WO2010007201A1 - Improved mandibular advancement device - Google Patents

Improved mandibular advancement device Download PDF

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Publication number
WO2010007201A1
WO2010007201A1 PCT/ES2009/070292 ES2009070292W WO2010007201A1 WO 2010007201 A1 WO2010007201 A1 WO 2010007201A1 ES 2009070292 W ES2009070292 W ES 2009070292W WO 2010007201 A1 WO2010007201 A1 WO 2010007201A1
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WO
WIPO (PCT)
Prior art keywords
advancement
jaw
airway
pockets
mandibular advancement
Prior art date
Application number
PCT/ES2009/070292
Other languages
Spanish (es)
French (fr)
Inventor
Felix De Carlos Villafranca
Angel Fernandez-peña Artime
Covadonga Alvarez Abad
Libia Lopez Iglesias
Maria Pilar Fernandez Mondragon
Aranzazu Senosiain Oroquieta
Angela Garcia Suarez
Juan M. Cobo Plana
Alberto Alvarez Suarez
Berta Pardo Lopez
Belen Diaz Esnal
Emilio Macias Escalada
Teresa Cobo Diaz
Juan Jose Garcia Fernandez
Original Assignee
Felix De Carlos Villafranca
Fernandez-Pena Artime Angel
Covadonga Alvarez Abad
Libia Lopez Iglesias
Fernandez Mondragon Maria Pila
Aranzazu Senosiain Oroquieta
Angela Garcia Suarez
Cobo Plana Juan M
Alberto Alvarez Suarez
Berta Pardo Lopez
Belen Diaz Esnal
Emilio Macias Escalada
Teresa Cobo Diaz
Juan Jose Garcia Fernandez
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by Felix De Carlos Villafranca, Fernandez-Pena Artime Angel, Covadonga Alvarez Abad, Libia Lopez Iglesias, Fernandez Mondragon Maria Pila, Aranzazu Senosiain Oroquieta, Angela Garcia Suarez, Cobo Plana Juan M, Alberto Alvarez Suarez, Berta Pardo Lopez, Belen Diaz Esnal, Emilio Macias Escalada, Teresa Cobo Diaz, Juan Jose Garcia Fernandez filed Critical Felix De Carlos Villafranca
Priority to DE112009001742T priority Critical patent/DE112009001742T5/en
Publication of WO2010007201A1 publication Critical patent/WO2010007201A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/36Devices acting between upper and lower teeth
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00Dental auxiliary appliances
    • A61C19/04Measuring instruments specially adapted for dentistry
    • A61C19/05Measuring instruments specially adapted for dentistry for determining occlusion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/08Mouthpiece-type retainers or positioners, e.g. for both the lower and upper arch
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/56Devices for preventing snoring
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/56Devices for preventing snoring
    • A61F5/566Intra-oral devices

Definitions

  • the object of the present invention is an improved mandibular advancement device, adjustable and adaptable to the upper and lower dentures, keeping them connected with a sufficient opening for a smooth and comfortable breathing, forcing the lower jaw to advance with its denture with respect to the upper one, but allowing virtually natural mobility in every way, but limited.
  • the mandibular advancement devices are introduced into the mouth and modify the position of the jaw, tongue, and other support structures of the Upper Airway (VAS) for the treatment of snoring and / or Sleep Apnea-Hypopnea Syndrome (SAHS), are devices used in the dental, stomatological and orthodontic medical field, the main objective being to advance or advance the lower jaw with respect to the upper jaw, in order to keep the airway permeable or released to a sufficient degree, in such a way that it largely avoids its fortuitous or unconscious closure.
  • VAS Upper Airway
  • SAHS Sleep Apnea-Hypopnea Syndrome
  • the present invention characterizes the special configuration and design of a device that coupled in the dental arches, advances or advances the jaw, separates the jaws from each other, and allows us to perform a series of very wide movements controlled or limited by the device. Incorporating an interchangeable piece that will be replaced periodically by a similar piece of different size, according to the appropriate medical treatment, achieving the necessary progress to achieve the final goal of the treatment.
  • REPLACEMENT SHEET (Rule 26) Thanks to the use of the device object of the invention it is possible to achieve the displacement of the jaw in a progressive, little traumatic, and comfortable way. Allowing us a good jaw mobility with respect to the devices that are currently known for this same purpose.
  • the present invention is mainly circumscribed, within the medical field of orthodontics.
  • REPLACEMENT SHEET (Rule 26)
  • the mandibular advancement devices perform an anterior and inferior movement of the jaw, generating anatomic variations in the upper airway that increase the pharyngeal sectional area. This movement stabilizes and fixes the jaw and the hyoid bone, which prevents the post-rotation of these structures during the recumbency and prevents the occupation of the airway. It has been proven that in individuals (SAHS) the total percentage of time in which patients sleep with their mouths open more than 5 mm. (posterior rotation and retrusion) is significantly higher (69.3%) than in healthy individuals (11.1%); therefore, the movement of rotation and fixation of the jaw during sleep can be one of the important elements during treatment with the mandibular advancement devices.
  • REPLACEMENT SHEET (Rule 26) mandibular Said mandibular functional advance induces changes in the position of the hyoid bone towards a more advanced position. A new equilibrium situation of the suprahyoid musculature appears now, which favors the increase in volume and the permeability of the upper airway.
  • the patient is trained for insertion and maintenance care. After getting the patient accustomed to the device, progress is gradually made.
  • Treatment with these devices is a reasonable alternative, since they do not involve a permanent change in individuals (as is the case with surgery) and can be dismissed at any time.
  • the appropriate study of the patient in terms of risk / benefit assessment must be presented individually in order to achieve the best therapy in each case.
  • the present invention of an improved mandibular advancement device basically consists of a set of pieces that are arranged inside the mouth, adjusted in the corresponding denture, which will allow us to advance the lower jaw with respect to the upper one, but in a progressive way, by being able to replace periodically, according to medical treatment, the main link piece (1) that will modify its progress.
