Custom reduction splint for edentulous patients

• US 9,192,505 B2
• Filed: 02/23/2015
• Issued: 11/24/2015
• Est. Priority Date: 02/24/2014
• Status: Active Grant

• Current Assignee: University of South Florida (State University System of Florida)
• Original Assignee: University of South Florida (State University System of Florida)
• Inventors: Decker, Summer Joy, Ford, Jonathan Michael, Ching, Jessica Allen
• Primary Examiner(s): Le, Vu
• Assistant Examiner(s): BEG, SAMAH A
• Application Number:
  US14/629,074
• Publication Number:
  US 20150238345A1
• Time in Patent Office: 274 Days
• Field of Search: None
• US Class Current: 1/1
• CPC Class Codes: A61B 6/032 Transmission computed tomography [CT]
• CPC Class Codes: A61B 6/037 Emission tomography
• CPC Class Codes: A61B 6/51 for dentistry
• CPC Class Codes: A61C 13/0004 Computer-assisted sizing or machining of dental prostheses
• CPC Class Codes: A61C 17/08 Aspiration nozzles
• CPC Class Codes: A61C 5/007 Dental splints; teeth or jaw immobilisation devices; stabilizing retainers bonded to teeth after orthodontic treatments
• CPC Class Codes: A61C 9/0053 Optical means or methods, e.g. scanning the teeth by a laser or light beam
• CPC Class Codes: A61F 5/05891 for the head, e.g. jaws, nose nose correcting A61F5/08
• CPC Class Codes: G06T 17/20 Finite element generation, e.g. wire-frame surface description, tesselation
• CPC Class Codes: G06T 2200/08 involving all processing steps from image acquisition to 3D model generation
• CPC Class Codes: G06T 3/14 Transformations for image registration, e.g. adjusting or mapping for alignment of images
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture

Abstract

A custom oral splint that is operatively secured to the maxilla and mandible of a subject/patient to assist in reduction and provide maintenance of reduction of maxillary and mandibular fractures in the edentulous or partially edentulous subject/patient. In this difficult patient population, there are very limited options for maxillomandibular fixation, and none provide stable reduction of fractures. The novel device minimizes operative time and equipment, as well as offers the ability to transition the patient from rigid fixation to elastics postoperatively. The novel device is custom-designed for each patient'"'"'s degree of bone atrophy, ensuring a high quality, and effective product.

Claims

1. A method of fabricating an oral splint for reduction of an oral fracture in an edentulous or partially edentulous subject or patient, comprising:

scanning or imaging a jaw of said subject or patient;

importing results of said scanning or imaging into one or more software applications that segments a maxilla and a mandible of said jaw;

realigning said fracture within said maxilla or said mandible on said one or more software applications into a normal position;

outlining an upper palate of said jaw on said one or more software applications;

outlining a lower palate of said jaw on said one or more software applications;

interpolating a distance between said outline of said upper palate and said outline of said lower palate on said one or more software applications;

indicating said distance as an initial splint configuration on said one or more software applications;

removing bone and dentition of said maxilla and said mandible from said image of said jaw on said one or more software applications; and

splitting said initial splint configuration into a maxillary splint and a mandibular splint on said one or more software applications, thus forming a virtual image of said oral splint, wherein said oral splint is fabricated physically based on said virtual image of said oral splint.

2. A method as in claim 1, further comprising:

tessellating said maxilla and said mandible into a three-dimensional model after importing said results of said scanning or imaging into said one or more software applications.

3. A method as in claim 1, further comprising:

expanding said initial splint configuration outwardly to snugly fit or contain said maxilla and said mandible in said normal position.

4. A method as in claim 1, further comprising:

forming an evacuation aperture in an anterior portion of said initial splint configuration, wherein an upper portion of said evacuation aperture is disposed in said anterior portion of said maxillary splint and a lower portion of said evacuation aperture is disposed in said anterior portion of said mandibular splint.

5. A method as in claim 1, further comprising:

the step of splitting said initial splint configuration performed by positioning an anterior-posterior plane within a midsection of said initial splint configuration, wherein the position of said plane in a cranial-caudal direction is based on a presence or absence of teeth within said jaw of said subject or patient, and

separating said maxillary splint and said mandibular splint along said plane.

