The patent supplement to the main patent application no. P.420625 titled Ά measurement device and a method for recording the positions of teeth’ relates to a device and method for the definition of mandibular function and a method for ensuring repeatability of results of measurements carried out using the device disclosed in the main patent application no. P.420625 titled Ά measurement device and a method for recording the positions of teeth’

Polish patent application no. P.420625 discloses a measurement device and a method for recording the positions of teeth characterized by a specific method for mounting measurement devices to patients’ heads so as to record anatomical head reference points and determine jaw anatomy as well as spatial positions of individual teeth using recording devices, markers, cameras, etc. positioned along the arbitrary facial symmetry axis. The solution provides information on the shape and relative spatial positions of elements, e.g. teeth.

A method for human motion capture is known and involves the use of a camera or a set of cameras and markers wherein markers in the form of geometric shapes, printed sticker tags, LEDs and others, are placed on the body surface at specific anthropometric points so that the movement of these markers is recorded by the cameras. Reconstruction of motion on the basis of marker position data obtained using the cameras involves digital reconstruction of the patient model and marker motions on a computer screen. The method provides information on the structure and the range of motions of the skeletal system with joints acting as hinges defining rotation centers and bones/ skeleton being used as immobile reference for reconstruction of object motions based on minimization of distances between individual markers and the reference point marker. The motion capture technique can be used for medical purposes and is widely applied in physiotherapy. However, the method may be used for reconstruction of positions and motions of larger elements, such as for determination of limb tremor parameters, or for determination of phases of motions of body parts being at the highest risk of potential falls.

The objective of this patent supplement is to enhance the disclosure of the main Polish patent no P.420625 titled‘A measurement device and a method for recording the positions of teeth’ by providing a method for recording the spatial movements of the lower jaw using the motion capture technology and reference points determined using the solution disclosed in the main patent as well as procedures used for obtaining information used e.g. for preparation of prosthetic jobs.

The solution according to the invention is substantially characterized in that the measurement device for determination of constant reference points according to the main patent consisting of recording devices (4a and 4b) mounted interchangeably to the hoop frame (1) featuring a reference handle (3) and the para-occlusal index tray comprising an upper dentition bracket, comprises an additional lower dentition bracket (5 ¹ ) mounted to lower teeth preferably using the impression material (15) wherein both the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) feature the recording devices (4a and 4b) and markers (18), preferably in the form of LEDs, geometric shapes, or sticker tags

The solution according to the invention is substantially characterized in that it also comprises additional ear plugs (20) with external markers (18).

The solution according to the invention is substantially characterized in that the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) feature a spacer (22) preferably in the shape of a wedge adjacent to the space between the front upper and lower incisor teeth so as to maintain constant distances from the markers (18) / recording devices (4a, 4b) mounted to the external brackets for precise determination of reference points at a constant distance from patient's teeth.

The solution according to the invention is substantially characterized in that markers (18) on the upper dentition bracket (5) and lower dentition bracket (5 ¹ ) as well as on the ear plugs (20) placed within the patient's acoustic openings (11) are tracked by cameras (a camera system) (19) positioned around the patient's face (11) so as to determine relative positions of upper dentition bracket (5) and lower dentition bracket (5 ¹ ) as well as the positions of brackets (5, 5 ¹ ) relative to the arbitrary temporomandinbular joint hinge axis running through external acoustic openings. As a consequence, precise mapping of individual reference points on the patient's face is possible in the digital reconstruction process for a more accurate measurement of relative positions of upper and lower jaws as well as the lower jaw motions.

The solution according to the invention is substantially characterized in that the cameras (camera system) (19) positioned around the patient's face (11) record the entire facial area including the positions of all recording devices (4a, 4b) and markers (18) to read information on the position and movements of markers (18) placed at individual patient's reference points so that the positions of the upper and lower jaw of the patient model (11) in relation to each other and in relation to the arbitrary hinge axis as well as the position of the arbitrary hinge axis defined as a straight line (axis), preferably a fixed straight line connecting markers (18) mounted to ear plugs (20) so as to provide a reference for movements, are reconstructed on a computer screen by means of a digital process on the basis of said information on the position and movements of markers (18) -Taking into consideration information obtained in the procedure disclosed in patent application no. P.420625, one is able to reconstruct the position and angular relationship between the upper and the lower jaw with accurate identification of angular positions of individual teeth, including their positions relative to the arbitrary temporomandibular joint hinge axis Thus, the disclosed method facilitates visualization of mutual interactions of the upper and the lower jaw so that information for further use e.g. in dental prosthetics may be obtained in a quick and precise manner.