  • the set of the device that attaches to the denture is constituted by five pieces fundamentally, a top splint of material
  • REPLACEMENT SHEET (Rule 26) plastic (6) and a lower one, which incorporates frontally inside metal pockets (3), which will be linked by an interchangeable feed piece (1) of different frontal dimensions, and fixed to the pocket (3) by means of captive screws (8), which will allow us to easily and periodically exchange the pieces (1), placing each one with a larger advance in its area (13).
  • the device object of the present invention it is possible to carry out a simple and correct treatment of progressive mandibular advancement of a patient, achieving a precise advancement of the jaw, which achieves the desired therapeutic objectives.
  • the present device allows us a very simple and comfortable adaptation to the denture.
  • the number of pieces used are minimal and easy to manufacture.
  • the user will quickly get used to using it.
  • REPLACEMENT SHEET (Rule 26) Its characteristics are accompanied by the present specification, of a set of drawings in whose figures, in an illustrative and non-limiting manner, the most significant details of the invention are represented.
  • Figure 1 a Shows a partial lateral section made by the center of a person's head; it highlights the airways, from the trachea (17), to the nasal cavity (20) and the mouth (10). It clearly depicts the upper (12) and lower (11) jaws, among which is the tongue (14). We also indicate with "A” the direction of the movement that we intend to make in order to release the area of the larynx "X”.
  • Figure 2 a Shows a partial partial section made by the center of a person's head; it highlights the airways actively with arrows that communicate at the height of the pharynx (16), from the trachea (17), to the nasal cavity (20) and the mouth (10). It clearly depicts the upper (12) and lower (11) jaws, among which is the tongue (14). We also note with W A "movement direction we have made the lower jaw (11) releasing the area of the larynx> ⁇ Z". This movement is what we will be able to perform with the use of the mandibular advancement device that is being described.
  • Figure 3 a Shows a detailed and enlarged section of the area indicated in Figure 2 a , with the mandibular advancement device incorporated into the denture (9) of the patient's mouth (10).
  • Figure 4 a Shows a partial partial section made by the center of the device, clearly representing as
  • REPLACEMENT SHEET (Rule 26) It is the assembly of it. We have occlusal splints
  • Figure 5 a Shows two lower plan views of the two splints (6) that have to face to get the device, before linking with the piece (1). Each of them will adapt perfectly to the upper and lower dentures. These are made by removing a mold from the patient's complete denture in the traditional way, and when melting the piece to make the splint, the pockets (3) are incorporated frontally, being perfectly covered by the plastic material of the splint.
  • Figure 6 a Shows a somewhat schematic front view of the device, indicating how the splint (6) is assembled frontally with the built-in pockets (3), with the pieces (1) in the form of eight centrally located, and with the screws (8) tied in the pockets (3).
  • Figure 7 a Shows two front views of the body (1) interchangeable in the form of eight. This incorporates two windows (2) for its mooring in the pockets (3) by means of the screws (8). It also shows a central area (13) of variable dimension, which can then incorporate a staggering of different measures as you can see in figure 8 a to increase the progressive advance of the device.
  • Figure 8 a Shows the profile body (1) in different sizes according to the size or advance of the zone (13), which will be
  • Figure 9 a Shows a perspective of the body (1) with its windows (2) and advance zone (13).
  • Figure 10 a Shows three views of the pockets that are to be placed in front of the splints (6) and that will be cast together, with its interior (4) for insertion of the piece (1) and with the holes (15) for the placement of the captive screw (8) •
  • Figure 11 a Shows a semi-sectioned view on the lower floor of how the part (1) is inserted inside the pocket (3) a moment before the screw (8) is introduced for fixing.
  • Figure 12 a Shows a semi-sectioned view on the lower floor of how the piece (1) is placed inside (4) of the pocket (3) once the screw (8) has been inserted fixing the device for use.
  • Figure 13 a Shows a schematic front view of the device at rest indicating possible movements that can be performed with the use of this device once incorporated into the patient's denture, vertical movement (BB) and horizontal movement (CC). 14, the 15 and 16 to movement once performed is shown.
  • Figure 14 a Shows a front schematic view indicating the vertical movement (BB) in its maximum closing position. We see how the cashier (3) limits the movement internally.
  • Figure 15 a Shows a front schematic view indicating the vertical movement (BB) in its maximum opening position. We see how the screw (8) located in the pocket (3) limits the opening movement.
  • Figure 16 shows a schematic front view showing the movement performed horizontally (CC) in place of lateral displacement. We see how the screw (8) located in the pocket (3) allows to act in this movement.
  • Figure 17 a Shows a schematic front view where it can be seen that the device also allows us to perform laterally decompensated balancing movements (DD), thanks to the arrangement between the pockets (3) and the parts (1) controlled by the screws ( 8).
  • DD laterally decompensated balancing movements
  • 1 - Main body of the device is the interchangeable piece or (advance piece) that will mark the progress made.
  • This piece can be flat or incorporate a stepping (13) of the precise measurement.
  • Figure 9 a we see a perspective of it, and in Figure 8 a several pieces are shown with steps of different measures, which will mark the advance.
  • the body has two windows (2) that will be used for fixing inside (4) of the pockets (3) by means of captive screws (8).
  • REPLACEMENT SHEET (Rule 26) occlusal splint (6).
  • REPLACEMENT SHEET (Rule 26) 18 - Esophagus of the patient (food route).

Abstract

The invention relates to a mandibular advancement device for use in the intraoral treatment of problems involving obstruction of the upper airway, which device is fitted and adapted to the upper and lower teeth so as to maintain same interlinked with a sufficient advancement and opening to enable breathing and to leave the airway unobstructed. The advancement distance between the lower jaw bone and teeth and the upper jaw bone can be altered progressively, enabling effective but limited mobility through the use of a set of interlinked parts cast in occlusal splints, which can be used to adjust the position between the two opposing jaw bones with the simple incorporation of an interchangeable connecting part having different advancement measurements in the intermediate zone thereof, said part including two upper and lower flanges which are in turn inserted into recesses for stabilisation using set screws.

