Dental Sleep Medicine Insider December 2015 | Page 10

CHOOSING THE BEST ORAL APPLIANCE

FOR TREATING OBSTRUCTIVE SLEEP APNEA
DR. STEVEN LAMBERG

FOR BOTH YOU AND YOUR PATIENT
what you should consider
when prescribing a particular
appliance.
Of course the
main effect, and side effects,
result
from
mandibular
advancement…which all of the
appliances achieve in a similar
way, and to a similar degree.

W

hat is “the best” for the patient
is unquestionably “the best” for
the doc. Determining what may
be “the best” oral appliance for
a particular patient is based
on the outcome. If you have
found a device that will satisfy
compliance and efficacy….and
durability, no one would argue
with your selection. So let’s
take a look at this appliance
selection process and help you
navigate the myriad of choices
we all have.
At this point in the evolution of
appliances it is recommended
to only use a custom fitted
appliance that is adjustable in a
minimum of .5mm increments
protrusively, and that has been
cleared by the FDA specifically
for OSA.
Additional qualities that you
will need to judge include the
following list appearing on the
next page.
(not in order of significance)
This is just the beginning of

A great place to gain
experience with appliances is
to order demos from your lab
and examine them critically.
Imagine wearing one of them
yourself every night for the rest
of your life.
“‘the best’ oral appliance for a
particular patient is based on
the outcome.”

Try some of the common
appliances on your patients, or
yourself, and see how it goes.
Begin trying a: dorsal appliance
by Somnodent, Herbst, TAP or
a Lamberg SleepWell appliance,
ResMed Narval or Panthera
D-SAD, EMA, and an Oasys. After
making a 100 or so appliances
you will begin to appreciate
there are many ways to skin
the cat. Additionally it must
be stated that if a patient has
been wearing an appliance
successfully in their past, and
they need a new one, it makes
sense to offer them the same
device they had already been
happy with.
In the contest between
evidenced
based
science
versus opinion, opinion seems
to have the leg up on this
topic due to the lack of head
to head scientific studies. I

participated in a blog recently
on this very topic. There were
over 175 “influencers” who
read or contributed to the
thread. I don’t believe there
was absolute agreement on
using a particular appliance
for any particular patient,
however the group seemed to
concur that the many qualities
of appliances listed above
should be considered and that
having familiarity with a few
different appliances would
be a benefit over just making
one appliance. Additionally,
it may be necessary to switch
appliances sometimes due to
breakage, patient comfort, or
to satisfy some of the other
qualities listed above which
may have been missed. My
opinion is that the practitioner
who does thorough follow-ups
and adjustments for patient
comfort will ultimately have
the highest compliance.
“select a few appliances and

perform careful follow-ups
to see how comfortable you
can make your patients.”
Select a few appliances and
perform careful follow-ups to
see how comfortable you can
make your patients. In the
end, if you maintain a critical
posture
when
evaluating
efficacy and compliance, you’ll
be the happy one and your
practice will thrive.

Contact Information:
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