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.