Description

DISPOSITIVO DE AVANCE MANDIBULAR MEJORADO IMPROVED MANDIBULAR ADVANCE DEVICE
DESCRIPCIÓNDESCRIPTION
OBJETO DE LA INVENCIÓNOBJECT OF THE INVENTION
Es objeto de la presente invención un dispositivo de avance mandibular mejorado, ajustable y adaptable a la dentadura superior e inferior, manteniéndolas enlazadas con una apertura suficiente para una respiración fluida y cómoda, obligando a avanzar el maxilar inferior con su dentadura respecto a la superior, pero permitiendo una movilidad prácticamente natural en todos los sentidos, pero limitada. Los dispositivos de avance mandibular se introducen en la boca y modifican la posición de la mandíbula, la lengua, y otras estructuras de soporte de la Via Aérea Superior (VAS) para el tratamiento del ronquido y/o el Sindrome de Apneas-Hipopneas del Sueño (SAHS) , son dispositivos empleados en el campo médico odontológico, estomatológico y ortodoncia, siendo el principal objetivo el de adelantar o avanzar el maxilar inferior respecto al maxilar superior, con el fin de mantener permeable o liberada la via aérea en un grado suficiente, de tal forma que evite en gran medida su cierre fortuito o inconsciente.The object of the present invention is an improved mandibular advancement device, adjustable and adaptable to the upper and lower dentures, keeping them connected with a sufficient opening for a smooth and comfortable breathing, forcing the lower jaw to advance with its denture with respect to the upper one, but allowing virtually natural mobility in every way, but limited. The mandibular advancement devices are introduced into the mouth and modify the position of the jaw, tongue, and other support structures of the Upper Airway (VAS) for the treatment of snoring and / or Sleep Apnea-Hypopnea Syndrome (SAHS), are devices used in the dental, stomatological and orthodontic medical field, the main objective being to advance or advance the lower jaw with respect to the upper jaw, in order to keep the airway permeable or released to a sufficient degree, in such a way that it largely avoids its fortuitous or unconscious closure.
Caracteriza a la presente invención la especial configuración y diseño de un dispositivo que acoplado en las arcadas dentales, adelanta o avanza la mandíbula, separa los maxilares entre si, y nos permite realizar una serie de movimientos muy amplios controlados o limitados por el dispositivo. Incorporando una pieza intercambiable que se irá sustituyendo periódicamente por una pieza similar de distinta medida, según el tratamiento medico oportuno, consiguiendo el avance necesario para conseguir el objetivo final del tratamiento.The present invention characterizes the special configuration and design of a device that coupled in the dental arches, advances or advances the jaw, separates the jaws from each other, and allows us to perform a series of very wide movements controlled or limited by the device. Incorporating an interchangeable piece that will be replaced periodically by a similar piece of different size, according to the appropriate medical treatment, achieving the necessary progress to achieve the final goal of the treatment.
HOJA DE REEMPLAZO (Regla 26) Gracias a la utilización del dispositivo objeto de la invención es posible conseguir el desplazamiento de la mandibula de una forma progresiva, poco traumática, y cómoda. Permitiéndonos una buena movilidad mandibular respecto a los dispositivos que se conocen actualmente para este mismo fin.REPLACEMENT SHEET (Rule 26) Thanks to the use of the device object of the invention it is possible to achieve the displacement of the jaw in a progressive, little traumatic, and comfortable way. Allowing us a good jaw mobility with respect to the devices that are currently known for this same purpose.
Por lo tanto, la presente invención se circunscribe principalmente, dentro del ámbito médico de la ortodoncia.Therefore, the present invention is mainly circumscribed, within the medical field of orthodontics.
ANTECEDENTES DE IA INVENCIÓNBACKGROUND OF THE INVENTION
La utilización de los aparatos intraorales en el tratamiento de los problemas obstructivos de la "Via Aérea Superior (VAS) " no es un concepto nuevo. Ya en 1902, Pierre Robin preconizaba la utilización de un aparato de estas mismas caracteristicas (monobloc) con el objeto de realizar un adelantamiento funcional mandibular, llevando a esta última hasta una posición más avanzada. Con ello se conseguía un arrastre añadido de la lengua y se evitaba la caida lingual hacia atrás (glosoptosis) que aparecía durante el decúbito supino en niños con hipoplasia mandibular. Las primeras publicaciones de la aparatologia intraoral en relación con el "Síndrome de Apneas-Hipopneas del Sueño, (SAHS)" aparecen en la década de los años ochenta del pasado siglo, como un intento de buscar tratamientos alternativos, tanto a los procedimientos quirúrgicos como a la presión positiva continua en la via respiratoria superior. Aunque se han descrito en el mercado más de 50 tipos de aparatos eficaces para el tratamiento del ronquido, los aparatos de avance mandibular en sus dos versiones (avance fijo y avance regulable) son los realmente eficaces en el manejo de los problemas obstructivos de las vias aéreas superiores .The use of intraoral devices in the treatment of obstructive problems of the "Superior Airway (VAS)" is not a new concept. Already in 1902, Pierre Robin advocated the use of an apparatus of these same characteristics (monobloc) in order to perform a functional mandibular overtaking, leading the latter to a more advanced position. With this, an additional drag of the tongue was achieved and the backward lingual fall (glossoptosis) that appeared during the supine position in children with mandibular hypoplasia was avoided. The first publications of intraoral appliances in relation to "Sleep Apnea-Hypopnea Syndrome (SAHS)" appear in the eighties of last century, as an attempt to seek alternative treatments, both surgical procedures and at continuous positive pressure in the upper airway. Although more than 50 types of effective devices for the treatment of snoring have been described in the market, the mandibular advancement devices in their two versions (fixed advance and adjustable advance) are the really effective ones in the management of obstructive road problems upper aerial
HOJA DE REEMPLAZO (Regla 26) Los dispositivos de avance mandibular realizan un movimiento anterior e inferior de la mandíbula generando variaciones anatómicas en la via aérea superior que consiguen incrementar el área seccional faríngea. Este movimiento estabiliza y fija la mandíbula y el hueso hioides, lo que impide la posterorrotación de estas estructuras durante el decúbito y evita la ocupación de la via respiratoria. Se ha comprobado que en los individuos (SAHS) el porcentaje total de tiempo en el que los pacientes duermen con la boca abierta más de 5 mm. (rotación posterior y retrusión) es significativamente mayor (69,3%) que en individuos sanos (11,1%); por tanto, el movimiento de rotación y fijación de la mandíbula durante el sueño puede ser uno de los elementos importantes durante el tratamiento con los dispositivos de avance mandibular.REPLACEMENT SHEET (Rule 26) The mandibular advancement devices perform an anterior and inferior movement of the jaw, generating anatomic variations in the upper airway that increase the pharyngeal sectional area. This movement stabilizes and fixes the jaw and the hyoid bone, which prevents the post-rotation of these structures during the recumbency and prevents the occupation of the airway. It has been proven that in individuals (SAHS) the total percentage of time in which patients sleep with their mouths open more than 5 mm. (posterior rotation and retrusion) is significantly higher (69.3%) than in healthy individuals (11.1%); therefore, the movement of rotation and fixation of the jaw during sleep can be one of the important elements during treatment with the mandibular advancement devices.
