Evie Summers
Oral appliances are used to treat sleep apnea by pulling the jaw or tongue forward while the patient sleeps. Before recommending treatment options, a sleep study should be performed to determine the severity of the patient's symptoms. If oral appliances are recommended, a dentist will take impressions of the patient's teeth to create a custom-fitted device. Fine detail impressions of both arches are critical to the success of the appliance, and the quality of the digital impressions is important as the dentist will need to keep digital models of the appliance.
| Characteristics | Values |
|---|---|
| Impression material | Polyvinyl siloxane (PVS) |
| Impression technique | Fine details of both arches are critical. Impressions must depict the molar region and tissue distal to the posterior molars, and clearly capture the gingival sulcus. |
| Contamination prevention | Keep mixing tips fully submerged in the impression material to avoid air bubbles. |
| Bite scanning | Eliminate the tongue from being scanned and ensure jaws do not move during the process. |
| Bite fork | Use a 2mm bite fork of the George Gauge and add cotton pellets/paper at the incisal edges to increase the vertical gap. |
| Additional images | Return to the maxilla and mandible catalog box to take additional images and complete any remaining voids in the model. |
| Alginate impressions | Pour immediately, but first check that the alginate is not pulling away from the tray in any area. |
| Digital impressions | Will require a printed model. |
| Lingual tongue buttons | A poured model should be included to capture the lingual tissue and tori. |
| Midlines | Check in centric and in protrusive to minimize patient discomfort and maximize effectiveness. |
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What You'll Learn
Perform a sleep study to determine the severity of the patient's symptoms
A sleep study, formally known as a polysomnogram, is a diagnostic test that tracks and records how multiple body systems work while you sleep. This test can help determine the severity of a patient's symptoms and involves the following:
Sensors and Monitoring Methods
Sensors are placed on the patient's head and body to detect and record electrical activity in the brain, measure heart rate and rhythm, and monitor oxygen levels in the bloodstream. Elastic belts may be wrapped around the chest and abdomen to measure breathing, and an oximeter probe may be placed on the finger to measure oxygen in the blood. These sensors can also detect eye and muscle movements, including face twitches, teeth grinding, and leg movements.
Sleep Environment and Timing
Sleep studies typically take place at night, during a patient's normal sleeping hours, in a comfortable sleep lab or sleep center that resembles a hotel room. However, accommodations can be made for those who work night shifts and sleep during the day. The goal is for the patient to sleep for at least seven hours, but a diagnosis can still be made with less sleep.
Patient Preparation
Patients are advised to avoid caffeine and alcohol before the study, as they can interfere with results. They should bring comfortable clothing and any items that may aid their sleep, such as a book or a special pillow.
Data Analysis
The sleep study produces a large amount of data, which a sleep specialist will analyze to identify any sleep disorders or issues. This process may take some time, after which the results will be reviewed by a physician who will discuss the findings and next steps with the patient.
Treatment
If a breathing disturbance, such as severe apnea, is detected early in the study, technicians may attempt to provide treatment during the same night. This could involve the use of a continuous positive airway pressure (CPAP) machine and breathing mask.
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Use a George Gauge to capture the buccal bite
To capture the buccal bite using a George Gauge, you must first ensure that you have taken impressions of both arches. This is critical to the success of your sleep appliance. These impressions must be detailed and capture the landmarks of a denture impression, including the fine details of a crown and bridge impression.
The George Gauge is a tool that allows the clinician to capture the protrusive bite registration and vertical opening. It is ideal for mandibular repositioning and eliminates the guesswork involved in relying on the patient to achieve proper positioning. It is extremely accurate and easy to use.
To use the George Gauge to capture the buccal bite, you should start by eliminating the tongue from being scanned. This can be done by using a 2mm bite fork of the George Gauge and adding cotton pellets or paper at the incisal edges of the gauge to increase the vertical gap to the desired height. This prevents the intraoral scanner from picking up scan data from the tongue.
Once the tongue is eliminated from the scan, you can capture the buccal bite by scanning both the upper and lower jaws. It is important to ensure that the jaws do not move during the scanning process. After capturing the bite, you can move back to the maxilla and mandible catalog box to take additional images and complete any remaining voids in the model.
By following these steps and using the George Gauge, you can accurately capture the buccal bite and create a custom-fit device for your patient.
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Scan both the upper and lower jaws
To ensure quality digital impressions for sleep appliances, it is important to scan both the upper and lower jaws. This process captures the bite relationship between the jaws, which is crucial for designing a custom-fitted oral device. Here are some detailed instructions on how to scan the upper and lower jaws effectively:
Firstly, it is recommended to use an intraoral scanner, such as the Medit i500, to capture digital impressions. This scanner provides clear and accurate scans of the dental arches. When using an intra-oral scanner, it is important to eliminate the tongue from the picture to capture the buccal bite effectively. This can be achieved by using a 2mm bite fork of the George Gauge and adding cotton pellets or paper at the incisal edges to increase the vertical gap.