The solution according to the invention is substantially characterized in that the first reference measurement consists of three stages wherein the first stage consists in the patient's face (11) being photographed using cameras (a camera system (19) at least from the front and from a side or according to the FGTP sequence so that the camera's field of vision encompasses the recording devices (4a, 4b) mounted to the hoop frame (1) and the upper and lower dentition brackets (5 and 5 ¹ ), preferably comprising markers (18), and markers (18) on ear plugs (20); preferably, markers (18) should be located at predefined distances from the patient's anatomical points with the distance of markers located on the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) being preferably fixed by means of spacers (22) adjacent to the space between the front upper and lower incisor teeth wherein the position of the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) is preferably fixed using the impression material (15) so that the markers (18) on ear plugs (20) determine the anatomical facial reference points for definition of the arbitrary temporomandibular joint hinge axis; angular positions relative to the facial reference lines and the temporomandibular joint hinge axis are measured using the recording and recorded devices (4a and 4b) mounted to the hoop frame (1) and the upper dentition bracket (5); the second stage consists in the measurement of the positions of upper and lower jaw teeth upon occlusion (e.g. habitual occlusion), i.e. the measurement of the relative position (angular position) of the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) using the recording devices (4a and 4b) while the third stage consists in the recording of the movement pattern of the marker (18) on the lower dentition bracket (5 ¹ ) relative to the marker (18) on the upper dentition bracket (5) and in relation to the previously determined distance between both markers being recorded using the camera; preferably, the movement pattern is correlated and recorded relative to the arbitrary hinge axis defined by markers (18) on ear plugs (20) placed in both external acoustic openings of patient's head (11). A significant advantage of the solution consists in that markers (18) mounted to brackets (5 and 5 ¹ ) using spacers (22) facilitate correlation of 3D models with 2D models obtained during the first stage measurements.

The solution according to the invention is substantially characterized in that during the second measurement carried out in the patient (11) in clinical setting in a manner consistent to that of the first measurement, prosthetic jobs previously prepared in a prosthetic lab on the basis of information obtained during the first measurement and preferably firmly fixed, e.g. by means of positioning indices, are fitted to the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) for better verification of measurements so as to ensure better repeatability and prosthetic fitting in clinical settings and to determine appropriate numerical values.

An advantage of the solution consists in the ability to obtain information on the relative movements of the upper and lower jaw ( by means of recording the movement pattern of the marker (18) on the lower dentition bracket (5 ¹ ) relative to the marker (18) on the upper dentition bracket (5)) also in relation to the arbitrary hinge axis defined by anatomical reference points i.e. external acoustic openings, as well as relative positions of individual teeth during their movement relative to the arbitrary hinge line so that a more accurate model and prosthetic job may be obtained; the model should include and preferably measure the positions of individual teeth relative to the prosthetic jobs during occlusion as well as jaw movements.

Another advantage of the solution according to the patent supplement is that verifiable and repeatable measurement result are obtained.

Another advantage of the solution consists in the ability of performing an analysis of the patient's face for determination of arbitrary aesthetic points as reference for future measurements. Yet another advantage consists in the ability of photographs obtained using cameras with distance measurement function being used for determination of the positions of markers (18) upon occlusion as well as during jaw movements.

The subject of the invention is presented as an example embodiment and illustrated in the enclosed figures: Fig. 1 and Fig. 2.

Fig. 1 presents an embodiment consisting of a patient model (11) wearing upper and lower dentition brackets (5, 5 ¹ ) with recording devices (4a and 4b) and markers (18) as well as markers (18) placed on the ear plugs (20) within the patient's external acoustic openings (11). The entire patient model (11) including all recording devices (4a, 4b), brackets (5, 5 ¹ ) and markers (18) is recorded using an external camera (19) and the image from the external camera is analyzed as a digital model within a computer system.

