anterior mandibular abutment surface 125 avoids or reduces the likelihood of mandibular teeth being inadvertently displaced.

In the embodiment of the invention shown in FIG. 1, the member 110 has a bias 135 to allow sufficient room for the tongue to be comfortable to the patient. The intraoral posterior maxillary abutment surfaces 140 and 140' are flat projections which contact the maxillary surface.

The contact between the intraoral posterior maxillary abutment surfaces 140 and 140' and the maxillary surface helps to resist rotation of the dental orthotic device 100 due to the interaction of the anterior mandibular abutment surface 125 and the anterior maxillary abutment surface 115. The intraoral posterior maxillary abutment surfaces 140 and 140' are positioned such that: they are unlikely to apply a lateral force to the teeth large enough to cause undesirable displacement of the teeth. The intraoral posterior maxillary abutment surfaces 140 and 140 'are shaped to comfortably conform to the shape of the patient's posterior maxillary region. The two guide surfaces 150, 150 'are positioned to make loose contact with the maxillary surfaces, and in other embodiments, the intraoral posterior maxillary abutment surfaces may contact the maxillary molars or premolars to position the orthotic in the patient's mouth.

The degree of mandibular protrusion or advancement depends on clinical requirements. The relative displacement of the mandible can be seen as having both a lateral and a forward and backward motion component. Protrusion of the mandible drives the tongue forward, thereby reducing the tendency of the tongue to block the throat, particularly during sleep.

Referring to the second embodiment of the invention shown in figure 2, the orthotic device 200 incorporates a concave anterior maxillary abutment surface 215 mounted via bolts 220 to the extraoral member 205. The intraoral member 210 has a member 230 and an anterior mandibular abutment surface 225. The intraoral posterior maxillary abutment surfaces 240, 240' are flat projections. The guide surfaces are positioned to make loose contact with the maxillary surfaces to prevent lateral movement of the orthotic device 200. In other embodiments, these guide surfaces are in loose contact with the maxillary molars or premolars. In other embodiments, the shape and configuration of these guide surfaces may be adjusted to suit the needs of the patient.

Referring to the third embodiment of the invention shown in figure 3, the orthotic device 300 incorporates a concave anterior maxillary abutment surface 315 mounted via bolts 320 to the extraoral member 305. The intraoral member 310 has a member 330, an anterior mandibular abutment surface 325, and two posterior maxillary abutment surfaces 340, 340' located intraorally. In this embodiment, the guide surfaces 350 and 350' are positioned to make loose contact with the maxillary surfaces. In other embodiments, these guide surfaces contact the maxillary molars or premolars to position the orthotic device 300 in the patient's mouth and resist lateral movement within the mouth. The member 310 also forms an aperture into which the patient's tongue can extend.

Referring to the fourth embodiment of the invention shown in figure 4, the orthotic device 400 incorporates a concave anterior maxillary abutment surface 415 mounted via a bolt 420 to the extraoral member 405. The intraoral member 410 has a member 430, an anterior mandibular abutment surface 425, and two posterior maxillary abutment surfaces 440, 440' located intraorally. In this embodiment, the guide surfaces 450 and 450' are connected by a member 460, the member 460 being raised so as to leave sufficient space for the tongue to be comfortable to the patient.

Referring to the fifth embodiment of the invention shown in figure 5, the orthotic device 500 incorporates a concave anterior maxillary abutment surface 515 mounted via a sliding arm 520 to the extraoral member 505. In this embodiment, the length of the sliding arm may be adjusted by the action of knob 560. In alternative embodiments, other means may be used in place of the knob to control the position of the concave anterior maxillary abutment surface. Other devices may incorporate mechanisms for controlling the angle of the relevant anterior maxillary abutment surfaces to suit the patient's needs and/or preferences.

As shown, the length of the extraoral member 505 can be adjusted using the extraoral adjustment 555. Alternatively, the length of the extraoral member can be customized to the needs of the patient, such as when manufacturing the orthotic.