6. A method as in claim 1, further comprising:

disposing an extrusion on one of a superior surface of said mandibular splint or an inferior surface of said maxillary splint on said one or more software applications;

disposing a channel in the other of said superior surface of said mandibular splint or said inferior surface of said maxillary splint that did not receive said extrusion on said one or more software applications, wherein a position of said channel corresponds to a position of said extrusion,

said extrusion and said channel forming a tongue and groove fitting between said maxillary splint and said mandibular splint.

7. A method as in claim 6, further comprising:

said extrusion being U-shaped along a jaw line of said subject or patient, and

said channel being U-shaped along said jaw line of said subject or patient.

8. A method as in claim 1, further comprising:

disposing a first maxillary projection and a second maxillary projection on said maxillary splint; and

disposing a first mandibular projection and a second mandibular projection on said mandibular splint,

wherein said first maxillary projection and said first mandibular projection are aligned with each other, and

wherein said second maxillary projection and said second mandibular projection are aligned with each other.

9. A method as in claim 1, further comprising:

prior to outlining said upper and lower palates, positioning a spacer on said maxilla or said mandible of said subject or patient on said one or more software applications in order to provide proper spacing within said jaw of said subject or patient.

10. A surgical technique for reduction of an oral fracture in an edentulous or partially edentulous subject or patient, comprising:

scanning or imaging a jaw of said subject or patient;

importing results of said scanning or imaging into one or more software applications that segments a maxilla and a mandible of said jaw;

realigning said fracture within said maxilla or said mandible on said one or more software applications into a normal position;

outlining an upper palate of said jaw on said one or more software applications;

outlining a lower palate of said jaw on said one or more software applications;

interpolating a distance between said outline of said upper palate and said outline of said lower palate on said one or more software applications;

indicating said distance as an initial splint configuration on said one or more software applications;

removing bone and dentition of said maxilla and said mandible from said image of said jaw on said one or more software applications;

splitting said initial splint configuration into a maxillary splint and a mandibular splint on said one or more software applications, thus forming a virtual image of said oral splint;

fabricating said oral splint based on said virtual image of said oral splint;

positioning and securing said maxillary splint of said fabricated oral splint on said maxilla of said subject or patient in a normal or reduced fracture position of said maxilla; and

positioning and securing said mandibular splint of said fabricated oral splint on said mandible of said subject or patient in a normal or reduced fracture position of said mandible.

11. A surgical technique as in claim 10, further comprising:

tessellating said maxilla and said mandible into a three-dimensional model after importing said results of said scanning or imaging into said one or more software applications.

12. A surgical technique as in claim 10, further comprising:

expanding said initial splint configuration outwardly to snugly fit or contain said maxilla and said mandible in said normal position.

13. A surgical technique as in claim 10, further comprising:

forming an evacuation aperture in an anterior portion of said initial splint configuration, wherein an upper portion of said evacuation aperture is disposed in said anterior portion of said maxillary splint and a lower portion of said evacuation aperture is disposed in said anterior portion of said mandibular splint.

14. A surgical technique as in claim 10, further comprising:

the step of splitting said initial splint configuration performed by positioning an anterior-posterior plane within a midsection of said initial splint configuration, wherein the position of said plane in a cranial-caudal direction is based on a presence or absence of teeth within said jaw of said subject or patient, and

separating said maxillary splint and said mandibular splint along said plane.

15. A surgical technique as in claim 10, further comprising:

disposing an extrusion on one of a superior surface of said mandibular splint or an inferior surface of said maxillary splint on said one or more software applications;

disposing a channel in the other of said superior surface of said mandibular splint or said inferior surface of said maxillary splint that did not receive said extrusion on said one or more software applications, wherein a position of said channel corresponds to a position of said extrusion,

said extrusion and said channel forming a tongue and groove fitting between said maxillary splint and said mandibular splint.

16. A surgical technique as in claim 15, further comprising:

said extrusion being U-shaped along a jaw line of said subject or patient, and

said channel being U-shaped along said jaw line of said subject or patient.

17. A surgical technique as in claim 10, further comprising:

disposing a first maxillary projection and a second maxillary projection on said maxillary splint; and

disposing a first mandibular projection and a second mandibular projection on said mandibular splint,

wherein said first maxillary projection and said first mandibular projection are aligned with each other, and

wherein said second maxillary projection and said second mandibular projection are aligned with each other.

