Evie Summers
Sleep appliances are used to treat sleep apnea, and custom appliances are expensive and must be fitted by a dentist. A titration appliance is a cheaper alternative that can be used to predict custom appliance outcomes or provide temporary therapeutic benefits. Impressions are used to make castings, which are then used to fabricate the custom appliance. Digital Impressions require a printed model, and the George Gauge and the Perfect Bite are tools that can be used to take the Construction Bite for an O2 OASYS. Alginate Impressions should be poured immediately, but it's important to first check that the alginate isn't pulling away from the tray. Polyvinyl Siloxane (PVS) Impressions can be beneficial for multiple pours, but special care must be taken to avoid pulls and distortions.
| Characteristics | Values |
|---|---|
| Purpose | To treat sleep apnea, hypoventilation, and hypoxemia |
| Mechanism | Blows air into a person's nose or mouth to keep their airway open |
| Types of Impressions | Digital Impressions, Alginate Impressions, Polyvinyl Siloxane (PVS) Impression |
| Impression Requirements | Detailed recording of all teeth and tissue, capturing the upper vestibule, lingual tissue, and tori |
| Tools | George Gauge, Perfect Bite, Bite Jig |
| Sleep Study Procedure | Sensors attached to the body to monitor sleep, gradual increase in air pressure through a nasal or full-face mask |
| Sleep Study Outcome | Determination of optimal air pressure setting for CPAP machine or recommendation for a variable pressure device |
| Custom Appliance | Fabricated by a dental laboratory using impressions, with adjustments made for optimal mandible protrusion |
| Custom Appliance Efficacy | Reduced apnea/hypopnea index by 50% in 77% of patients, found to be more comfortable than the titration appliance |
| Titration Appliance | Apnea Guard®, adjustable across protrusive ranges |
| Titration Appliance Efficacy | Reduced apnea/hypopnea index by 50% in 53% of patients, preferred by patients over no therapy |
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What You'll Learn
Impressions should include a detailed recording of all teeth and tissue
Digital Impressions will require a printed model. If Lingual Tongue Buttons are requested, the Digital Model does not usually capture Lingual Tissue and Tori adequately, so a poured model should be included. The George Gauge and the Perfect Bite are tools that can be used to take the Construction Bite for an O2 OASYS. The Midlines should be checked in Centric and in Protrusive to minimize patient discomfort and maximize effectiveness. The patient can usually be guided to keep the same midline position, but any variance should be noted on the RX of a midline/position line variance from centric. The Protrusive Bite Registration should be taken with an Incisal Opening of 5-7mm, at 60-70% of Maximum Protrusion. If the patient can extend 10mm using the George Gauge, a starting position for the device would be a 6 or 7mm advancement.
The easy sliding feature of the Oasys allows you to increase or decrease protrusion after delivery. Having the patient try to snore with the Bite Jig in their mouth at different protrusive positions may indicate a starting position where the airway is open. Other bite methods can be used without these tools, but by keeping the registration medium on the posterior teeth, the midline position can be maintained, and adequate vertical dimension captured.
Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances must be fitted by a dentist and are expensive, but they offer a longer useful life of two or more years. A dental laboratory uses the impressions to make castings, then fabricates the custom appliance to the prescribed protrusive setting. Once the patient receives the appliance, further adjustments are made until the mandible is optimally protruded and symptoms resolve.
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Digital Impressions will require a printed model
Digital Impressions are now commonplace, using intraoral scanners with digitized data for 3D dental impressions. There are two types of scanners on the market: those that use blue LED (light-emitting diode) and optical scanners that require a reflective surface and a contrasting medium or powder, and those that use laser technology to scan and measure distances from the tooth surface.
The digital impression files are saved as STL (standard tessellation language) files and sent to the denture lab. Here, specialized software is used to print 3D models that can be articulated into centric occlusion. The clinician scans the patient's teeth and tissue, as well as the periphery of the soft tissue, to obtain a good-fitting set of dentures.
Digital Impressions offer greater accuracy, especially when restoring multiple units, and there is no contamination from the patient. They also offer time savings, with no need for model pouring, disinfection, or cleanup of impression guns. There is also no need for packaging or shipping, as impressions are sent electronically. Furthermore, the scanned impression images are preserved digitally, which is advantageous should the patient require another set of dentures in the future.
However, there are some disadvantages to digital impressions. There is an initial cost to the equipment, and it is still difficult to scan a prepped tooth for a crown to fit an existing partial.
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Alginate Impressions should be poured immediately
Alginate is a popular impression material used in dentistry. It is an irreversible hydrocolloid that can undergo dimensional changes over time, which can impact the accuracy of dental models poured from the impressions. These dimensional changes can be influenced by three key processes: imbibition, evaporation, and syneresis. Imbibition is the absorption of fluid by the colloid, resulting in swelling, while syneresis is the expulsion of liquid from the gel. Therefore, it is crucial to pour alginate impressions in a timely manner to maintain accuracy.
