January 2019 DSM Insider 30 | Page 19

MARK MURPHY, DDS, FAGD HELPING YOU PREVENT BITE CHANGES A undesirable, lthough generally side effects are one of the costs of doing business in the delivery of healthcare solutions. In Oral Appliance Therapy, unwanted tooth movement, discomfort and bite changes rank at the top of the “what keeps you up at night” list. Precision engineered, bilateral and symmetrical titration along with the retainer like fit of the new device materials and design go a long way at mitigating the first two, which leaves the question, “how do we prevent untoward bite changes?” Like the artisanal manufacturing of handmade appliances, the intraoral fabrication of a Morning Aligner or Morning Occlusal Guide (MOG) has been the only methodology available until recently. The AADSM (1) recommends use of a MOG to mitigate side effects of OAT for SDB. The goal and use of these are recommended in the October 2017 JDSM. Fig.(1) • Function: MOGs are devices designed to reposition the mandible into its pre-treatment position. • Indication: MOGs are intended to address the occlusal discrepancy noted after removal of the OA device each morning. • Patient Use: Each morning the patient should bite into the [MOG] until the maxillary and mandibular teeth are fully seated for as long as it takes the teeth to re- establish occlusion. ProSomnus ® Sleep Technologies has recently launched two precision engineered and milled MOG variants made out of the same control-cured PMMA that their devices are made from, the ProSomnus [MOG] and the ProSomnus [MOG] MIP. Both have a ramp that guides the mandible back from the advanced position towards MIP. The [MOG] MIP has perforations where the posterior occlusal contacts will be, that confirms the end point and returns to the original pre-treatment bite. The original [MOG] ramp places the mandible on the correct trajectory, the patient’s normal occlusal contact can be confirmed after removal.