Aunque su mayor efecto al utilizar estos dispositivos, aparece en la zona velofaringea, también tienen repercusiones en todos los segmentos faríngeos. Inicialmente aparece un aumento de rigidez y un ensanchamiento del espacio entre los pilares anterior y posterior de la faringe.Although their greatest effect when using these devices, appears in the velopharyngeal area, they also have repercussions in all pharyngeal segments. Initially there is an increase in stiffness and a widening of the space between the anterior and posterior pillars of the pharynx.
Se ha comprobado electromiográficamente cómo se incrementa el tono de la musculatura lingual (sobre todo el geniogloso) tras utilizar estos dispositivos y cómo este vuelve a descender tras quitar el aparato. La lengua se desplaza hacia delante y ocupa una posición superior, dificultando asi su calda hacia atrás durante el sueño. Estos dispositivos realizan una función similar a la que se produce durante las maniobras de sedación consciente, y de resucitación cardiopulmonar en las que tras asegurar y preservar la permeabilidad de la via aérea superior, liberándola de cualquier objeto extraño, se realiza una maniobra de tracción anterior e inferiorIt has been electromyographically verified how the tone of the lingual musculature (especially the genioglossus) is increased after using these devices and how it descends again after removing the device. The tongue moves forward and occupies a superior position, thus hindering its broth back during sleep. These devices perform a function similar to that which occurs during conscious sedation, and cardiopulmonary resuscitation maneuvers in which after ensuring and preserving the permeability of the upper airway, releasing it from any foreign object, an anterior traction maneuver is performed and lower
HOJA DE REEMPLAZO (Regla 26) mandibular. Dicho avance funcional mandibular induce cambios en la posición del hueso hioides hacia una posición más adelantada. Aparece ahora una nueva situación de equilibrio de la musculatura suprahioidea que favorecerla el aumento de volumen y la permeabilidad de la via aérea superior.REPLACEMENT SHEET (Rule 26) mandibular Said mandibular functional advance induces changes in the position of the hyoid bone towards a more advanced position. A new equilibrium situation of the suprahyoid musculature appears now, which favors the increase in volume and the permeability of the upper airway.
Aunque la respuesta a la utilización de estos dispositivos de avance mandibular, no es la misma en todos los pacientes, muchos entendidos admiten que hay un efecto dependiente de la dosis, ya que al aumentar el grado de avance mandibular mejora la situación clínica del paciente. Asi, conforme incrementamos la protrusión aparece una mejoría tanto en el número como en la gravedad de las desaturaciones . De la misma forma se ha asociado una mejor respuesta a la utilización de estos dispositivos, en pacientes con bajo Índice de masa corporal, circunferencia del cuello reducida, pacientes jóvenes, índice de apnea-hipopnea (IAH) basal bajo y en episodios apneicos asociados a la posición supina.Although the response to the use of these mandibular advancement devices is not the same in all patients, many experts admit that there is a dose-dependent effect, since increasing the degree of mandibular advancement improves the patient's clinical situation. Thus, as we increase the protrusion, an improvement appears both in the number and severity of desaturations. In the same way, a better response to the use of these devices has been associated, in patients with low body mass index, reduced neck circumference, young patients, low basal apnea-hypopnea index (AHI) and in apneic episodes associated with the supine position.
Aunque en un principio el diseño del dispositivo utilizado no parecía tener relación con su efectividad, recientemente se ha descrito que incluso se puede mejorar el porcentaje de éxitos con el uso de dispositivos con avance regulable, con lo que se concluye que cuanto más agresivos resultan los protocolos, tanto mayor es la relación de éxitos.Although initially the design of the device used did not seem to be related to its effectiveness, it has recently been described that even the percentage of successes can be improved with the use of devices with adjustable advance, which concludes that the more aggressive the protocols, the greater the success ratio.
Estos dispositivos son muy eficaces en el tratamiento del ronquido con una eliminación en el 50% de los casos, y consiguen una reducción significativa del mismo en un 90/100% de los pacientes, así como una mejora en la calidad del sueño.These devices are very effective in the treatment of snoring with a 50% elimination of cases, and achieve a significant reduction in 90/100% of patients, as well as an improvement in sleep quality.
La fabricación del dispositivo supone sólo el primer eslabón del tratamiento. Estos deben de acomodarse según unos protocolos para alcanzar resultados óptimos, tanto deThe manufacture of the device is only the first link in the treatment. These must be accommodated according to protocols to achieve optimal results, both
HOJA DE REEMPLAZO (Regla 26) eficacia como de comodidad para los usuarios.REPLACEMENT SHEET (Rule 26) efficiency as comfort for users.
Una vez que el aparato ha sido realizado y ajustado se entrena al paciente para su inserción y los cuidados de mantenimiento. Tras conseguir acostumbrar al paciente al aparato se comienza a realizar el avance gradualmenteOnce the device has been performed and adjusted, the patient is trained for insertion and maintenance care. After getting the patient accustomed to the device, progress is gradually made.