The extraoral member 505 is connected to the intraoral body portion 565 of the orthotic device by member 510. The length of the member 510 may be adjusted to suit the needs of the patient. In this embodiment, air holes 570 and 570' are shown extending through the intraoral portion 565 to facilitate air flow through and around the orthotic device 500. The provision of the above features can provide a number of advantages for patients with dyspnea, such as nasal congestion or nasal congestion.

The anterior mandibular abutment surface 525 is connected to the body portion 565 by members 530 and 530'. Such a modification allows the tongue of the user to have a more comfortable extension space. In the illustrated embodiment, arms 530 and 530' are permanently secured to body portion 565. Alternatively, the arms may be adjustably mounted using a sliding mechanism or other means known in the art.

As shown, the anterior mandibular abutment surface 525 is a convex strip that presses against the gingiva covering the mandible. In an alternative embodiment, the anterior mandibular abutment surface is shaped appropriately to contact at least a portion of the anterior mandibular surface.

The intraoral posterior maxillary abutment surfaces 540 and 540 'are connected to intraoral body portion 565 by arms 535 and 535'. This configuration of arms 535 and 535' is advantageous in that: more space is left for the tongue of the user, thereby improving the comfort of the device. As shown, the abutment surfaces 540, 540' are flat projections that contact at least a portion of the maxillary surfaces. This contact prevents rotation of the orthotic device 500 due to the interaction of the mandibular abutment surface 525 and the anterior maxillary abutment surface 515.

The surfaces 540, 540' are separated by a soft jaw abutment surface 550. In the illustrated embodiment, the surface is arcuate in shape, which fits or rests on the soft jaw of the patient. Such a configuration is advantageous for patients whose soft palate may collapse during sleep. By supporting the soft palate, the effectiveness of the orthotic device may be improved in some circumstances.

Referring to the sixth embodiment of the invention shown in figure 6, the orthotic device 600 incorporates a concave anterior maxillary abutment surface 615 mounted via a sliding arm 620 to an extraoral member 605. In this embodiment, the length of the sliding arm may be adjusted by the action of knob 660. As shown, the length of the extraoral member 605 can be adjusted using the extraoral adjustment means 655.

The extraoral member 605 is connected to the intraoral body portion 665 of the orthotic device by member 610. In this embodiment, air holes 670 and 670' through the intra-oral body portion 665 are positioned to facilitate air flow through and around the orthotic device 600. The convex band shaped anterior mandibular abutment surface 625 is connected to body portion 665 by members 630 and 630'.

The intraoral posterior maxillary abutment surfaces 640 and 640 'are connected to intraoral body portion 665 by arms 635 and 635'. The abutment surfaces 640, 640' are flat projections that contact at least a portion of the maxillary surfaces. Such a contact relationship prevents rotation of the orthotic device 600 due to the interaction of the mandibular abutment surface 625 and the anterior maxillary abutment surface 615.

The abutment surfaces 640 and 640 ' have guide surfaces 650 and 650 ', respectively, that are positioned to contact the maxillary surfaces to assist in positioning the orthotic in the patient's mouth.

For this embodiment, there is no direct connecting member between the two abutting surfaces 640 and 640'. The advantages of this structure are: the user's tongue has a more comfortable extension space, which is particularly advantageous for patients who do not have the problem of soft palate slump during sleep.

Referring to the seventh embodiment of the invention shown in figure 7A, the orthotic device 700 incorporates a concave anterior maxillary abutment surface 715 mounted via an adjustable arm 720 to the extraoral member 705. In this embodiment, the length of the arm 720 can be adjusted by the action of the knob 760. As shown, the length of the extraoral member 705 can be adjusted using the extraoral adjustment means 755.

The extraoral member 705 is connected to the intraoral body portion 765 of the orthotic device by member 710. The convex band shaped anterior mandibular abutment surface 725 is connected to the body portion 765 by members 730 and 730'. The body portion 765 is adapted to comfortably conform to the anterior maxillary and mandibular surfaces of the user.

