Dental Sleep Medicine Insider March 2016 | Page 18

DR. ROY HAKALA

NOT A HEAVY METAL FAN?
Dr. Roy Hakala
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.

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 dimension 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?”
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