(suele requerir semanas o meses de ajuste) hasta que se consigue una posición confortable y adecuada para aliviar el ronquido y/o la apnea del sueño.(usually requires weeks or months of adjustment) until a comfortable and adequate position is achieved to relieve snoring and / or sleep apnea.
El tratamiento con estos dispositivos son una alternativa razonable, puesto que no suponen un cambio permanente en los individuos (como ocurre con la cirugia) y pueden desestimarse en cualquier momento. El estudio adecuado del paciente en cuanto a evaluación de riesgos/beneficiosos ha de exponerse individualmente para poder conseguir la mejor terapia en cada caso.Treatment with these devices is a reasonable alternative, since they do not involve a permanent change in individuals (as is the case with surgery) and can be dismissed at any time. The appropriate study of the patient in terms of risk / benefit assessment must be presented individually in order to achieve the best therapy in each case.
Por lo tanto, es objetivo de la presente invención el mejorar los dispositivos existentes en la actualidad, realizándolos de una forma menos sofisticada, más práctico y de fácil utilización, mas confortable, y económico.Therefore, it is the objective of the present invention to improve the existing devices today, performing them in a less sophisticated, more practical and easy to use, more comfortable, and economical way.
DESCRIPCIÓN DE IA INVENCIÓNDESCRIPTION OF THE INVENTION
La presente invención de dispositivo de avance mandibular mejorado, básicamente consiste en un conjunto de piezas que dispuestas en el interior de la boca, ajustado en la dentadura correspondiente nos permitirá adelantar el maxilar inferior respecto al superior, pero de una forma progresiva, al poder sustituir periódicamente, según el tratamiento médico, la pieza de enlace principal (1) que irá modificando su avance.The present invention of an improved mandibular advancement device basically consists of a set of pieces that are arranged inside the mouth, adjusted in the corresponding denture, which will allow us to advance the lower jaw with respect to the upper one, but in a progressive way, by being able to replace periodically, according to medical treatment, the main link piece (1) that will modify its progress.
Como ya ha sido explicado el hecho de adelantar el maxilar inferior hace que se libere la via aérea superior.As already explained, the fact of advancing the lower jaw causes the upper airway to be released.
El conjunto del dispositivo que se acopla a la dentadura esta constituido por cinco piezas fundamentalmente, una férula superior de materialThe set of the device that attaches to the denture is constituted by five pieces fundamentally, a top splint of material
HOJA DE REEMPLAZO (Regla 26) plástico (6) y otra inferior, que incorporan frontalmente en su interior unas cajeras metálica (3), las cuales serán enlazadas por una pieza de avance (1) intercambiable de distintas dimensiones frontales, y fijadas a la cajera (3) por medio de unos tornillos prisioneros (8) , que nos permitirán intercambiar fácilmente y periódicamente las piezas (1), colocando cada vez una de mayor dimensión de avance en su zona (13) .REPLACEMENT SHEET (Rule 26) plastic (6) and a lower one, which incorporates frontally inside metal pockets (3), which will be linked by an interchangeable feed piece (1) of different frontal dimensions, and fixed to the pocket (3) by means of captive screws (8), which will allow us to easily and periodically exchange the pieces (1), placing each one with a larger advance in its area (13).
Por lo tanto, con el dispositivo objeto de la presente invención es posible llevar un tratamiento sencillo y correcto de avance mandibular progresivo de un paciente, consiguiendo un avance preciso de la mandíbula, que consiga los objetivos terapéuticos deseados.Therefore, with the device object of the present invention it is possible to carry out a simple and correct treatment of progressive mandibular advancement of a patient, achieving a precise advancement of the jaw, which achieves the desired therapeutic objectives.
VENTAJAS DE LA INVENCIÓNADVANTAGES OF THE INVENTION
Las principales ventajas de la presente invención son las siguientes:The main advantages of the present invention are the following:
El presente dispositivo nos permite una adaptación muy sencilla y cómoda a la dentadura.The present device allows us a very simple and comfortable adaptation to the denture.
El número de piezas utilizadas son mínimas y de fácil fabricación .The number of pieces used are minimal and easy to manufacture.
Su conjunto es firme y estable, de la misma forma que nos permitirá realizar prácticamente todos los movimientos necesarios, pero limitados.Its set is firm and stable, in the same way that will allow us to perform practically all necessary, but limited movements.
El usuario se acostumbrará rápidamente a la utilización del mismo.The user will quickly get used to using it.
La utilización del dispositivo durante el tratamiento es sencilla, cómoda, y rápida. - Su fabricación y montaje es económica y sencilla.The use of the device during treatment is simple, convenient, and fast. - Its manufacture and assembly is economical and simple.
DESCRIPCIÓN DE LOS DIBUJOSDESCRIPTION OF THE DRAWINGS
Para complementar la descripción que seguidamente se va a realizar y con objeto de ayudar a una mejor comprensión deTo complement the description that will then be made and in order to help a better understanding of
HOJA DE REEMPLAZO (Regla 26) sus características, se acompaña a la presente memoria descriptiva, de un juego de planos en cuyas figuras, de forma ilustrativa y no limitativa, se representan los detalles más significativos de la invención.REPLACEMENT SHEET (Rule 26) Its characteristics are accompanied by the present specification, of a set of drawings in whose figures, in an illustrative and non-limiting manner, the most significant details of the invention are represented.
Figura 1a Muestra una sección parcial lateral realizada por el centro de la cabeza de una persona; en ella se destacan las vias respiratorias, desde la tráquea (17) , hasta la cavidad nasal (20) y la boca (10) . En ella se representan claramente los maxilares superior (12) e inferior (11) , entre los cuales se encuentra la lengua (14) . También señalamos con "A" la dirección del movimiento que pretendemos realizar con el fin de liberar la zona de la laringe "X".Figure 1 a Shows a partial lateral section made by the center of a person's head; it highlights the airways, from the trachea (17), to the nasal cavity (20) and the mouth (10). It clearly depicts the upper (12) and lower (11) jaws, among which is the tongue (14). We also indicate with "A" the direction of the movement that we intend to make in order to release the area of the larynx "X".