When scanning, ensure there is no movement of the jaws to capture an accurate occlusion. This can be facilitated by using the bite fork of the George Gauge, which helps stabilize the jaws during the scanning process. It is crucial to capture the fine details of both arches, including the molar region, the gingival sulcus, and the tissue distal to the posterior molars. The impressions should also capture the landmarks of a denture impression, similar to a crown and bridge impression.
Additionally, when scanning the upper and lower jaws, it is important to use the right impression material. A PVS impression material with a heavy body and a light body wash is recommended. Grade 4 stone can also be used for fabrication if preferred. It is crucial to carefully monitor the working and setting times of the impression material to ensure optimal results.
By following these instructions, you can effectively scan both the upper and lower jaws, capturing the necessary details for designing a custom-fitted sleep appliance. This process ensures that the oral device accurately fits the patient's mouth, improving the effectiveness of the treatment for conditions such as sleep apnea.
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Take detailed impressions of both arches
Fine detail impressions of both arches are critical to the success of a sleep appliance. To take detailed impressions of both arches, follow these steps:
Firstly, use a suitable impression material. Polyvinyl siloxane (PVS) impression material is a good option as it can benefit multiple pours, but special care must be taken to avoid distortions, especially when using two-part systems. Alternatively, you can use alginate, but be sure to check that it isn't pulling away from the tray before pouring.
When taking the impression, ensure that you capture the landmarks of a denture impression with the fine detail of a crown and bridge impression. The full upper and lower impressions must effectively show the molar region and, if possible, 5mm of tissue distal to the posterior molars. It is also important to clearly capture the gingival sulcus and the upper vestibule, as this is important for setting the Labial Acrylic Shield and Nasal Dilator Buttons.
After obtaining the impressions, you can move on to scanning the bite. To capture the buccal bite effectively, use a 2mm bite fork of the George Gauge and add cotton pellets or paper at the incisal edges to increase the vertical gap to the desired height. This will ensure the tongue is not included in the scan and that the jaws remain stable during the process.
Finally, return to the maxilla and mandible catalog box to take additional images and fill in any remaining voids in the model. Once you are satisfied that everything is in order, your detailed digital impressions are ready to be used as a reference for designing a custom-fit sleep appliance.
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Design a custom-fitted oral device
Oral appliances are often used to treat sleep apnea and snoring. The design of a custom-fitted oral device begins with a sleep study to determine the severity of the patient's symptoms and the best therapy option. This is followed by a detailed impression of the patient's teeth, which can be done through a physical mould or a digital scan. Fine detail impressions of both arches are critical to the success of the sleep appliance. This includes capturing the landmarks of a denture impression, such as the molar region and the gingival sulcus.
To create a custom-fitted oral device, dentists often use impression materials like Polyvinyl Siloxane (PVS), which can benefit multiple pours, but special care must be taken to avoid distortions. Alginate impressions, for example, should be poured immediately, but one must first check that the alginate is not pulling away from the tray. To ensure quality impressions, it is important to keep the mixing tips fully submerged in the impression material to avoid air bubbles.
After obtaining the impressions, the next step is to scan the bite. To capture the buccal bite effectively, the tongue should be kept out of the scan, and the movement of the jaws should be minimised. This can be achieved by using a 2mm bite fork of the George Gauge and adding cotton pellets or paper at the incisal edges to increase the vertical gap.
Once the bite has been captured, additional images may be taken to complete the model. At this stage, the digital impressions can be used as a reference to design a custom-fit device. The design process should consider the patient's specific needs, as each patient's condition differs. The custom-fitted oral device is then manufactured and fitted to the patient during a subsequent visit.
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Frequently asked questions
A sleep appliance is a dental device used to treat sleep apnea and snoring by pulling the jaw or tongue forward while sleeping.
First, a sleep study is conducted to determine the severity of the patient's symptoms and the appropriate therapy option. Then, detailed impressions of both arches are taken using a George Gauge to capture the bite relationship. After obtaining the impressions, the bite is scanned, ensuring the tongue is not included in the scan and that the jaws do not move during the process. Finally, additional images are taken to complete any remaining voids in the model.
Polyvinyl siloxane (PVS) impression material is commonly used for taking impressions. It offers the benefit of multiple pours, but special care must be taken to avoid distortions and pulls when using one or two-part systems. Alternatively, alginate impressions can be used, but they must be poured immediately and checked for any signs of pulling away from the tray.
It is important to capture fine details of both arches, including the landmarks of a denture impression and the molar region. The gingival sulcus should also be clearly captured. To avoid contamination, keep the mixing tips fully submerged in the impression material. Additionally, check for any distortions, such as voids, drag, bubbles, incomplete arch areas, or broken teeth.
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