Table of Contents
Sleep Apnea; Adjustable Anti-Snoring Devices
Fully adjustable anti-snoring device are the most versatile of all the anti-snoring devices because they contains a jack screw assembly or some other orthodontic arrangement which allows the dentist to progressively increase the jaw protrusion over the course of several weeks. This usually results in a much greater jaw protrusion with consequently greater relief of the symptoms of snoring and obstructive sleep apnea.
One of the more commonly prescribed semi adjustable anti-snoring devices is called the “SilentNite“. This appliance is really a proprietary form of standard orthodontic device called a Herbst appliance. In this case impressions are taken by the dentist and poured with plaster to make models of the upper and lower teeth. The models are sent to the lab, in this case without a protrusive bite registration. The lab sends back an appliance composed of two separate plastic bite trays, one each for the bottom and top teeth. These trays are attached together with a pair of plastic hinges which keep the lower jaw in protrusion while allowing the patient to open and close his mouth.
Notice that in this type of appliance the bar that connects the top and bottom trays may be lengthened or shortened to accommodate the needs of the patient. The shorter the bar, the more the protrusion.
This type of appliance is more expensive than the fixed relation anti-snoring device, partly because the lab costs are higher, and partly because there is more service necessary in replacing the connecting bars.
My experience with this device has been less than outstanding. Although the lab has been very helpful in remaking the device when it has failed, I feel that the materials out of which it is constructed are too difficult to fit properly, and too fragile to withstand prolonged usage. I now prefer to prescribe a TAP, the EMA, or a Herbst appliance since they hold up better to wear and tear, are much easier during initial fitting, and easier to adjust.
The Moses Appliance
This design is probably the newest on the market. In addition to protruding the lower jaw affecting a widening of the pharyngeal airway, the appliance is said to activate the tongue protrucing reflexes which increases its effectiveness in reducing apnea. It’s major problems involve asymetrical adjusting of the two independent jack screws and some difficulties with the compatibility of the upper and lower segments after extensive adjustments.
One of the most frequently prescribed fully adjustable anti-snoring device is a Canadian invention called the Klearway, and is shown in the four images below. The lower right image shows only the top arch and provides a detail of the jack screw that that allows for minute adjustment of the appliance. The two wires that project forward would be attached to the lower arch in a complete appliance.
This type of anti-snoring device is the most expensive, not only because of the more complex design and hardware requirements, but especially because it is quite labor intensive on the part of the dentist who must see the patient on numerous visits subsequent to the initial insertion in order to adjust the jack screw, progressively advancing the jaw.
The Herbst has been around for a very long time as an orthodontic appliance. Recently, it has been adapted to the role of snoring appliance, and it has since become one of the most commonly prescribed devices for the relief of snoring and obstructive sleep apnea. It consists of two hard, acrylic trays, one for each arch (upper and lower). The inside of the trays are formed to fit tightly over the teeth. The upper and lower trays are attached together by two bars that are placed along either side. They allow the lower tray to be advanced using 1, 2 and 3 mm shims which extend the stop at the end of the bar. The Herbst is available with either thermoflex trays, which are pliable when heated in warm water and can be more easily adjusted to fit the teeth, or hard acrylic trays, which are not as easily adjusted, but are more durable and hygienic.
The Herbst is similar to the Silent Night in that it allows some vertical and horizontal movement without disengaging the appliance. It is more expensive than the silent night, but much sturdier. The elastic bands on either side are to close the jaw once the patient is asleep in order to keep the lower jaw from opening which would reduce the amount of protrusion and decrease the effectiveness of the appliance.
The Snore-Aid is another proprietary form of anti-snoring device which is suitable for persons who wear an upper full denture (in other words have no upper teeth), but still have sufficient lower teeth to retain a plastic tray which can protrude the lower jaw. This anti-snoring device uses an extra-oral lip shield (engaging the outside of the upper lip) to hold the lower jaw forward. It too can be adjusted to increase the jaw protrusion over time.
This appliance is probably the most extensively tested appliance on the market. It’s simple design, high durability and easy adjustment make it a great choice. It can be prescribed and fabricated by any licensed dentist. It limits the the patient’s ability to open the mouth while wearing the appliance, but this has the advantage of maintaining the mouth in a closed position while sleeping, thus reducing the likelihood of mouth breathing. It has an added advantage in being fabricated with a thermal plastic which makes fitting and re-fitting very easy.
This appliance is probably the easiest one to insert and adjust. The yellow connectors in the image above are actually elastic rubber. Adjustments are made by choosing longer or shorter connectors. The shorter the connector, the greater the jaw advancement. The appliance is made out of a single laminate plastic and is actually more durable than it looks in this image.