Figura 2a Muestra una sección parcial lateral realizada por el centro de la cabeza de una persona; en ella se destacan las vías respiratorias de forma activa con unas flechas que se comunica a la altura de la faringe (16) , desde la tráquea (17) , hasta la cavidad nasal (20) y la boca (10) . En ella se representan claramente los maxilares superior (12) e inferior (11), entre los cuales se encuentra la lengua (14) . También señalamos con WA" la dirección del movimiento que hemos realizado del maxilar inferior (11) liberando la zona de la laringe Z" . Este movimiento es el que conseguiremos realizar con la utilización del dispositivo de avance mandibular que se está describiendo.Figure 2 a Shows a partial partial section made by the center of a person's head; it highlights the airways actively with arrows that communicate at the height of the pharynx (16), from the trachea (17), to the nasal cavity (20) and the mouth (10). It clearly depicts the upper (12) and lower (11) jaws, among which is the tongue (14). We also note with W A "movement direction we have made the lower jaw (11) releasing the area of the larynx> Λ Z". This movement is what we will be able to perform with the use of the mandibular advancement device that is being described.
En esta figura se señala un circulo de detalle que será ampliado en la figura 3a en el cual incorporaremos el dispositivo.This figure indicates a circle of detail that will be expanded in Figure 3 a in which we will incorporate the device.
Figura 3a Muestra una sección detallada y ampliada de la zona señalada en la figura 2a, con el dispositivo de avance mandibular incorporado a la dentadura (9) de la boca (10) del paciente.Figure 3 a Shows a detailed and enlarged section of the area indicated in Figure 2 a , with the mandibular advancement device incorporated into the denture (9) of the patient's mouth (10).
Figura 4a Muestra una sección parcial lateral realizada por el centro del dispositivo, representando claramente comoFigure 4 a Shows a partial partial section made by the center of the device, clearly representing as
HOJA DE REEMPLAZO (Regla 26) es del montaje del mismo. Contamos con unas férulas oclusalesREPLACEMENT SHEET (Rule 26) It is the assembly of it. We have occlusal splints
(6) realizadas de una forma tradicional, a la cual se le incorpora frontalmente cuando son realizadas, quedando enfrentadas entre si por su apertura del interior (4) unas cajeras (3) donde se insertarán unas piezas (1) que incorporan una zona intermedia (13) que generará el avance del dispositivo, pudiendo ser intercambiables para colocar piezas (1) de distintos tamaños, quedando amarradas a las cajeras (3) por medio de unos tornillos prisioneros (8) , al atravesar las ventanas (2) del cuerpo (1) .(6) made in a traditional way, which is incorporated frontally when they are made, facing each other by its opening of the interior (4) some pockets (3) where parts (1) that incorporate an intermediate zone will be inserted (13) that will generate the advance of the device, being able to be interchangeable to place pieces (1) of different sizes, being tied to the pockets (3) by means of captive screws (8), when crossing the windows (2) of the body (one) .
Figura 5a Muestra dos vistas en planta inferior de las dos férulas (6) que han de enfrentarse para conseguir el dispositivo, antes de enlazarse con la pieza (1) . Cada una de ellas se adaptara perfectamente a la dentadura superior e inferior. Estas se realizan sacando un molde de la dentadura completa del paciente de la forma tradicional, y a la hora de fundir la pieza para realizar la férula se le incorporan las cajeras (3) frontalmente, quedando perfectamente recubiertas por la materia plástica de la férula.Figure 5 a Shows two lower plan views of the two splints (6) that have to face to get the device, before linking with the piece (1). Each of them will adapt perfectly to the upper and lower dentures. These are made by removing a mold from the patient's complete denture in the traditional way, and when melting the piece to make the splint, the pockets (3) are incorporated frontally, being perfectly covered by the plastic material of the splint.
Figura 6a Muestra una vista frontal un tanto esquemática del dispositivo, indicando como se realiza el montaje de las férula (6) frontalmente con las cajeras (3) incorporadas, con las piezas (1) en forma de ocho situadas centralmente, y con los tornillos (8) amarrados en las cajeras (3) .Figure 6 a Shows a somewhat schematic front view of the device, indicating how the splint (6) is assembled frontally with the built-in pockets (3), with the pieces (1) in the form of eight centrally located, and with the screws (8) tied in the pockets (3).
Figura 7a Muestra dos vistas frontales del cuerpo (1) intercambiable en forma de ocho. Este incorpora dos ventanas (2) para su amarre en las cajeras (3) por medio de los tornillos (8) .También muestra una zona (13) central de dimensión variable, que después podrá incorporar un escalonamiento de distintas medidas como se puede ver en la figura 8a para aumentar el avance progresivo del dispositivo.Figure 7 a Shows two front views of the body (1) interchangeable in the form of eight. This incorporates two windows (2) for its mooring in the pockets (3) by means of the screws (8). It also shows a central area (13) of variable dimension, which can then incorporate a staggering of different measures as you can see in figure 8 a to increase the progressive advance of the device.
Figura 8a Muestra el cuerpo (1) de perfil en distintos tamaños según el tamaño o avance de la zona (13) , que se iránFigure 8 a Shows the profile body (1) in different sizes according to the size or advance of the zone (13), which will be
HOJA DE REEMPLAZO (Regla 26) intercambiando según el tratamiento.REPLACEMENT SHEET (Rule 26) exchanging according to the treatment.
Figura 9a Muestra una perspectiva del cuerpo (1) con sus ventanas (2) y zona de avance (13) .Figure 9 a Shows a perspective of the body (1) with its windows (2) and advance zone (13).
Figura 10a Muestra tres vistas de las cajeras que han de ser situadas frente a las férulas (6) y que serán fundidas conjuntamente, con su interior (4) para la inserción de la pieza (1) y con los agujeros (15) para la colocación del tornillo prisionero (8) •Figure 10 a Shows three views of the pockets that are to be placed in front of the splints (6) and that will be cast together, with its interior (4) for insertion of the piece (1) and with the holes (15) for the placement of the captive screw (8) •
Figura 11a Muestra una vista semi-seccionada en planta inferior de cómo se inserta la pieza (1) en el interior (4) de la cajera (3) un momento antes de introducirse el tornillo (8) para su fijación.Figure 11 a Shows a semi-sectioned view on the lower floor of how the part (1) is inserted inside the pocket (3) a moment before the screw (8) is introduced for fixing.
