The patient can be fit the same day they have been qualified for care. “For an office that is doing one or more appliances per week, there are some really great advantages of in-office fabrication of sleep appliances: Jamison Spencer, director of the Center for Sleep Apnea and TMJ in Boise, Idaho, said the following: When asked about the process of chairside fabrication, Dr. Note that a trained technician at Glidewell can fabricate an EMA appliance in about 30 minutes. A trained assistant can take a patient from impressions to a completed appliance in a single visit using the ERKODENT ® Erkoform-3d motion vacuum-forming machine (Table 1). Same-visit dentistry is possible with the EMA appliance because it is a thermoformed device, with a straightforward fabrication process. Provisional treatment is well suited for immediate, same-day care. Dogs love to chew on unattended sleep appliances that are stored on the bedside table and not kept in their case. It is very important for patients to keep their appliance stored in a temperature-controlled environment (not too cold, not too hot). EMA elastic straps should be replaced with straps of the same length and color on a monthly basis to ensure a therapeutic jaw position is maintained. Elastics by their nature stretch over time. This can cause cracking or crazing of the appliance on the midline. Orientation of the elastic straps is shown with the printed numerals on the outside.Ĭare should be taken when adjusting and removing the straps not to put lateral pressure on the posterior area of the appliance. When replacing the straps, it is easier to hook the elastics on the lower arch first and then the upper arch. The elastic straps should be removed about once a week in order to clean the elastic hook components. Place the appliance in the case provided to dry throughout the day. After a full night of wear, run the EMA appliance under clean, cold water and brush the appliance with a clean, dry toothbrush. The EMA appliance is worn at night, and it is important to brush and floss before using the device in order to keep the appliance clean and to protect patient dentition. Allow five days in the lab for the final appliance to be shipped back to the dental office. If the dentist is not yet set up for same-visit sleep therapy services, bite records may be sent to Glidewell - either as a physical impression or digitally - for the lab to fabricate the final EMA appliance. The EMA appliance can be made in the dental office for immediate delivery. In most cases, this is determined as an edge-to-edge or a comfortable protrusive bite position. To begin immediate treatment with the EMA appliance, the dentist makes an impression of the patient’s teeth and takes a bite registration, indicating where the mandible shall be positioned on initial delivery of the appliance. Central to this strategy is the use of an informed consent document that records the patient’s understanding of the provisional nature of the treatment and the importance of the referral to a physician. For individuals at risk for SDB, provisional mandibular advancement device (PMAD) therapy is a strategy that any general dentist can use to treat their patients, who are then referred to a physician for definitive diagnosis and medical management. Many dentists have found that their patients cannot easily access sleep diagnostic services and may go untreated. If patients are found to be at risk, they should be referred to a physician for a diagnosis. The American Dental Association (ADA) encourages dentists to screen for SDB as part of a comprehensive medical history.
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