DynaFlex Dorsal® Accu-Fit® Appliance
The DynaFlex Dorsal® Accu-Fit® Appliance is a two-part
mandibular advancement device that utilizes the time-tested dorsal design to guide and hold the mandible into the
desired protrusive position. Adjustments of as little as 0.1
mm are possible with the adjustable screws embedded in
the upper part of the appliance. Typically I use 6-8 mm of
anterior opening for the fabrication of my appliances in
order to reduce the amount of mandibular protrusion
required and accommodate an anterior opening between
the upper and lower parts of the appliance to allow for
tongue space. The body of the appliance is made of dense,
durable, lab-processed acrylic, while retention is provided
by an inner lining of Accu-Fit material (Figure 2). This unique
feature allows the appliance to be fit easily and comfortably each and every time with a minimal amount of
adjustment and chair time. Another benefit of using
thermal acrylic for retention is that it may be reformed in
the event a patient requires future dental work that might
otherwise render the appliance obsolete. Lastly, the Accu-Fit
material is ideal for patients with short clinical length crowns
because it ensures sufficient retention in all cases.
Confirmation of Airway Increase with
CBCT
Although all patients undergo a period of titration, using a
combination of methods such as audio sleep recordings
with smart phone apps such as SnoreLab (iOS) and SnoreClock (iOS and Android), Observer Sleep Scale forms, and
changes in Epworth Sleepiness Scale scores, we have found
documenting airway volume changes (as well as condylar
positions and bite changes) with CBCT scans extremely
valuable. Utilizing low dose scans from our i-CAT® FLX CBCT
we are able to visualize paranasal sinus abnormalities as
well as identify and measure airway restrictions. Typically
with an oral sleep appliance such as the DynaFlex
Dorsal® Accu-Fit® Appliance that I use, we see significant
increases in airway volume and cross-sectional area,
often as much as 2 to 3 times the original airway (Figure 3).
FIGURE 3
FIGURE 2
DynaFlex Dorsal® Accu-Fit® Appliance
Delivery
After years of using appliances that required time-consuming adjustments of acrylic and ball clasps at the delivery
appointment, I absolutely love the ease and simplicity of
fitting the DynaFlex Dorsal® Accu-Fit® Appliance. Although
the appliance comes fit-ready on digitally printed models of
the patient’s dentition, we further customize it by heating
the Accu-Fit liner in hot water. Per instructions from DynaFlex, we heat water to a precise 160 degrees using an
inexpensive electric kettle that can be programmed for the
desired temperature and then pour the water into a disposable paper cup. The appliances are then placed in the
heated water for 3-5 seconds to slightly soften the thermal
acrylic prior to fitting them in the patient’s mouth. Once
seated, the appliances are cooled with a few short bursts of
air from an air/water syringe and then removed for further
cooling in cold water. Following this procedure ensures a
perfect fit in a matter of minutes each and every time.
Summary
When determining which devices to add to your armamentarium, consider durability, patient comfort, degree of
titratability, tongue space, and ease of deliverability. The
DynaFlex Dorsal® Accu-Fit® Appliance meets all of these
criteria. It fits perfectly every time due to the unique Accu-Fit
material which is ideal for minimizing chairtime, ensuring
sufficient retention, & for patients that have pending restorative work. Whether you’re considering entering the
rewarding field of dental sleep medicine, or just reevaluating the sleep appliances you presently use, I highly recommend the DynaFlex Dorsal® Accu-Fit Appliance for your
practice.