1. Appliances for snoring and sleep apnoea
Oral appliances are now widely regarded by sleep physicians as the best available treatment for snoring and a frontline treatment for sleep apnoea.
It is important that dentists can choose from a range of new generation appliances as there is no one appliance that is ideal for each and every patient. While there are many appliances available, only a few have the features which dental experts regard as essential for achieving predictably successful results.
The criteria for an optimal Mandibular Advancement Splint:
It is important that dentists can choose from a range of new generation appliances as there is no one appliance that is ideal for each and every patient. While there are many appliances available, only a few have the features which dental experts regard as essential for achieving predictably successful results.
The criteria for an optimal Mandibular Advancement Splint:
- Scientifically proven by gold standard studies to be effective, comfortable and safe.
- Easily adjusted by the patient in order to achieve a comfortable jaw position which alleviates snoring and the symptoms of sleep apnoea.
- Of minimal dimensions for long term comfort and compliance
- Allows for freedom of mandibular movements in order to minimise potential side-effects.
- Is robust, long lasting, and able to withstand the forces of bruxism.
DorsalThe Dorsal appliance is the first of the appliances developed in which the upper and lower components are not joined together.
The lateral fin design maximises patient comfort and minimises side effects and it allows the patient to open and close, talk easily, sip water etc. As the upper and lower components can move independently of each other during mandibular movements there are less forces on teeth, thereby enhancing patient comfort. |
The Dorsal Appliance
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The lateral fins hold the mandible forward even during mouth opening. As the upper and lower components are not connected there are little dislodging forces when in use and retention is rarely a problem.
First designed in 1985 the new generation Dorsal appliance has been successfully used in tens of thousands of patients throughout the USA, Europe and Australia. There have been many studies of the lateral fin designed appliances demonstrating effectiveness.
First designed in 1985 the new generation Dorsal appliance has been successfully used in tens of thousands of patients throughout the USA, Europe and Australia. There have been many studies of the lateral fin designed appliances demonstrating effectiveness.
SilensorThe Silensor is a metal free appliance designed in Germany with the side connectors made from high strength nylon.
It is an extremely unobtrusive appliance in wide spread use throughout the USA and Europe. It comes with an array of different length side connectors, which allows for optimal mandibular positioning. It is simple for the patient to be able to change the connectors in achieving control of snoring and sleep apnoea. The silencer is an excellent choice when the patient has narrow arches, minimal intra oral space or is a gagger. |
The Silensor Appliance
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MDSAThe MDSA (Medical & Dental Sleep Appliance) is an Australian device that has excellent scientific studies demonstrating effectiveness and comfort.
The MDSA is robust and often indicated for patients who are heavy clenchers and grinders. It is easy for the patient to make adjustments for mandibular advancement and achieving optimal control of the symptoms of sleep apnoea and snoring. The MDSA allows for an excellent range of lateral mandibular movements when connected. |
The MDSA device
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EMAThe EMA (Elastomeric Mandibular Advancement) is an unobtrusive mandibular advancement splint designed in the USA. The upper and lower individual components are held together with elastic straps of varying lengths and flexibility.
These straps provide excellent lateral movement as well as dictating the amount of mandibular advancement. |
The EMA appliance
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The EMA is indicated for patients who are very sensitive and have a tendency to gag, as well as people who have a full upper denture and some lower teeth.
HerbstThe Herbst appliance has been proven through many published studies to be effective for chronic snoring and obstructive sleep apnoea.
This appliance allows for lateral and vertical movement and the components are extremely robust. The strength of the components makes it ideally suited for patients with bruxism. The mandible can easily be moved forward in small increments by simple adjustments of the laterally placed telescopic hardware. |
The Herbst appliance
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2. Occlusal Splints for Bruxism
Protecting teeth and restorations is universally regarded as one of the most valuable services a dentist can provide. Many dentists make the provision of a bruxism splint an integral part of any treatment plan when wear on teeth and restorations are present.
Three essential factors for a successful bruxism splint:
Three essential factors for a successful bruxism splint:
- Achieving good compliance through maximal comfort. An occlusal splint should be of minimal thickness, minimal extensions and highly polished
- Minimal chair side time for the dentist. No adjustment required to the fit or the occlusion.
- Maintains occlusal stability.
The Mini FM
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A mini full mouth occlusal splint designed by dentists to fulfil the criteria for an optimal splint.
The MiniFM has minimal dimensions and is designed to achieve long term patient compliance The MiniFM is widely regarded by dentists as the most comfortable, unobtrusive, full mouth splint available. |
 The Mini FM Occlusal Splint
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Features of the MiniFM
• Absolutely minimal dimensions makes it extremely comfortable and easy for patients to wear long term,
• Unique hard, thermosensitive material allows the dentist to provide, and maintain a optimal fit and occlusion each time,
• Maintains long term occlusal stability.
Made from a unique thermosensitive material
The thermosensitive material is composite-based with increased strength for severe bruxism patients. The optical clarity permits the MiniFM to be unnoticeable while wearing. The material is also amine free so it will stay clear and never yellow. Allergy problems are eliminated as the material does not contain any methyl methacrylate.
