Maintaining and Adjusting a Sleep Apnea Appliance

Overview: Learn how to properly insert, adjust, and clean the Preferred Nylon and Freedom Nylon Sleep Apnea appliances to ensure patient comfort and device longevity.

Manage the Preferred Nylon Sleep Appliance

The Preferred Nylon Sleep Appliance uses a two-piece construction for snoring and obstructive sleep apnea treatment.

Rod Insertion Guide

Step 1: Attach to the Lower Splint

• Positioning: Orientation is key—ensure the rod dimension number faces inwards.
• Alignment: Align the head of the rods with the corresponding shapes of the anchor cutout.
• Securing: Press firmly with the base of your thumb to clip the rod to the lower splint.
• Final Check: Once attached, align the rods parallel to the lower splint.

**The rod size is etched on the side

Steps 2–3: Connect the Upper Splint (Dominant Side)

• First Clip: Clip the rod on your dominant hand's side to the upper splint.
• Adjustment: Bring the upper splint forward.
• Rotation: Rotate the remaining unclipped rod so it faces the upper splint's anchor cutout.

Steps 4–5: Secure the Final Side

⚠️ Pro-Tip: Because of the rigidity of the orthosis, this last insertion can be a bit tricky. Take your time.

• Angle: Position the side of the upper splint that has no rod attached at a 70° to 90° angle from the lower splint.
• Insertion: Align the head of the rod to match the shape of the anchor cutout and press firmly.
• Reset: Once inserted, rotate the gutter back to return it to its normal position.

Rod Removal Guide

Steps 6–8: Disassembly

• Set the Angle: Place the top gutter at approximately a 90° angle to the bottom gutter.
• Disconnect the First Rod:
  • Slide the tip of your fingernail between the gutter and the rod, then pull.
  • Rotate the rod backwards, place the tip of your nail between the rod and the triangle, and pull again.
• Remove the Remaining Sides:
  • Turn the rods to match their heads with the shape of the anchors, then pull straight out.

Manage the Freedom Nylon Sleep Appliance

The Freedom Nylon Sleep Appliance is a two-piece construction designed for patient comfort.

Adjusting the titration on a Freedom Nylon Sleep Appliance (Mandibular Advancement Device) is done by swapping out the insertable clips on both sides of the appliance. This moves the lower jaw forward to reduce snoring or sleep apnea. Always change both clips to the exact same length. 

Protocol: Treatment typically begins at approximately 70% of maximum jaw advancement. To protect  joints, advancement is done progressively in 1 mm intervals (or 0.5 mm increments, depending on the specific interchangeable rod kit) based on your patient's comfort and tolerance, until snoring is managed

How to Adjust Your Clips

1. Remove the old clips: Place your fingernail between the clip and its housing, then slide the clip completely out.
2. Insert the new clips: Align the new clip's angle with the housing, slide it in, and push until you feel or hear a distinct "click". 
3. Control protrusion:
   • Use a higher numbered clip (e.g., advancing from 3 mm to 4 mm to push the jaw further forward.
   • Use a shorter clip to reduce protrusion and pull the jaw back. 

Important Adjustment Tips

• Start slow: Avoid adjusting the clips during the first week to let your patient's mouth acclimate.
• Pacing: After the first week, make adjustments progressively, typically advancing 0.5 mm to 1 mm at a time.
• Monitor discomfort: Mild tenderness in the teeth and jaw is normal. If your patient experiences significant pain or jaw joint tenderness, wait a few extra days between adjustments or drop back to the previous, more comfortable clip size. 

Clinical Adjustment Protocol: Retention & Material Reduction

Required Tools & Materials

• Retention Adjustments: Hot water unit, cold water bath, tweezers, and patient models.

• Material Reduction: Slow-speed handpiece and carbide lab bur.

Retention Adjustments (Thermal Modification)

General Preparation

1. Identify the specific area or areas requiring adjustment.

2. Detach the titration rods from the appliance.

3. Heat water to 85°C - 90°C (185°F - 194°F).

   • Note: Ensure the water is within this effective range to allow adjustment without deforming the overall structure of the appliance.