Fig. 2 presents an embodiment consisting of a model of the patient's upper and lower jaw (11) with upper and lower dentition brackets (5 i 5 ¹ ) being mounted using impression material (15) and featuring recording devices (4a, 4b) and markers (18) wherein said upper and lower dentition brackets (5 and 5 ¹ ) are equipped with spacers (22) adjacent to the space between the front upper and lower teeth (median inter-incisor line).

In addition, two possible variants for the obtained information being used in a prosthetic device-forming process are provided for better explanation of value delivered by the solution:

Office visit 1

A standard scan of upper and lower teeth is acquired. Next, the dentist places the customized upper and lower dentition brackets fitted with inclinometers onto patient's upper and lower teeth, respectively. Before the brackets are placed onto the teeth, they are covered with a material facilitating the position of brackets being recorded, i.e the brackets being unambiguously positioned relative to the facial surface of teeth); next, the material- covered brackets are placed along with the inclinometers onto patient's teeth.

1. The impression material sets on the brackets; then, the dentist removes the brackets and processes excess impression material so that the brackets don’t collide with each other and thus don't change their positions relative to patient's teeth after they are placed in patient's mouth again. Next, the hoop frame with a reference handle (marker) is placed on patient’s head and reference photographs are taken at least from the front and both sides using common photographic cameras, preferably smartphone cameras. The handle facilitates identification of facial reference (aesthetic) lines and positioning of the jaw models within the 3D space in combination with the photographs of the patient's face taken from the front and the sides or according to the FGTP sequence. Next, with upper dentition bracket complete with set impression material matching the upper teeth and the reference handle on, the patient optionally undergoes the reference measurement of the angle between the reference handle and the upper dentition bracket. Photographs of patient's face are taken (at least two photographs including one from the front and one from a side, or a facially generated treatment planning (FGTP) photo sequence) with at least the upper dentition bracket (5) and the hoop frame (1) on (lower dentition bracket (5 ¹ ) or ear plugs (20) may also be put in place. Next, measurements of angular positions are taken at the upper dentition bracket (5) (including the recording device 4a) being mounted to the upper teeth and at the index plate including the recording device (4a) affixed to the occlusal surface of the upper teeth. The latter is identical to the upper dentition occlusal surface index plate disclosed in the main patent. Before being fixed, the index plate is covered with the same impression material to facilitate the recording of its position relative to the occlusal surface of the upper teeth. The index plate and the impression material is affixed to the occlusal surface of upper teeth and left there until the setting of the impression material. After the measurement, the index plate is taken off the teeth and removed from the patient's mouth while the upper dentition bracket (5) is being left on the upper teeth. Next, the lower dentition bracket (5 ¹ ) covered with processed impression material (15) and featuring a recording device mounted thereto is put into place. Patient is allowed to bring their teeth to the reference position (occlusion) and another measurement of the relative angular position between the upper dentition bracket (5) and the lower dentition bracket (5 ¹ ) is taken. Only after this measurement, the upper dentition bracket (5) may be taken off the patient's teeth and removed from their mouth. The hoop frame (1) featuring a reference handle (3) (as disclosed in the main patent) with marker (18) remains on patient's head (11), and analogous photographs are taken with patient’s upper and lower teeth (11) exposed (i.e. free of dentition brackets (5, 5 ¹ ), optionally according to the FGTP sequence)

Lab visit 1

*The dental technician receives:

Linked angular data from the recording devices (4a, 4b) (attached to the hoop frame (1), upper and lower dentition brackets (5, 5 ¹ ), and upper dentition occlusal surface index plate at different clinical stages), scans of brackets (5, 5 ¹ ) with the impression material (15) fitting the dentition and reflecting the position of brackets (5, 5 ¹ ) relative to the facial surface of upper and lower teeth (scans acquired when brackets are placed on the teeth inside patient's mouth), scans of patient's teeth (11), a scan of the index plate with the fitting impression material (15), the position of the upper dentition occlusal surface, front photographs of patient's face (x2, one with and one without the upper dentition bracket (5)), side photographs of patient’s face (x2, likewise with and without the upper dentition bracket (5) or according to the FGTP sequence).