18. A surgical technique as in claim 17, further comprising:

securing said maxillary splint and said mandibular splint together via intersplint wires wrapped around said first maxillary projection and said first mandibular projection and also around said second maxillary projection and said second mandibular projection.

19. A surgical technique as in claim 10, further comprising:

prior to outlining said upper and lower palates, positioning a spacer on said maxilla or said mandible of said subject or patient on said one or more software applications in order to provide proper spacing within said jaw of said subject or patient.

20. A surgical technique for reduction of an oral fracture in an edentulous or partially edentulous subject or patient, comprising:

scanning or imaging a jaw of said subject or patient;

importing results of said scanning or imaging into one or more software applications that segments a maxilla and a mandible of said jaw;

tessellating said maxilla and said mandible into a three-dimensional model;

realigning said fracture within said maxilla or said mandible on said one or more software applications into a normal position;

positioning a spacer on said maxilla or said mandible of said subject or patient on said one or more software applications in order to provide proper spacing within said jaw of said subject or patient;

outlining an upper palate of said jaw on said one or more software applications;

outlining said maxilla of said jaw on said one or more software applications;

outlining a lower palate of said jaw on said one or more software applications;

outlining said mandible of said jaw on said one or more software applications;

interpolating a distance between said outline of said upper palate and said outline of said lower palate on said one or more software applications;

indicating said distance as an initial splint configuration on said one or more software applications;

expanding said initial splint configuration outwardly to snugly fit or contain said maxilla and said mandible in said normal position;

trimming or filing an upper edge or a lower edge of said initial splint configuration to better fit said jaw of said subject or patient;

removing bone and dentition of said maxilla and said mandible from said image of said jaw on said one or more software applications;

forming an evacuation aperture in an anterior portion of said initial splint configuration;

splitting said initial splint configuration into a maxillary splint and a mandibular splint on said one or more software applications, thus forming a virtual image of said oral splint, wherein an upper portion of said evacuation aperture is disposed in said anterior portion of said maxillary splint and a lower portion of said evacuation aperture is disposed in said anterior portion of said mandibular splint,

wherein the step of splitting said initial splint configuration is performed by

positioning an anterior-posterior plane within a midsection of said initial splint configuration, wherein the position of said plane in a cranial-caudal direction is based on a presence or absence of teeth within said jaw of said subject or patient, and

separating said maxillary splint and said mandibular splint along said plane;

forming a plurality of wire apertures in said maxillary splint and said mandibular splint to accommodate wiring to secure said maxillary splint to said maxilla and to accommodate wiring to secure said mandibular splint to said mandible;

disposing an extrusion on one of a superior surface of said mandibular splint or an inferior surface of said maxillary splint on said one or more software applications;

disposing a channel in the other of said superior surface of said mandibular splint or said inferior surface of said maxillary splint that did not receive said extrusion on said one or more software applications, wherein a position of said channel corresponds to a position of said extrusion,

said extrusion being U-shaped along a jaw line of said subject or patient and said channel being U-shaped along said jaw line of said subject or patient, wherein said extrusion and said channel form a tongue and groove fitting between said maxillary splint and said mandibular splint;

disposing a first maxillary projection and a second maxillary projection on said maxillary splint;

disposing a first mandibular projection and a second mandibular projection on said mandibular splint, wherein said first maxillary projection and said first mandibular projection are aligned with each other, and wherein said second maxillary projection and said second mandibular projection are aligned with each other,

said first and second maxillary projections and said first and second mandibular projections including divots;

fabricating said oral splint based on said virtual image of said oral splint by transmitting said virtual image to a three-dimensional printer for printing of said oral splint;

positioning and securing said maxillary splint of said fabricated oral splint on said maxilla of said subject or patient in a normal or reduced fracture position of said maxilla, wherein the step of securing said maxillary splint on said maxilla of said subject or patient is performed by a mechanism selected from the group consisting of a pyriform drop wire and transpalatal-pyriform wire;

positioning and securing said mandibular splint of said fabricated oral splint on said mandible of said subject or patient in a normal or reduced fracture position of said mandible, wherein the step of securing said mandibular splint on said mandible of said subject or patient is with circummandibular wires performed by utilizing an awl; and

securing said maxillary splint and said mandibular splint together via intersplint wires wrapped around said first maxillary projection and said first mandibular projection within said divots and also around said second maxillary projection and said second mandibular projection within said divots.