Protocol for Low Retention (Tightening the Fit)

1. Dip the appliance in the hot water for approximately 1 minute.

2. Remove and squeeze the target area using tweezers or fingers for about 5 seconds.

3. Submerge the appliance in cold water while maintaining pressure on the squeezed area.

4. Try the appliance in the patient’s mouth to check the fit.

5. Repeat the process if further tightening is necessary.

Protocol for High Retention (Loosening the Fit)

1. Dip the appliance in the hot water for approximately 1 minute.

2. Remove and place the appliance onto the patient's model, pushing it only about 2/3 of the way down.

3. Submerge both the appliance and model in cold water while maintaining downward pressure.

4. Try the appliance in the patient’s mouth to check the fit.

5. Repeat the process if further loosening is necessary.

Material Reduction (Relieving Pressure Points)

Perform this procedure if the patient experiences localized pain or discomfort from the appliance.

1. Locate the specific internal area(s) requiring modification.

2. Using a slow-speed handpiece and a carbide lab bur, gently remove thin layers of the nylon material.

3. Do not polish the inside of the appliance. Instead, use a hand instrument to cleanly remove any residual loose material or sharp areas.

4. Assess the modifications frequently during the chairside appointment.

💡 Clinical Tip: If only a small amount of mild pressure remains after adjustment, have the patient wear the appliance at home for a few days to see if they acclimate before performing any further material reduction.

Recommended Adjustment Tools

🟥 Brasseler USA (Carbide Cutters)

These straight handpiece carbide cutters are primarily used for structural adjustments and managing elastic grooves.

Package Label / Ref	Shank Type	Head Shape	Head Size (1/10 mm)	Cutting Length
H73EF.11.023 Carbide Cutter	11-Straight Handpiece	Not Specified	023	4.2 mm
H79DF.11.040 Carbide Cutter 1P	11-Straight Handpiece	Round-End Taper	040	13.0 mm
H79GE.11.050 Carbide Cutter 1P	11-Straight Handpiece	Round-End Taper	050	13.0 mm

🟦 Rio Grande USA (Specialty Burs, Drills & Polishing)

These specialty tools feature a standard 3/32" shank size and are utilized for precise detailing, drilling, and final finishing work.

1. Lynx™ Crown Saw Burs (#348513) 

• Brand: Lynx™

• Head Shape: Crown saw

• Shank Size: 3/32"

2. Lynx™ High-Speed Steel Twist Drills (#349206)

• Brand: Lynx™

• Material: High-speed steel

• Head Size: 0.6 mm

• Shank Size: 3/32"

3. Miniature Felt Point (#330172)

• Material: Felt

• Density: Hard

• Head Shape: Point

• Dimensions: 3/4" Height x 1/4" Diameter

• Shank Size: 3/32"

Troubleshooting

• Muscle/Joint Pain: Usually indicates an improper adjustment. May require rod modification.
• Loose Dental Work: On rare occasions, existing dental restorations (crowns/fillings) may loosen. Secure the restoration and adjust the device fit.

Recommended Morning Jaw Exercises

Because the device stresses the jaw joints during the night, your patient may experience temporary difficulty returning their jaw to its normal position in the morning. Suggest performing these exercises daily:

• Bite Alignment: Move their chin backwards and close their molars together while biting. Repeat 5 to 10 times.
• Natural Realignment: Eating breakfast or chewing sugar-free gum right after removal will help return their bite to normal.

Clean and Maintain Sleep Apnea Appliances

Maintaining cleanliness prevents discoloration and device damage.

Daily Care

• Clean the device every morning using lukewarm water and a soft toothbrush.
• Rinse thoroughly, dry completely, and store in its case.

Weekly Care

• Twice a week, clean the device using an antibacterial, chlorine-free orthodontic cleaning solution according to the manufacturer's instructions.

• 🚫 PROHIBITED CLEANING METHODS:

  • NEVER use chlorine-based products (such as bleach, standard denture cleansers, or acetic acid).
  • NEVER submerge the device in water warmer than 45°C (133°F).

Storage & Inspection

• Before each use, check for: Visible damage/wear, cleanliness, and a snug fit.
• Environment: Store in its designated box at room temperature, away from direct heat and humidity.
• Safety: Keep out of reach of children. Keep away from pets (especially dogs), as they are frequently attracted to oral appliances.
• Note: Over time, saliva acidity may cause slight discoloration. This is normal and does not impact device function if properly cleaned.

Instructions for Use

• Global IFU - Sleep-Disordered Breathing Orthosis