A key benefit - A perfect occlusion can be achieved in seconds
• Absolutely minimal dimensions makes it extremely comfortable and easy for patients to wear long term,
• Unique hard, thermosensitive material allows the dentist to provide, and maintain a optimal fit and occlusion each time,
• Maintains long term occlusal stability.
Made from a unique thermosensitive material
The thermosensitive material is composite-based with increased strength for severe bruxism patients. The optical clarity permits the MiniFM to be unnoticeable while wearing. The material is also amine free so it will stay clear and never yellow. Allergy problems are eliminated as the material does not contain any methyl methacrylate.
A key benefit - A perfect occlusion can be achieved in seconds
If required simply immerse the MiniFM in boiling water, place into position over the teeth while soft and then get the patient to bite firmly onto the occlusal surface in the centric position. The splint is then placed in cold water for 20 seconds. Simultaneous contact is then achieved and maintained for the longer term without any need for further adjustment. This totally eliminates any occlusal grinding to achieve an optimal occlusion.
A mandatory part of the treatment plan
Many dentists are making the provision of the MiniFM splint a mandatory part of the treatment plan when there is any evidence of bruxism. This is a very valuable service for your patients and a significant source of revenue for your practice.
Please note: The MiniFM splint can be made in the “Michigan” format with anterior and cuspid guidance, or with a fully flat occlusal pane.
Other splints
Splints of specific designs such are available on request.
A mandatory part of the treatment plan
Many dentists are making the provision of the MiniFM splint a mandatory part of the treatment plan when there is any evidence of bruxism. This is a very valuable service for your patients and a significant source of revenue for your practice.
Please note: The MiniFM splint can be made in the “Michigan” format with anterior and cuspid guidance, or with a fully flat occlusal pane.
Other splints
Splints of specific designs such are available on request.
Full mouth splints versus anterior splints
The key principle in dentistry and medicine is to primarily do no harm. Anterior splints such as the NTI and the MCI are recognised to cause an anterior bite in a significant amount of cases. The open bite can occur within four weeks of use and can be severe and irreversible. This open bite is not due to over eruption of teeth but due to a re-positioning of the mandible. .
The key principle in dentistry and medicine is to primarily do no harm. Anterior splints such as the NTI and the MCI are recognised to cause an anterior bite in a significant amount of cases. The open bite can occur within four weeks of use and can be severe and irreversible. This open bite is not due to over eruption of teeth but due to a re-positioning of the mandible. .
Hard or Soft splints?
It has been established that the occlusal surface of the splint should be made of a hard material.
Professor Jeffrey Okeson published an article* demonstrating that a hard occlusal splint significantly reduced muscle activity in eighty percent of participants. A soft occlusal splint significantly reduced muscle activity in only 10 percent of subjects while causing a statistically significant increase in muscle activity in 50 percent of the participants.
* “The effects of hard and soft occlusal splints on nocturnal bruxism.”
Okeson JP.J Am Dent Assoc. 1987 Jun;114(6):788-91
It has been established that the occlusal surface of the splint should be made of a hard material.
Professor Jeffrey Okeson published an article* demonstrating that a hard occlusal splint significantly reduced muscle activity in eighty percent of participants. A soft occlusal splint significantly reduced muscle activity in only 10 percent of subjects while causing a statistically significant increase in muscle activity in 50 percent of the participants.
* “The effects of hard and soft occlusal splints on nocturnal bruxism.”
Okeson JP.J Am Dent Assoc. 1987 Jun;114(6):788-91
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"The best thing that dentists can do for patients with bruxism" - an interview with Professor Robert Cronin.
Professor Robert Cronin, from the University of Texas Health Science Centre, is the director of the post doctoral prosthodontics program and Professor at the San Antonia dental school. This interview is a transcript from the ADA Clinical & Business Updates for Dentists - Audio Program 3 – 2007 Track 1: Bruxism |
DOWNLOAD PDF - Read the Interview with Professor Robert Cronin, University of Texas Health Science Centre.
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Which type of splint is best - flat plane or cuspid with anterior guidance?
A published scientific study demonstrated that both these occlusal schemes are equally effective when used for patients with TMD or for the medium to long term protection of teeth. It can be left to the personal choice of the dentist.
“effects of canine versus molar occlusal splint guidance on nocturnal bruxism and craniomandibular symptomatology.”
J D Rugh; G S Graham; J C Smith; R K Ohrbach
Journal of craniomandibular disorders : facial & oral pain 1989;3(4):203-10.
A published scientific study demonstrated that both these occlusal schemes are equally effective when used for patients with TMD or for the medium to long term protection of teeth. It can be left to the personal choice of the dentist.
“effects of canine versus molar occlusal splint guidance on nocturnal bruxism and craniomandibular symptomatology.”
J D Rugh; G S Graham; J C Smith; R K Ohrbach
Journal of craniomandibular disorders : facial & oral pain 1989;3(4):203-10.