Figura 12a Muestra una vista semi-seccionada en planta inferior de cómo queda colocada la pieza (1) en el interior (4) de la cajera (3) una vez introducido el tornillo (8) fijando el dispositivo para su utilización.Figure 12 a Shows a semi-sectioned view on the lower floor of how the piece (1) is placed inside (4) of the pocket (3) once the screw (8) has been inserted fixing the device for use.
Figura 13a Muestra una vista esquemática frontal del dispositivo en reposo indicando unos movimientos posibles que se pueden realizar con la utilización de este dispositivo una vez incorporado en la dentadura del paciente, movimiento vertical (B-B) y movimiento horizontal (C-C) .En la figura 14a, la 15a y la 16a se muestra el movimiento una vez realizado.Figure 13 a Shows a schematic front view of the device at rest indicating possible movements that can be performed with the use of this device once incorporated into the patient's denture, vertical movement (BB) and horizontal movement (CC). 14, the 15 and 16 to movement once performed is shown.
Figura 14a Muestra una vista esquemática frontal indicando el movimiento realizado vertical (B-B) en su posición de cierre máximo. Vemos como la cajera (3) limita el movimiento internamente .Figure 14 a Shows a front schematic view indicating the vertical movement (BB) in its maximum closing position. We see how the cashier (3) limits the movement internally.
Figura 15a Muestra una vista esquemática frontal indicando el movimiento realizado vertical (B-B) en su posición de apertura máxima. Vemos como el tornillo (8) situado en la cajera (3) limita el movimiento de apertura.Figure 15 a Shows a front schematic view indicating the vertical movement (BB) in its maximum opening position. We see how the screw (8) located in the pocket (3) limits the opening movement.
HOJA DE REEMPLAZO (Regla 26) Figura 16a Muestra una vista esquemática frontal indicando el movimiento realizado horizontal (C-C) en su posición de desplazamiento lateral . Vemos como el tornillo (8) situado en la cajera (3) deja actuar en este movimiento.REPLACEMENT SHEET (Rule 26) Figure 16 shows a schematic front view showing the movement performed horizontally (CC) in place of lateral displacement. We see how the screw (8) located in the pocket (3) allows to act in this movement.
Figura 17a Muestra una vista esquemática frontal donde se puede ver que el dispositivo nos permite también realizar movimientos de balanceo descompensados lateralmente (D-D) , gracias a la disposición existente entre las cajeras (3) y las piezas (1) controladas por los tornillos (8) .Figure 17 a Shows a schematic front view where it can be seen that the device also allows us to perform laterally decompensated balancing movements (DD), thanks to the arrangement between the pockets (3) and the parts (1) controlled by the screws ( 8).
DESCRIPCIÓN DE LOS DIFERENTES ELEMENTOS REPRESENTADOS EN LOS DIBUJOS DE IA INVENCIÓNDESCRIPTION OF THE DIFFERENT ELEMENTS REPRESENTED IN THE DRAWINGS OF THE INVENTION
1 - Cuerpo principal del dispositivo, es la pieza intercambiable o (pieza de avance) que nos marcará el avance realizado. Esta pieza puede ser plana o incorporar un escalonamiento (13) de la medida precisa. En la figura 9a vemos una perspectiva de la misma, y en la figura 8a se muestran varias piezas con escalonamientos de distintas medidas, las cuales marcarán el avance. El cuerpo presenta dos ventanas (2) que serán utilizadas para su fijación en el interior (4) de las cajeras (3) por medio de unos tornillos prisionero (8) .1 - Main body of the device, is the interchangeable piece or (advance piece) that will mark the progress made. This piece can be flat or incorporate a stepping (13) of the precise measurement. In Figure 9 a we see a perspective of it, and in Figure 8 a several pieces are shown with steps of different measures, which will mark the advance. The body has two windows (2) that will be used for fixing inside (4) of the pockets (3) by means of captive screws (8).
2 - Ventanas que presenta el cuerpo (1) y que serán utilizadas para su fijación en el interior (4) de las cajeras2 - Windows that presents the body (1) and that will be used for fixing inside (4) of the pockets
(3) por medio de unos tornillos prisioneros (8) .(3) by means of captive screws (8).
3 - Cajeras colocadas en cada extremo del cuerpo (1), donde quedarán gracias al tornillo (8) .3 - Pockets placed at each end of the body (1), where they will be thanks to the screw (8).
4 - Espacio interior de las cajeras (3) donde se insertarán los extremos del cuerpo (1) .4 - Interior space of the pockets (3) where the ends of the body (1) will be inserted.
5 - Capa plástica envolvente de la cajera (3) , unida a la5 - Plastic envelope layer of the pocket (3), attached to the
HOJA DE REEMPLAZO (Regla 26) férula oclusal (6) .REPLACEMENT SHEET (Rule 26) occlusal splint (6).
6 - Férulas oclusales superior e inferior de material plástico personalizadas, que se adaptan a la dentadura superior e inferior (9) . Dichas férulas incorporan frontalmente las cajeras (3) quedando fundidas y revestidas plásticamente junto a estas.6 - Upper and lower occlusal splints of custom plastic material, which adapt to the upper and lower dentures (9). Said splints incorporate the pockets (3) frontally being molten and plastic coated next to them.
7 - Interior de las férulas (6) donde se aloja la dentadura del paciente.7 - Inside the splints (6) where the patient's denture is housed.
8 - Tornillos prisioneros de fijación del cuerpo (1) en el interior de las cajeras (3) .8 - Body fixing screws (1) inside the pockets (3).
9 - Dentadura del paciente que se insertará en la férula (6) .9 - Patient's denture to be inserted into the splint (6).
10 -Boca del paciente donde se ha de insertar el dispositivo.10-Patient's mouth where the device is to be inserted.
11 - Maxilar inferior, el cual pretendemos avanzar según (A) , respecto al maxilar superior (12) .11 - Lower jaw, which we intend to advance according to (A), with respect to the upper jaw (12).
