The Simple Sleep Solution

Editor’s intro: Read about how MATRx plus, an at-home Sleep Theragnostic device, allows for scientifically validated tests, so that dentists can be confident in the treatments they prescribe, as well as their predictability and accuracy.

by Erin Elliott, DDS

I am a 70-year-old lady. Really, I’m 42 but when it comes to technology my friends tease me that I act like a 70-year-old. Don’t worry… I can handle the teasing. But what they mean is that I am not a tech geek. I used the technology when I needed to, but I did not care to beyond that or master it. This is my approach with any technology in my life. I didn’t even want my free upgrade for my iPhone 7.

Let me tell you about the end of 2016 when my partner and I were discussing adding technology to our general dental practice. Why would we invest in technology when what we were doing was working “just fine”? Granted, we took the plunge into being a paperless office with digital x-rays in 2004, before many other offices were, and I had reservations then. But could you imagine still having to develop film? Think about it! Paper charts and film worked ‘just fine’ but digital made our office better. Now we were at a crossroads. Our next step in our technology journey was scanning, chairside milling and cone beam. Once again, I was hesitant, and I had all the excuses NOT to move forward – what we were doing with analog dentistry was working ‘just fine.’ But thanks to the integration of Dentsply Sirona technology, we have elevated our dentistry and differentiated our sleep apnea services.

Dental Sleep Medicine has also seen advancements in technology, but sometimes we as dentists can be hesitant to adopt new technologies. Does this sound familiar in our world? Our practice was against cone beam for sleep. I know that an image from an upright and awake patient doesn’t translate to how an airway behaves when the patient is horizontal and asleep, but with our Dentsply Sirona SL cone beam, we can capture reliable images and I am happy I can use the volume coloring as a tool for patients to visualize their airway and understand why we as dentists even care about how they sleep. Patients used to look at me like I had two heads when I asked how they slept, but now with high-quality images of patients’ airways, they can better understand, and furthermore, I can evaluate the jaws for abscesses, cysts, bone loss, and other abnormalities. However, my favorite part of having the larger field of view is visualizing nasal obstructions. By evaluating the turbinates and sinuses I can set patient expectations and have a road map to nasal breathing, an important goal in sleep.

I am happy to report the most recent addition to our technology family: the MATRx plus, an at-home Sleep Theragnostic device developed by Zephyr Sleep Technologies. Traditionally when a patient was referred to me, we would assess the patient and tell them that, based on research, an appliance should work for them. Are they mild, moderate, or severe with C-PAP intolerance? What is their BMI? Age? Neck size? Skeletal class? We would look at all these things plus some other parameters to decide who we think would be a good candidate for an efficacious sleep appliance. We would make the appliance at a protrusive position that is a good guesstimate, have the patient advance their appliance based on their symptoms, give them time, re-test with the appliance in place, and then the most important part… cross our fingers and hold our breath until we get the therapeutic outcome results back.

Now, all in the comfort of their own home with Zephyr’s MATRx plus, we know in advance whether a sleep appliance will effectively treat a patient and the target protrusion. Not only that, there is research to support it. The MATRx plus device has been validated in two clinical trials; the article published in the Journal of Clinical Sleep Medicine1 can be found here: www.zephyrsleep.com/resources/research. But it boils down to the fact that the device has a positive predictive value of 97% and a target protrusion accuracy 86% of the time. The patients who did not show an ODI less than 10 at the predicted target protrusion only needed minor adjustments to their sleep appliance for full resolution of their SRBD.
Zephyr’s MATRx plus also simplifies my workflow because the patient is confident to move forward, we know exactly where to set the bite, and, with fewer follow up appointments, I need less chairtime. A win for everyone. My assistant makes the temporary trays and instructs the patient how to use the at-home MATRx plus device for the Sleep Theragnostic test. The how-to videos are easy to follow. At less than 3 oz., the motor that moves the jaw is not a problem. Once we receive the results stating that the patient will be a responder to mandibular advancement with a sleep appliance, we use our CBCT to build the appliance to that target protrusion by taking a low-resolution scan with the MATRx trays in the mouth. Software links the Dicom CT image and the STL chairside scans. With a click of a button we can order the appliance without impression material ever touching the patient, and there is no mailing or shipping. Sorry, US Postal Service!

This technology, known as The Simple Sleep Solution, not only makes our treatment and screening better, it makes things better for our patients, too. Physicians and Dentists have similar goals: scientifically validated tests, to be confident in the treatments they prescribe, predictability and accuracy, and their patients’ happiness.
You may think that old appliances and old workflows work “just fine.” Today, however, “just fine” isn’t good enough anymore. At least, not for this 42-year-old!

Read Dr. Tarun Agarwal’s experience with MATRx plus in “The simple sleep story solution”.  

Dr. Erin Elliott grew up in Southern California but went away to a small NAIA school in Western New York where she played collegiate soccer and graduated summa cum laude from Houghton College. After graduating Creighton Dental School in 2003, she settled in North Idaho to begin her general dentistry career. She has a special interest in Dental Sleep Medicine. She has lectured extensively on this topic and loves to help general dentists extend this life-saving service to their patients. She is an active member of her local American Dental Association, the American Academy of Sleep Medicine, American Academy of Dental Sleep Medicine and is the past president and a diplomate of the American Sleep and Breathing Academy. She’s teaching sleep apnea with 3D-Dentists and Dr. Tarun Agarwal as well as privately coaching practices about sleep.

Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, Bruehlmann S, Charkhandeh S, Jahromi SA. A feedback-controlled mandibular positioner identifies individuals with sleep apnea who will respond to oral appliance therapy. J Clin Sleep Med. 2017;13(7):871-880

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