To ensure the best results, alginate impressions should be poured immediately after taking the impression. This helps to minimize the risk of distortion and maintain the dimensional stability of the impression. Before pouring, it is important to check that the alginate is not pulling away from the tray and that all teeth and surrounding tissue are captured. It is also crucial to disinfect the alginate impression to prevent the transmission of infectious pathogens to dental laboratories.
If it is not possible to pour the alginate impression immediately, proper storage is essential. The impression can be wrapped in a moistened paper towel and placed in a ziplock bag, ensuring the tissue remains adequately wet. Alternatively, it can be stored in a container with some water to create a humid atmosphere. These storage methods help maintain the dimensional stability of the alginate impression by controlling the moisture levels and delaying the processes of imbibition and evaporation.
While alginate impressions offer advantages such as lower cost, improved patient tolerance, and the ability to obtain detailed impressions, they also have some disadvantages. Alginate impressions have lower accuracy compared to elastomeric impression materials, providing less precise reproductions of soft and hard tissue details. They also have low tear strength, making them more prone to tearing during removal from deep undercuts. Additionally, alginate impressions can only be poured once, producing a single plaster model, unlike elastomeric impressions that can be poured multiple times.
In conclusion, alginate impressions should be poured immediately to ensure the highest accuracy and minimize the risk of distortion. Proper storage and disinfection procedures are also crucial steps in the process of taking alginate impressions for sleep appliance titration tools. By following these guidelines, dental professionals can ensure the reliability and accuracy of the resulting dental models.
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Polyvinyl Siloxane (PVS) Impressions can allow multiple pours
Polyvinyl siloxane (PVS) impression materials are widely used in dentistry because of their excellent reproduction of detail and dimensional stability over time. They are user-friendly, easy to mix, and have no unpleasant odour or taste. PVS impressions can also withstand disinfection routines without significant distortion.
PVS impression materials are available in different viscosities ranging from extralight body to putty. They have high tear strength and high elastic recovery, which means they can be poured multiple times. However, special care must be taken when using two-part systems as distortions are not always evident until the impressions are poured. Pulls are common in one and two-part systems and will affect the fit.
PVS is traditionally a hydrophobic material, and proper moisture control is important to obtain a clinically acceptable impression. Some newer PVS impression materials are advertised as hydrophilic, but these still seem to exhibit hydrophobic qualities when in an unpolymerized state. Their wetting abilities are also compromised in the presence of moisture, which can lead to inconsistent surface detail reproduction.
PVS impression materials have a significant interaction with latex. Any contact of unpolymerized PVS material with latex will result in the inhibition of the polymerization of the impression material. This can occur if the person mixing the putty material is wearing latex gloves or even if latex gloves were worn prior to mixing. Direct inhibition of polymerization can also occur if the impression material comes into contact with a rubber dam. Indirect inhibition of polymerization can occur intraorally when latex gloves contact tooth preparations and the surrounding periodontal tissues during tooth preparation or gingival displacement procedures.
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The George Gauge is a good tool for taking the Construction Bite
The George Gauge is a highly accurate and effective tool for taking the Construction Bite for an O2 OASYS. It is ideal for mandibular repositioning, allowing the clinician to capture the protrusive bite registration and vertical opening without relying on the patient to achieve the proper positioning. This eliminates guesswork and ensures a precise impression.
The George Gauge is particularly useful for capturing the bite registration at an incisal opening of 5-7mm, at 60-70% of maximum protrusion. If the patient can extend 10mm using the George Gauge, a starting position for the device would be a 6 or 7mm advancement. This helps to ensure the patient's comfort and the effectiveness of the device.
Furthermore, the George Gauge can aid in checking the midlines in centric and protrusive positions. While patients can usually be guided to maintain the same midline position, there may be variances. The George Gauge helps to identify and record these variances accurately.
The George Gauge is a valuable tool for dental professionals when creating custom appliances for treating sleep disorders such as obstructive sleep apnea. It ensures accurate impressions, patient comfort, and the effectiveness of the final appliance.
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Frequently asked questions
A sleep appliance titration tool is used to treat sleep apnea. It is a custom oral appliance that is fitted by a dentist and works by advancing the mandible to keep the airway open.
Taking impressions for a sleep appliance titration tool involves capturing all the teeth and surrounding tissue, especially the upper vestibule area. Alginate impressions should be poured immediately, but it's important to first check that the alginate isn't pulling away from the tray. Polyvinyl Siloxane (PVS) impressions can also be used for multiple pours, but special care must be taken to avoid pulls and distortions.
A CPAP titration study is an overnight sleep study that helps determine the ideal rate at which air should be pushed out of a CPAP machine to treat sleep apnea. It involves calibrating the CPAP machine by adjusting the air pressure through a nasal or full-face mask to find the right amount of air pressure to prevent the upper airway from becoming blocked.
Before a CPAP titration study, it is recommended to avoid alcohol and caffeine, take any prescribed medications, and bring comfortable clothing and a change of clothes for the next morning. It is also important to maintain good personal hygiene and avoid using any products or lotions.
During a CPAP titration study, sensors are attached to your body to monitor your sleep, including brain waves, heart rate, breathing, oxygen levels, and body movements. The technologist will gradually change the air pressure you receive through your mask throughout the night, starting at a very low level.