For the embodiment shown in fig. 7A, the body portion 765 has a cavity 770. As shown in fig. 7B, which is a view of the body portion 765 taken along direction a, the opening of the cavity 775 is adapted to provide an expansion space for the tongue and to maintain the tongue in an advanced position. This configuration advantageously improves the performance of the orthotic device on certain patients.

The intraoral posterior maxillary abutment surfaces 740 and 740 'are connected to intraoral body portion 765 by arms 735 and 735'. Abutment surfaces 740, 740' are flat projections that contact at least a portion of the maxillary surfaces. This contact prevents rotation of the orthotic device 700 due to the interaction of the mandibular abutment surface 725 and the anterior maxillary abutment surface 715.

Abutment surfaces 740 and 740 ' have guide surfaces 750 and 750 ', respectively, that are positioned to contact the maxillary surfaces to help position the orthotic in the patient's mouth.

For this embodiment, there is no direct connecting member between the two abutment surfaces 740 and 740'. The advantages of this structure are: the user's tongue has a more comfortable extension space, which is particularly advantageous for patients who do not have the problem of soft palate slump during sleep.

Referring to the eighth embodiment of the invention shown in figure 8, the orthotic device 800 incorporates a concave anterior maxillary abutment surface 815 mounted via a sliding arm 820 to the extraoral member 805. In this embodiment, the length of the sliding arm 820 may be adjusted by the action of the knob 860. As shown, the length of the extraoral member 805 can be adjusted using an extraoral adjustment device 855.

Extraoral member 805 is connected to intraoral body portion 865 of the orthotic device by member 810. The convex band shaped anterior mandibular abutment surface 825 is connected to the body portion 865 by a single member 830.

The intraoral posterior maxillary abutment surfaces 840 and 840 'are connected to intraoral body portion 865 by single arm 835 and connecting arms 870, 870'. The length of arm 835 can be adjusted to suit the needs of the patient. The abutment surfaces 840, 840' are flat projections that contact at least a portion of the maxillary surfaces. This contact prevents rotation of the orthotic device 800 due to the interaction of the mandibular abutment surface 825 and the anterior maxillary abutment surface 815.

The abutment surfaces 840 and 840 ' have guide surfaces 850 and 850 ', respectively, that are positioned to contact the maxillary surfaces to assist in positioning the orthotic in the patient's mouth.

Attached to arm 835 is a rear tail shaped portion 875 adapted to press against the user's tongue during sleep. The structure brings the following advantages: for some patients, it improves the performance of the orthotic device in treating sleep apnea.

Referring to the ninth embodiment of the invention shown in figure 9, the orthotic device 900 incorporates an intraoral concave anterior maxillary abutment surface 915 mounted on an intraoral member 905. While intraoral, member 905 is external to the upper jaw as required by the present invention and is thus adapted to be positioned between the patient's upper lip and upper jaw. As shown, the position of the intraoral member 905 may be adjusted using the adjustment device 960.

Intraoral member 905 is connected to intraoral body portion 965 of the orthotic device by member 910. The convex band shaped anterior mandibular abutment surface 925 is connected to body portion 965 by members 930 and 930'. The position of convex band shaped anterior mandibular abutment surface 925 can be adjusted by movement of body portion 965 along member 910. The angle and/or length of members 930 and 930 'may also be adjustable to suit the patient's needs. As shown, an air hole 955 is shown extending through intraoral body portion 965 and is positioned to facilitate air flow through and around the orthotic device. This feature can be advantageous for patients with dyspnea, such as nasal congestion or nasal congestion.

The intraoral posterior maxillary abutment surfaces 940 and 940 'are connected to intraoral body portion 965 by single arm 935 and connecting arms 970 and 970'. The length of arm 935 can be adjusted to suit the patient's needs.

The abutment surfaces 940, 940' are flat projections that contact at least a portion of the maxillary surfaces. This contact prevents rotation of the orthotic device 900 due to the interaction of the mandibular abutment surface 925 and the anterior maxillary abutment surface 915.