12 - Maxilar superior.12 - Upper jaw.
13 - Zona intermedia del cuerpo (1) la cual creará el avance progresivo del dispositivo al ser intercambiadas las piezas13 - Intermediate area of the body (1) which will create the progressive advance of the device when the pieces are exchanged
(1) , utilizando piezas de distintas medidas , tal y como vemos en la figura 8a.(1), using pieces of different sizes, as we see in Figure 8 a .
14 - Lengua del paciente.14 - Patient's language.
15 - Agujeros roscados de la cajera (3) para la inserción y amarre del tornillo prisionero (8) .15 - Threaded holes of the pocket (3) for the insertion and fastening of the captive screw (8).
16 - Faringe del paciente. Punto de comunicación entre la cavidad nasal y la bucal, la cual pretendemos mantener liberada.16 - Pharynx of the patient. Communication point between the nasal and the oral cavity, which we intend to keep released.
17 - Traquea del paciente (via respiratoria) .17 - Trachea of the patient (airway).
HOJA DE REEMPLAZO (Regla 26) 18 - Esófago del paciente (vía alimenticia) .REPLACEMENT SHEET (Rule 26) 18 - Esophagus of the patient (food route).
19 - Epiglotis del paciente. Situada en la parte posterior de la lengua (14) que hace de válvula o tapa de la tráquea (17) y que puede llegar a cerrar la vía respiratoria en la zona (X) de la laringe.19 - Epiglottis of the patient. Located on the back of the tongue (14) that acts as a valve or lid of the trachea (17) and can close the airway in the area (X) of the larynx.
20 - Cavidad nasal del paciente, que se comunica con la cavidad bucal, y la tráquea (17) .20 - The patient's nasal cavity, which communicates with the oral cavity, and the trachea (17).
X - Zona de la laringe que se pretende despejar o liberar, según vemos en la figura Ia.X - Area of the larynx that is intended to be cleared or released, as we see in Figure I a .
Z - Zona de la laringe una vez liberada o permeable, según vemos en la figura 2a Z - Area of the larynx once released or permeable, as we see in Figure 2 a
No se hace mas extensa esta descripción, en el buen entender de que cualquier experto en esta materia tendría suficiente información para comprender el alcance de la invención y sus ventajas derivadas, así como para proceder a reproducir la misma.This description does not become more extensive, in the good understanding that any expert in this field would have enough information to understand the scope of the invention and its derived advantages, as well as to proceed to reproduce it.
La invención, dentro de su esencialidad, puede ser llevada a la practica en otras formas de realización que difieran en detalle de la indicada a titulo del ejemplo de la descripción, y a la cual alcanzara igualmente la protección que se recaba. Así mismo, podrá construirse en cualquier forma y tamaño con los materiales mas adecuados, por quedar todo ello comprendido en el espíritu de las reivindicaciones. Los términos en que se ha descrito esta memoria deberán ser tomados siempre en sentido amplio y no limitativo.The invention, within its essentiality, can be put into practice in other embodiments that differ in detail from that indicated by way of example of the description, and to which it will also achieve the protection sought. Likewise, it may be constructed in any shape and size with the most suitable materials, since all of this is included in the spirit of the claims. The terms in which this report has been described must always be taken in a broad and non-limiting sense.
HOJA DE REEMPLAZO (Regla 26) REPLACEMENT SHEET (Rule 26)

Claims

REIVINDICACIONES
1.- Dispositivo de avance mandibular mejorado, del tipo de los utilizados para el tratamiento intraoral sobre problemas de obstrucción de la via aérea superior caracterizado por estar constituido por un conjunto de piezas enlazadas entre si, pudiendo ser adaptadas a la dentadura superior e inferior, que nos permitirá ajustar el posicionamiento entre el maxilar superior e inferior con una simple sustitución de una pieza intercambiable (1) que podrá tener distintas dimensiones en la zona (13), pieza que consta de dos ventanas (2) superior e inferior, que a su vez son insertadas en el interior (4) de las cajeras (3) para su fijación con un tornillo prisionero (8), que a su vez se encuentran fundidas formando una unidad con las férulas oclusales (6) que finalmente para su uso quedarán unidas a la dentadura superior y otra a la inferior, todo ello permitiendo realizar al conjunto unos movimientos mandibulares según (B-B) - (C-C) - (D-D) , y otros que los combine entre si.1.- Improved mandibular advancement device, of the type used for intraoral treatment on problems of obstruction of the upper airway characterized by being a set of parts linked together, and can be adapted to the upper and lower dentures, which will allow us to adjust the positioning between the upper and lower jaw with a simple replacement of an interchangeable piece (1) that may have different dimensions in the area (13), a piece consisting of two upper and lower windows (2), which in turn they are inserted into the inside (4) of the pockets (3) for fixing with a captive screw (8), which in turn are molten forming a unit with the occlusal splints (6) that will finally remain for use together with the upper denture and another with the lower one, all this allowing the joint to perform mandibular movements according to (BB) - (CC) - (DD), and others that combine them with each other.
HOJA DE REEMPLAZO (Regla 26) REPLACEMENT SHEET (Rule 26)
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WO2015104683A3 (en) * 2014-01-10 2015-10-29 The O Lab International Ltd An impression device and its methods to manufacture oral appliances
GB2537313A (en) * 2014-01-10 2016-10-12 The O Lab Int Ltd An impression device and its methods to manufacture oral appliances
GB2537313B (en) * 2014-01-10 2017-09-06 The O Lab Int Ltd An impression device and its methods to manufacture oral appliances
US11752256B2 (en) 2017-09-27 2023-09-12 Medirio S.A. Medical infusion device

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ES1069826Y (en) 2009-09-04
KR20110033840A (en) 2011-03-31
DE112009001742T5 (en) 2011-07-28
PT10448T (en) 2009-11-19
FR2933861A3 (en) 2010-01-22
CZ201119A3 (en) 2011-02-23
FR2933861B3 (en) 2010-11-26
ES1069826U (en) 2009-05-14

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