From Necessity, Innovation is Launched

600x300_New_Ideas_Ash_SomnowellGreat Britain’s National Health Service probably doesn’t bring to your mind cutting-edge, problem-solving, long-term health focus. Maybe it’s time to rethink that view. Read on to learn how a passionate English orthodontist set out to help his patients, and his practice.
New_Ideas_Ash_Somnowell_Fig1In the early 90’s Dr. Simon Ash, a Consultant & Specialist Orthodontist, joined with Chest Medicine and ENT Consultants to create a multidisciplinary approach to treating sleep related breathing disorders, snoring and obstructive sleep apnea, within the National Health Service (NHS). The service was overwhelmed with patient demand. The patient experience and compliance when treated with plastic mandibular advancement devices was unpredictable. Patients complained of device bulk, failure, breakages, a dry mouth, device hygiene and limited device longevity. It was quickly realised that there just were not the time available to repeatedly see patients with these problems and to remake and replace devices regularly. Unlike dental and orthodontic conditions, sleep related breathing disorders worsen with age and are chronic long-term diseases. The search was on to find a minimum bulk, long term resilient, robust, hygienic, sterilisable, ultra comfortable, adjustable, easy to wear mandibular advancement device that would withstand the rigours of the mouth and last fairly indefinitely. Indeed a tall order.
Simon resorted to his partial denture prosthetic dentistry training and made cast chrome cobalt tooth supported frameworks, leaving off the prosthetic teeth. To this frame he added heat- cured acrylic inclined blocks, creating cast chrome cobalt twin-blocks devices. This was published in the Journal of Orthodontics 2004. Whilst this was an advance on the all-plastic devices, patients still had bulk, tooth movement and hygiene issues. The acrylic blocks were then replaced by the piston rod Herbst mechanisms. The challenge was to devise a means of joining the piston rods to the cast chrome cobalt frameworks.
Most Herbst devices rely on screw attachments and this raised health risks to patients should the screws detach. Simon then invented the “Olympic Stud” which is an attachment included in the metal casting onto which the Herbst piston rods form a locking key. This simple, highly effective device has replaced the screws, reduced device bulk and given added strength to the fixing parts.

Patient with Somnowell device in place
Patient with Somnowell device in place

The active protrusion element in the device is the Herbst piston rod. Currently, they are prone to distortion, fracture and have limited adjustment capabilities. Simon then invented the “Ash Adjuster” which has metal injected moulded high strength end fixing parts to match the Olympic studs. The Ash Adjuster has a longer range of adjustment and the rods carry millimeter markings so that jaw advancements can be accurately titrated and measured.
Dr. Ash placing a Somnowell device on LondonLife TV
Dr. Ash placing a Somnowell device on LondonLife TV

It was apparent that device bulk and encroachment into tongue space was critically important for patient comfort. If the oral cavity and in particular the oral vault is filled, the tongue is forced backward, aggravating the breathing problem. The Somnowell major connector is located in the labio-mental sulcus to minimize oral vault encroachment and to take advantage of the inner fibres of the mentalis muscle, which on stretching would, via the Somnowell labial bar, provide a counterforce to the forward force vector of the Herbst.
Many patients with these sleep related breathing disorders have bruxism and jaw parafunction. To minimize damaging effects to the patient and the devices, all Somnowell Chrome devices are mounted on a semi adjustable articulator using a facebow transfer system. The opposing frameworks include occlusally balanced platforms. As the patient closes the jaws, the balanced metal platforms meet and distribute the load over all of the teeth. The dentist using all-metal devices also gains long-term orthodontic retention and periodontal tooth splinting.
Sadly the NHS could not support the service expansion or research and development to find answers to the problems created by all-acrylic devices, so Simon turned to his own resources.
Somnowell Ltd started in the front parlour and garage. Family members, neighbours and friends joined in to get the company underway. Somnowell now occupies a fully staffed purpose built laboratory and offices. In 2015 Somnowell achieved FDA approval and has established Somnowell Inc. to commence marketing the Somnowell in the USA.
Somnowell Inc is launching a Promoted Practitioner marketing program using the same digital marketing expertise that has propelled them to become the U.K. market leader within 3 years. They will run localised campaigns that exclusively promote one practitioner in each area. To learn more and to apply please visit www.somnowell.com/en-us/promoted-practitioners.
The Somnowell Chrome devices are low bulk, tooth borne, very strong comfortable appliances. They can be autoclaved and cleaned in a dishwasher. They are robust and easily maintained. Think of the concerns you, your staff, and your patients have had about some of the devices you’ve provided over the years. Do some of these innovative features address those needs? Would you have saved a lot of office time (read: $$) if you had not had to work through those problems? Somnowell’s innovative design has received awards Beyond just supporting the airway, it is truly changing lives within and without the dental sleep office.

ash_headshotSimon Ash, FDS, MSc, MOrth, BDS, is a Consultant and Specialist Orthodontist with over 30 years clinical experience, with a special interest in sleep related breathing disorders, TMJD, and bruxism. He currently works in Harley Street London and two private hospitals in London as part of a multi-disciplinary team managing snoring and sleep apnea, and is Visiting Professor of Orthodontics at the BPP University. He is a Fellow of the Royal College of Surgeons of England and an accredited Consultant and Fellow at the Royal College of Surgeons of Edinburgh. Furthermore, for many years Dr. Ash served as the Regional Dental and Speciality Orthodontic adviser (North Thames) to the Royal College of Surgeons of England.

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