As shown, intraoral posterior maxillary abutment surfaces 940 and 940 ' have guide surfaces 950 and 950 ', respectively, which are positioned to contact the maxillary surfaces to help position the orthotic in the patient's mouth. In an alternative embodiment, no guide surface is necessary.

Referring to the tenth embodiment of the invention shown in figure 10A, the orthotic device 1000 incorporates a concave anterior maxillary abutment surface 1015 mounted via an arm 1020 to the extraoral member 1005. In this embodiment, the length of the arm 1020 is adjustable by the action of the knob 1060. This adjustability may also be achieved by a socket nut mechanism (or jackscrew mechanism) which can be operated by a socket nut wrench to advance or retract the arm as required. In this way, appropriate treatment as determined by the clinician can be achieved.

In other embodiments, the length of the arm is fixed. As shown, the length of the extraoral member 1005 can be adjusted using an extraoral adjustment device 1055. Alternatively, the length of the arm may be fixed.

The extraoral member 1005 is connected to the intraoral arms 1035, 1035 'of the orthotic device by members 1010, 1010'. In this embodiment, the intraoral body portion 1065 is made of a resilient strip and is adapted to allow the user's tongue to slide into the cavity 1070 but not easily slide out of the cavity. This cavity is shown in more detail in fig. 10B, viewed in the direction of arrow a. The combined bite forces from the anterior maxillary and mandibular surfaces and/or elastic tension may hold the tongue firmly in the anterior position. This can improve the effectiveness of the orthotic device for certain patients.

The intraoral posterior maxillary abutment surfaces 1040, 1040 'are connected to intraoral arms 1035 and 1035'. Abutment surfaces 1040, 1040' are flat projections that contact at least a portion of the maxillary surfaces.

The convex band shaped anterior mandibular abutment surface 1025 is connected to intraoral arms 1035 and 1035 'by arms 1030 and 1030'.

The abutment surfaces 1040 and 1040 ' have guide surfaces 1050 and 1050 ', respectively, that are positioned to contact the maxillary surfaces to assist in positioning the orthotic in the patient's mouth.

Referring to the eleventh embodiment of the invention shown in figure 11, the orthotic device 1100 incorporates a concave anterior maxillary abutment surface 1115 mounted to the extraoral member 1105. The intraoral member 1110 has a variable position member 1130 and an anterior mandibular abutment surface 1125 attached thereto. The relative position of the surface 1125 can be changed by the action of the knob 1170 and the screw 1160. In alternative embodiments, other means known in the art may be utilized to control the position of the surface. With the movement of the member 1125, the extent of protrusion of the mandible can be controlled according to the needs of the patient.

The intraoral posterior maxillary abutment surfaces 1140 and 1140 'are flat projections with two guide surfaces 1150 and 1150' positioned in loose contact with the maxillary surfaces to prevent lateral movement of the orthotic device 1100.

Referring to the twelfth embodiment of the invention shown in figure 12, the orthotic device 1200 incorporates a concave anterior maxillary abutment surface 1215 mounted via an arm 1220 to the extraoral member 1205. The length of arm 1220 can be adjusted by the action of knob 1260. As shown, the length of the extraoral member 1205 can be adjusted using the extraoral adjustment device 1255.

The extraoral member 1205 is connected to the intraoral body portion 1265 of the orthotic device by member 1210. A convex band-shaped anterior mandibular abutment surface 1225 is connected to arm 1235 by a single member 1230. The length of member 1230 may be adjusted to suit the patient's needs by action of device 1275.

Intraoral posterior maxillary abutment surfaces 1240 and 1240' are connected to intraoral body portion 1265 by single arm 1235 and by connecting arm 1270. The length of arm 1235 can be adjusted to suit the patient's needs by the action of device 1280. Abutment surfaces 1240, 1240' are flat projections which contact at least a portion of the maxillary surface and are connected to arm 1235 by posterior arm 1270. Abutment surfaces 1240 and 1240 ' have guide surfaces 1250 and 1250 ', respectively, which are positioned to contact the maxillary surfaces to help position the orthotic in the patient's mouth. The movement of device 1290 can be used to change the distance between the two surfaces 1240 and 1240'.