1. Scans of patient’s teeth are entered into the 3D environment

2. Scans of brackets (5, 5 ¹ ) with impression materials (15) and the scan of upper dentition occlusal surface index plate are entered into the 3D environment..

3. Scans of teeth, brackets (5, 5 ¹ ) and the index plate are positioned relative to one another using the computer software.

Next, the computer software separates the mutually positioned scans of the brackets (5, 5 ¹ ), upper and lower teeth, and the upper dentition occlusal surface index plate and the patient’s facial scan; the scans of the teeth are then reduced to the 0 degree reference plane for workup by the dental technician (using the angular position data from the measurement devices (5, 5 ¹ ).

4. 2D images are entered and positioned within the 3D environment on the basis of markers (18). 5. Thus prepared, or positioned in relation to one another and to the photographs (of the patient’s face), scans (or models) of the patient’s teeth are sent to any dental lab software facilitating standard 3D workup so that the prosthetic job (crown, bridge, prosthesis, surgical template, dental guard, orthodontic apparatus) may be completed.

6. After the prosthetic job is completed, its positioning index is designed and obtained (taking into consideration the adapter as disclosed in the main patent for connecting (i.e. tightly fitting) the prosthetic job to the recording device (4a, 4b) housing socket). This facilitates verification of the angular position of upper and lower dentition brackets (5, 5 ¹ ) and the index plate relative to one another and to the patient’s teeth (11).

7. The positioning index is printed; if the dental/laboratory job is to encompass both the upper and the lower dental arch, upper and lower positioning indices are required respectively.

8. The laboratory jobs are sent to the dentist's office along with relevant positioning indices

Office visit 2

The laboratory job (or its intermediate/working stage), is placed on patients teeth and firmly connected to the positioning index specific for that job. Next, upper dentition occlusal surface index plate is optionally placed and the measurement is taken. The upper dentition occlusal surface index plate is removed from patient's mouth and the lower positioning index is placed (in case of jobs involving both dental arches, both jobs are placed together along with the upper and lower positioning indices).

1. The angular position of the upper positioning index rigidly fixed to the upper dental arch teeth is taken relative to the lower positioning index* rigidly fixed to the lower dental arch teeth while the teeth are in the reference occlusion position.

* This measurement is crucial for the procedure as it verifies the laboratory job by comparing the results to those obtained during the first visit. Verification consists in determination of the accuracy of the (assumed) angular position allowing the prosthetic job to be placed in a specific position being reproduced by the laboratory. Thanks to the use of the positioning index linked to the prosthetic job, the accuracy of job fitting may be expressed numerically for the assessment of the accuracy of mapping at the laboratory as well as at the dental office (this includes the variant of the office measurement being verified at the lab and the variant of lab measurement being verified during the second office visit)

2. The prosthetic job is placed on one of the patient’s dental arches, followed by the positioning index along with the adapter fitting the recording device (4a, 4b) housing socket (optionally, the positioning index is firmly connected to the prosthetic job at the working stage).

3. The bracket with the impression material used in the first measurement, corresponding positioning index or a prosthetic job with the positioning index is placed on the other dental arch and the patient is instructed to bring their teeth to the reference occlusion position before the measurement is taken.

In principle, the measurement should correspond to the difference by which the upper and/ or lower occlusal surface measured during the first visit had to be reduced by dental technician to the zero level (the dental technician knows the angles used for modification of the upper and/or lower occlusal surface i.e. the difference between the actual upper and/or lower occlusal surface and the future target upper and/or lower occlusal surface so as to meet both the aesthetic (prosthetic job being inscribed into patient’s facial photographs) as well as functional (teeth being positioned in relation to one another in a precisely repeatable manner, and movements of teeth in relation to one another in line with the mastication muscles and temporomandibular joints function being predictable and repeatable) criteria.