Dental Sleep Medicine Insider May 2018 | Page 38

ROY HAKALA, DDS NOT A HEAVY METAL FAN? I have been using oral sleep apnea appliances since 1985 and have watched their development closely. As new appliance designs came out, I developed a number of criteria to help me evaluate them. In my practice we prescribe the EMA (Elastic Mandibular Advancement) far more often than any other appliance, because EMA satisfies most completely these essential criteria: FULL COVERAGE. Having done orthodontics with fixed and removable appliances, I was well aware that partial coverage designs allow tooth movement. The EMA covers all the teeth completely and resists tooth movement better than any other appliance I tested. RETENTION. Full coverage means good retention in most cases, and the allthermoplastic polymer resin design makes EMA easy to adjust retention. We can trim the interproximals to loosen an EMA or use a heat gun or add a tiny bit of cold- cure acrylic to interproximal areas to tighten the appliance, all chairside, without lab fees or wire bending. ADJUSTABILITY. The EMA has a choice of 36 straps available in four levels of stiffness and can be adjusted by up to 9 mm of protrusion simply by snapping on a different set of straps. This is a wider range of adjustment than any other appliance I have used. The vertical dimen- sion can be changed almost as quickly, either by trimming the occlusal pads or by adding a bit of light-cure composite to increase their height. COMFORT. The EMA is the thinnest FDA-cleared oral sleep apnea appliance on the market, and its open anterior region allows speech and even taking a drink of water without taking the appliance out. The four levels of stiffness in the straps allow even more comfort. Additionally, there are no metals that may result in allergic reactions. COST. Lab fees for the EMA are the lowest of any of the FDA-cleared oral sleep apnea appliances that I have used. The simple design of the EMA keeps costs down, and also means an EMA can be constructed faster than other designs. At present, my first thought in developing a sleep apnea treatment plan is, “Is there any reason not to use an EMA?” ROY HAKALA, DDS Dr. Roy Hakala established the Minnesota Craniofacial Center Midway in Saint Paul, MN in 1994 and has limited his practice to the treatment of sleep breathing disorders and TMJ dysfunction since then. He is a Diplomate of the American Board of Dental Sleep Medicine, the Academy of Clinical Sleep Disorders Disciplines, and the American Board of Craniofacial Pain; and is a Fellow of the Academy of General Dentistry.