Referring to the thirteenth embodiment of the invention shown in figure 13, the orthotic device 1300 incorporates an intraoral concave anterior maxillary abutment surface 1315 mounted on intraoral member 1305. As shown, the position of the intraoral member 1305 may be adjusted using an adjustment device 1360.

The intraoral member 1305 is connected to the intraoral body portion 1365 of the orthotic device by member 1310. A convex band shaped anterior mandibular abutment surface 1325 is connected to body portion 1365 by members 1330 and 1330'. The position of the convex band shaped anterior mandibular abutment surface 1325 can be adjusted by movement of body portion 1365 along member 910. The angle and/or length of members 1330 and 1330' may also be adjustable to suit the needs of the patient. As shown, air holes 1355 are shown passing through intraoral body portion 1365 and are positioned to facilitate air flow through and around the orthotic device.

The intraoral posterior maxillary abutment surfaces 1340 and 1340 'are connected to intraoral body portion 1365 by single arm 1335 and connecting arms 1370 and 1370'. The length of the arm 1335 and connecting arms 1370, 1370 'can be adjusted to suit the patient's needs.

Abutment surfaces 1340, 1340' are flat projections which contact at least a portion of the maxillary surfaces. Such a contact relationship prevents rotation of the orthotic device 1300 that would otherwise occur due to the interaction of the mandibular abutment surface 1325 and the anterior maxillary abutment surface 1315.

Referring to the fourteenth embodiment of the invention shown in figure 14, the orthotic device 1400 incorporates a concave anterior maxillary abutment surface 1415 mounted via a sliding arm 1420 to the extraoral member 1405. In this embodiment, the length of the arm may be adjusted by the action of the adjustment device 1460. As shown, the length of the extraoral member 1405 can be adjusted by the extraoral adjustment means 1455.

The extraoral member 1405 is connected to the intraoral body portion 1465 of the orthotic device by member 1410. The convex band shaped anterior mandibular abutment surface 1425 is connected to body portion 1465 by members 1430 and 1430'. The position of the convex band shaped anterior mandibular abutment surface 1425 may be varied by movement of the connecting web portion 1490 according to the needs of the user.

Intraoral posterior maxillary abutment surfaces 1440 and 1440 'are connected to intraoral body portion 1465 by arms 1435 and 1435'. Abutment surfaces 1440, 1440' contact at least a portion of the maxillary surface. Such a contact relationship prevents rotation of the orthotic device 1400 that would otherwise occur due to the interaction of the mandibular abutment surface 1425 and the anterior maxillary abutment surface 1415.

The abutment surfaces 1440 and 1440 ' have guide surfaces 1450 and 1450 ', respectively, which are positioned to contact the maxillary surfaces to help position the orthotic in the patient's mouth.

For this embodiment, a coupling member 1470 is provided that couples the two abutting surfaces 1440 and 1440'. The connecting component is suitable for contacting with the tongue of a user and pressing the tongue, and the structure brings the advantages that: for some patients, it improves the performance of the orthotic device in treating sleep apnea. The position of attachment member 1470 may be adjusted by the action of adjustment devices 1480 and/or 1480'.

The corrective device for holding the mandible of a patient in a protracted position, in which the invention is embodied, has a number of advantageous applications, including: as an early positive device (interventional device) to promote growth of the mandible; treating certain orthodontic problems; treating certain temporomandibular joint problems; treating bruxism; and/or to treat snoring and obstructive sleep apnea, among other symptoms.

The orthotic device may be made from an orthopedic material such as acrylic, cobalt, chromium, gold, silver, platinum, or other acceptable materials.

