Impressions and Bite Record
Your impressions should include a detailed recording of all the teeth and tissue, with special attention to capturing the upper vestibule, as this is important in setting the Labial Acrylic Shield and Nasal Dilator Buttons. Alginate Impressions should be poured immediately, but first checked that the alginate is not pulling away from the tray in any area. All impressions should be checked that all the teeth and the surrounding tissue are captured , the tray is not showing and the teeth have not bitten through the impression material. Models also should be checked for distortion, voids, discrepancies, etc. Polyvinyl Siloxane (PVS) Impression can be a benefit for multiple pours, but special care must be taken when using two part systems. Distortions are not always evident until the impressions are poured. Pulls also are common in one and two part systems and will effect a good fit. Digital Impressions will require a printed model for us. If Lingual Tongue Buttons are requested, the Digital Model does not usually capture Lingual Tissue and Tori adequately. A poured model should be included if this detail is important.
Sleep Device Bite Tools & Guidelines
The George Gauge and the Perfect Bite are good tools for taking the Construction Bite for an O2 OASYS. The Midlines should be checked in Centric and in Protrusive, to minimize patient discomfort when wearing the device and to try to maximize effectiveness. Usually, the patient can be guided forward to keep the same midline position, but sometimes, there will be a variance. Please note this on the RX of a midline / position line variance from centric. The Protrusive Bite Registration should normally be taken with an Incisal Opening of 5-7mm, at 60-70% of Maximum Protrusion. Using the George Gauge, if the patient can extend 10mm, a starting position for the device would be 6 or 7mm advancement. The easy sliding feature of the Oasys allows you to increase or decrease protrusion the day of delivery and afterwards. Having the person try to snore with the Bite Jig in his/her mouth at different protrusive positions, may give you a starting position for where it appears he/she is not snoring and the airway is open. Other bite methods can be used without these tools, but by keeping the registration medium on the posterior teeth, you can be mindful of the midline position and capturing adequate vertical dimension.