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Appliances


Two Appliances are used: The Somnodent and Herbst

 

SomnoDent® MAS the right treatment option for me?

If you suffer from obstructive sleep apnea (OSA) or snore, the SomnoDent® MAS should benefit you. It will almost certainly put an end to your snoring and will most likely eliminate or significantly reduce your OSA. For your bed partner this means peace and quiet again and a better night's sleep. For you, it will mean better quality sleep. As a result, you will be less likely to suffer from headaches and daytime sleepiness and your ability to concentrate will improve.

If you have tried CPAP and found it uncomfortable, wake up to a brilliant alternative treatment for OSA. The difference in comfort and tolerance will astound you.

A study conducted by Dr Edmund Rose at the University of Freilberg 2004 proposed that the ideal patient for MAS therapy is one with a AHI < 25 and BMI < 30 with good dentition. Therefore, when identifying how effective the SomnoDent device is going to be for you, we recommend looking at 3 key areas:

Severity of OSA.

The American Academy of Sleep Medicine recommend the use of oral devices such as the SomnoDent® MAS for mild-to-moderate OSA (AHI < 25), or for patients with severe OSA who either are unable to tolerate CPAP or refuse treatment with CPAP.

Body Mass Index.

If BMI is below 30 (which means that a person is not obese) the probability that the device will work is higher. To calculate your BMI please use this chart.

Dentition

SomnoMed defines good dentition as at least 6 teeth on the lower mandible with no periodontal disease.

These three indicators offer a good guide to screening patients for oral device therapy and may increase the efficacy outcome of the treatment.

The Herbst for Snoring and Obstructive Sleep Apnea (OSA)

The Herbst appliance has been used for many years in the treatment of Class II malocclusions in children. With minor modifications, the Herbst appliance has been proven to be effective in the treatment of snoring and mild to moderate OSA. "Adjustability" is the primary advantage of the Herbst appliance in snoring and OSA cases. The post and sleeve mechanism advances the jaw into a forward position. If desired relief is not immediately achieved, this unique appliance design allows for additional forward movement of the mandible. With standard hardware, the mandible is advanced in 1mm increments by adding advancement shims onto the posts. The clinician crimps the shims to secure them so the patient will not lose the shims or the advancement position. The telescopic version of the Herbst allows the clinician to advance the mandible more precisely. One turn of the advancement collar, until the next hole appears, advances the mandible in 1/4 increments.

Please be aware that the arrows indicate the directions of advancement, ie: right side-up, left side-down.

Herbst Material Options

The Herbst appliance can be fabricated from three material options including hard acrylic, thermal active, or soft mouthguard material. Opposing ball hooks located in the upper and lower canine area are joined by elastics to maintain the vertical dimension. The standard elastic samples provided are #64, 5/16"-8oz. They will need to be replaced periodically. Any size elastic can be substituted as long as the mandible is maintained in the forward, closed bite position. Although the soft material may be viewed as more comfortable, periodic replacement may be necessary due to the nature of the material. For this reason, it is not recommended for clenchers or bruxers. If cared for properly, the metal framework can be reused in most cases. The hard acrylic is ideal for patients with normal dentitions. The thermal active material is suggested for patients with short clinical crowns and dental types that do not have an ideal complement of teeth.

Telescopic Hardware

Telescopic hardware for the Herbst permits the clinician to advance the mechanism without the use of shims. The unique threaded system will not separate, and provides for advancement in more precise 1/4 mm increments. The adjustment collar, on the lower portion of the arm near the
bicuspids, will gradually allow up to 5mm of movement.

Additional custom services provided by Dr. Buck at TMJ and Sleep Center of Seattle

A "chew toy" is a used to allow the patient in the morning to work to allow back teeth to fit together if it is difficult to do so after wearing the appliance through the night. This is worn for up to thirty minutes in the morning to allow muscles to accommodate to bring the teeth back together. This is a part of the comprehensive service Dr. Buck uses.

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