In some instances, it may be desirable to add a simple tooth stabilizing plate, such as a retainer that is secured to the orthotic device. This will help to prevent the teeth from moving due to engagement with the respective abutment surfaces and will avoid a degree of discomfort. The provision of such stabilising plates helps to secure the upper and/or lower dentition.

Those skilled in the art will recognize that: various changes and modifications may be made to the embodiments of the invention without departing from the spirit or broad scope thereof. The above-described embodiments are, therefore, to be considered in all respects as illustrative and not restrictive.

Claims (21)

1. A dental appliance for holding a patient's lower jaw in an advanced position, the dental appliance comprising:

a convex paneled anterior mandibular abutment surface located within the oral cavity which prevents the patient's mandible from retracting rearwardly by abutting the patient's gingiva overlying the mandible;

an extramaxillary anterior maxillary abutment surface on which the intraoral anterior mandibular abutment surface is supported by abutment against an extramaxillary anterior maxillary abutment surface of patient tissue covering the subnasal maxillary bone;

a posterior maxillary abutment surface located intraorally to prevent rotation of the dental orthotic device caused by interaction of the anterior mandibular abutment surface within the intraoral cavity with the anterior maxillary abutment surface external to the maxilla.

2. The dental orthotic device of claim 1, wherein: the anterior maxillary abutment surface is concave.

3. The dental orthotic device of claim 1, wherein: the anterior maxillary abutment surface is shaped to comfortably fit and conform to the tissue covering the maxilla.

4. The dental orthotic device of claim 1, wherein: the anterior maxillary abutment surface is extraoral.

5. The dental orthotic device of claim 1, wherein: the position of the anterior maxillary abutment surface is adjustable so that the extent of protrusion of the mandible is variable.

6. The dental orthotic device of claim 5, wherein: the adjustment of the position is achieved by means of a screw extension device.

7. The dental orthotic device of claim 1, wherein: the dental orthotic device further comprises a posterior tongue abutment surface that presses against at least a portion of the patient's tongue to avoid or at least reduce obstruction of the patient's airway.

8. The dental orthotic device of claim 7, wherein: the position of the posterior tongue abutment surface is adjustable to vary the degree of compression of at least a portion of the patient's tongue.

9. The dental orthotic device of claim 1, wherein: the dental orthotic device has a cavity for receiving at least a portion of an anterior segment of a tongue.

10. The dental orthotic device of claim 9, wherein: the cavity is adapted to hold the tongue in an advanced position.

11. The dental orthotic device of claim 10, wherein: the cavity includes an upper tongue retaining surface and a lower tongue retaining surface.

12. The dental orthotic device of claim 11, wherein: the combined biting forces from the anterior maxillary and mandibular abutment surfaces cause the superior and inferior tongue retaining surfaces to firmly retain the tongue in the advanced position.

13. The dental orthotic device of claim 1, wherein: the intraoral anterior mandibular abutment surface is shaped to fit comfortably on the gingiva covering the mandible.

14. The dental orthotic device of claim 13, wherein: the intraoral anterior mandibular abutment surface is made of an elastomeric material.

15. The dental orthotic device of claim 14, wherein: the intraoral anterior mandibular abutment surface is made of a thermoplastic elastomeric material.

16. The dental orthotic device of claim 15, wherein: the elastomeric material is silicone rubber.

17. The dental orthotic device of claim 1, wherein: the dental orthotic device includes at least one guide surface adapted to resist lateral movement of the dental orthotic device in the patient's mouth.

18. The dental orthotic device of claim 1, wherein: the dental orthotic device includes a soft palate abutment surface adapted to support the patient's soft palate.

19. The dental orthotic device of claim 18, wherein: the soft palate abutment surface is shaped to conform to the surface of the soft palate.

20. The dental orthotic device of claim 1, wherein: the dental orthotic device is provided with air holes to facilitate airflow through the patient's airway.

21. The dental orthotic device of claim 1, wherein: the dental appliance further includes a tooth stabilizing plate adapted to be fitted to the lower dentition and/or the upper dentition.