Overview: This guide explains the step-by-step process to capture a protruding bite scan for a sleep apnea device to ensure proper alignment and device fit.
Prerequisites
A projection of the patient's therapeutic bite position.
A bite gauge, jig, or firm makeshift stabilization device.
Preparing the Therapeutic Bite
Positioning the Sleep Apnea Bite
Position the patient's jaw into the projected therapeutic bite position before starting the scan. Ensure the sleep apnea bite position remains consistent throughout the scanning process.
Establishing Bite Clearance
Maintain roughly 3mm of vertical clearance between the dental arches. Ensure a 5mm gap exists between the opposing anterior teeth to provide adequate space for the sleep apnea device.
Capturing the Intraoral Scan
Stabilizing the Jaw Position
Secure the jaw in the therapeutic bite position using a bite gauge, jig, or firm makeshift device. Stabilization prevents the jaw from shifting, which is critical for an accurate sleep apnea bite scan.
Performing the Bite Scan
Scan the bite on both the left and right sides of the patient's mouth. The bite scan must cover at least 3-4 teeth on each side to allow the software to achieve proper alignment.
Where is the correct Sleep Apnea bite?
Using a disposable bite fork with a George Gauge ensures accurate protrusive bite registrations for oral appliances. Insert the fork into the top slot of the gauge, load it with dental bite-registration silicone, align the midlines in the patient's mouth, and record the desired measurement. The position of the Sleep Apnea bite differs for every patient. It is somewhere between centric relation and full protrusive.
2mm Bite Fork:
- Measures anterior vertical dimension.
- Ideal for deep bite cases.
3mm Bite Fork:
- Measures posterior opening only.
- Ideal for the D-SAD (Digital Sleep Apnea Device) appliance.
5mm Bite Fork:
- More widely preferred for measuring the anterior vertical dimension
George Gauge
The George Gauge is used to measure a patient’s absolute range of horizontal jaw movement. This data allows you to calculate a precise clinical starting position (typically 60% to 70% of maximum protrusion) and capture it using bite registration material.
Using the George Gauge
1. Setup and Preparation
- Select the fork: Choose the appropriate disposable bite fork based on your vertical dimension and case type (e.g., 2mm for deep bites, 3mm, or 5mm).
- Attach to gauge: Slide the bite fork into the top slot of the George Gauge and lightly tighten the upper turn screw to hold it in place.
2. Maxillary Alignment
- Position the upper teeth: Instruct the patient to bite directly into the groove/notch on the top portion of the bite fork with their maxillary central incisors.
- Align the midlines: Ensure the notch on the bite fork is centered with the patient's upper midline. The patient's upper teeth should fit cleanly into the provided indentation.
3. Applying Material
- Load the prongs: Coat both the top and bottom of the disposable bite fork's prongs generously with quick-setting bite registration silicone (e.g., vinylpolysiloxane).
4. Taking the Bite
- Insert the gauge: Place the fully loaded fork into the patient's mouth while the lower unit of the George Gauge rests against their mandibular incisors.
- Guide the jaw: Manually guide the patient's lower jaw forward to the desired millimeter reading (measurement) as calculated for their Mandibular Advancement Device (MAD).
- Bite down: Have the patient close firmly into the gauge while maintaining alignment.
5. Setting and Removal
- Wait to set: Allow the registration material to fully harden according to the manufacturer's directions.
- Remove: Once set, loosen the upper turn screw on the gauge, gently remove the main body, and ask the patient to open.
- Finalize for the lab: Carefully remove the bite fork with the hardened bite registration still attached. If scanning digitally, the handle of the fork can be snapped off at the scored indentation
Disposability: The bite forks are single-patient use and disposable. Do not reuse them.
Gauge Sterilization: The main body of the George Gauges can be autoclaved.
- Prepare to Clean
- Soak & Scrub
- Rinse
- Autoclave
- Place each device in appropriately sized sterilization pouches.
- Place all packaged devices into the sterilizer for 30 minutes at 121°C (250°F).
- Allow devices to dry for 30 minutes.