When teaching at the Pankey Institute in the early 90’s, I was fortunate to be influenced by some great minds in TMD, Chronic Pain and Sleep Medicine. Drs. Parker Mahan, Henry Gremillion, Keith Thornton, William Dement and others, all, unknowingly, had a hand in directing my journey; Mahan and Gremillion taught me about chronic pain and fibromyalgia, Stanford’s Dement and his books helped me be confused at a higher level about sleep and Thornton encouraged me to make my first Crude OSA appliance an early TAP. Without titration or pre or post Polysomnograms, it looked more like an impression tray on the maxilla with a flat area on the lower anterior that patients would have to protrude past to close…hence opening the airway. Or so we hoped. The second generation or Static Twin Block Appliances were far more attractive and comfortable to wear but really offered little else than cosmetics as an improvement. The science began to evolve and pre and post testing began to showcase the efficacy of this new way of treating OSA.
Generation 3 or the Titratable appliance designs, saw a vast improvement in both the science and the function of OAT. Hooks, tubes, screws, straps and bars were all used to measure and hold the mandible in a protruded position to open the airway. PSGs and HSTs provided data that demonstrated we were in a new era of treating OSA. The dentist had an advantaged solution over pressurized air that patients found far more comfortable to wear.
Dr. Steve Carstensen recently told me that the most impactful thing about the fourth generation of CAD CAM optimized appliances is how they serve the patient. The reduction in chair time, patient education and maintenance regarding use were all worthwhile, but the fact that this generation makes it easier for the end user was the point he made. He said, “CAD CAM appliances make it easier for the patient to fit, wear, acclimate to and depend on my appliance. Many of my patients feel like they couldn’t live without it!”. He continues, “the intricacies and complexities we saw in the Gen 3 devices were things we could understand and adjust, but patients struggled with them. The engineers who designed the MicrO2 and Narval CAD CAM solutions clearly used the technology to not only improve the product, they improved the patient experience as well”.
The milled MicrO2 has distinct advantages over the earlier generations of appliances. The denser acrylic puck used in the milling is stronger and leaches less monomer than other PMMA forms. Removing the lower lingual acrylic allows the patient to feel their teeth and leaves 11% more tongue space. This type of MAD can be made thinner and with significantly less overall bulk and volume. The CAD CAM digital process allows for accuracies that we have not seen before. With a retainer like fit, teeth do not more and the initial delivery adjustments disappear. Patients rave about how much more comfortable the MicrO2 is to wear and have chosen it over other appliances when give a choice. There is no doubt a dental sleep medicine provider can leverage the new generation of materials and processes into a patient experience that sets them apart.
For most dentists, the era of wanting infinite adjustment settings has also passed. The ability to design the appliance and prescribe 0.5 or 1.0 mm titration increments and control them accurately and easily is the new norm. Patients do better, call less and it saves valuable chair time. There will always be less expensive appliances, but if they “cost” more time, they are not cheaper at all. Incorporating dental sleep medicine into your practice has never been easier, more fulfilling or profitable.
Today, a full arch of teeth can be scanned along with a protruded, open bite and sent digitally to MicroDental, where, without a model, a CAD CAM OSA appliance can be milled and finished with fit and function like never before. Dentistry has moved a giant step towards a digital future resulting in better patient health and outcomes, a more fulfilling and less stressful practice and a patient experience that has been optimized. This spring, April 21-24, 2016, several of North America’s most prestigious leaders in Dental Sleep Medicine will gather in Austin, Texas for the “Sleep Matters” MicrO2 Users conference. For more information and to step into digital sleep dentistry, visit the Sleep Matters conference site.