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4 Tips for Reducing Your Headaches And Chairtime at Appliance Delivery

Frank Madrigal, owner/founder of True Function Laboratory, offers guidance on how to get better fit, reduced chair time, and improved patient comfort. 

Figure 1

by Frank Madrigal, CDT, Owner/Founder of True Function Laboratory

What if you could consistently get?

  • A great fit
  • Reduced chairtime
  • Improved patient comfort which can lead to better compliance

From the laboratory perspective, the clinician should consider the following 4 items for improved success:

  1. Digital Technology – Quality and Efficiency

Did you know that at True Function, approximately 70% of cases received come from intraoral scans and that over 90% of our devices produced have some form of digital process? There are many advantages to using digital including:

  • Efficiency – we receive the scans the day you send them
  • Quality – you are able to QC your scans before the patient leaves the chair and make corrections
  • Cost savings – because you can quality check your cases immediately, there is less of a possibility of the lab calling and requesting a new scan
  • Repeatability – Dog ate the appliance? No problem! If we have scans, no need to bring the patient back for impressions
  • We have begun offering some model- less appliances
  1. Device Choice – Keep It Simple

  • Do I need a PDAC Device?
    If so, this will limit your device and design options. Devices like Panthera DSAD, True Herbst, OASYS Hinge, and TAPs are PDAC approved.
  • The market is flooded with well over 100 devices. This can be overwhelming. If you are new to oral appliance therapy, try a few different appliance types for yourself and team members.

Consider using tried and true devices like: EMA, Dorsal, Herbst, TAP, Panthera, etc. These appliance designs have been around for over 20 years, providing confidence to any dentist.

  1. Patient Anatomy – Will Affect Fit, Retention, Vertical

Missing teeth, steep curve of Spee, open bites, tipped teeth, and other details affect the choices matching device to the patient. By sending an accurate scan and requesting a consult with the lab artist, you can work out the specifics. You may have to compromise on your appliance and material choice, but staying open minded and collaborative will give you the best design for success.

  1. The Bite – Will Impact Device and Material Choice

I often get asked, “Frank, what type of bite do you prefer?”My response is “Well Doctor, as a technician, my favorite bite is perfectly symmetrical and provides sufficient vertical for the device and material choice.”

There are many variables that go into a great bite. Here are a couple to consider:

  • Vertical – Depending on material choice, minimum vertical for devices is about 3mm to 5mm inter-occlusally (in posterior). The amount of opening needed is typically material dependent. Check with your lab/manufacturer for minimum vertical requirements. When preparing to take a bite registration, place the instrument of choice; George Gauge, ProGauge, Airway Metrics, SomnGauge, etc. and look in the posterior. You should be able to see approximately 3-5mm of space between upper and lower most posterior teeth. If vertical is not sufficient, change the size of bite fork or shim.
  • Midline – One of a laboratory’s most common reasons for reaching out to clinicians is related to bite shifts. When taking a bite, document any bite shifts and communicate on the prescrip This will let us know that you are aware of the discrepancy and whether we should proceed with device as is.

Given the anatomical features of the images in Figure 1, think about appliance design, material choice and certain compromises that might be necessary for successful Oral Appliance Therapy.

90% of True Function Lab devices produced have some form of digital process.

Communication is extremely important to us, and we will contact you if we see a challenge with your choice in appliance, material, retention,v ertical, biteshifts, etc.

At True Function, our goal is to deliver Peace of Mind to all stakeholders, including our customers, our team, and our partners. If you are ready for a more efficient device delivery experience, give us a call. We are ready to help.

After reading the article by True Function Laboratory owner/founder Frank Madrigal, check out how to retrofit crowns under sleep appliances. Click here: https://dentalsleeppractice.com/retrofitting-crowns-sleep-appliances/

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