I saw another patient yesterday that had an appliance for treating obstructive sleep apnea made by a doctor in the Midwest. The appliance was made well and the obstructive sleep apnea was under control. The patient reported she slept better and loved the appliance.
This patient had a serious side effect from the appliance and was seeking my help. She could not bite on her back teeth anymore. She only was able to bite on her front teeth.
Upon further discussion she was not being called in for monthly recalls for the first few months, she was told when she felt better she was done. There was never a home sleep test or PSG taken to objectively verify the titration of the appliance. She was also put into a TAP AM aligner to protect the bite and told to use it for 20 minutes per day.
What went wrong for her, and what can we do to fix it?
The treating dentist did not conduct enough follow-ups and did not educate the patient enough. This patient should have been told about potential teeth shifting or bite changes, and at the onset of such things happening to come back right away for correction. Also the patient should have had a follow-up HST or PSG to verify the appliance is working and if adjustments need to be made
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The AM aligner is better than nothing for keeping the bite stable, but it has flexibility and can distort very fast. Even though it may look in good condition it may be altered from excessive force due to the nature of the material. The proper way to ensure the bite is with a rigid hard acrylic appliance to reset the teeth. I call this appliance a morning repositioner. This appliance ensures the bite is maintained. This appliance is a mandibular appliance indentations for the maxillary teeth to fit into it.
For this patient I adjusted her bite by slightly adjusting the lower anterior teeth with a softlex disc on a high speed. Then her posterior teeth touched with a stable bite. If she wants to move back into class I instead of the pseudo class III it would have required orthodontic and she did not want that. She discontinued her sleep appliance until we had a hard acrylic morning repositioner to deliver to her. Upon delivery of the morning appliance she was told to clench into it for 30 minutes each morning right after taking out her sleep appliance and to let us know immediately if there was any bite changes.
You can get a morning repositioner by taking impressions and a stable natural bite registration and sending it to Either Dynaflex lab or Gergens Lab. With Dynaflex ask for the morning repositioner Dr. Mark Collins uses. See opening picture of what a morning repositioner looks like.
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