Understanding Why Some Oral Appliances Achieve a Better Fit!

August 7, 2024

Musings from a Orthodontic Sleep Technician (Artist)

A Perfect Fit
We love the moment when a mandibular advancement device “just pops right in” to the patient’s mouth, achieving a perfect fit. This seamless fit is not just about comfort; it's a testament to the precision and quality of the device, as well as the skill of the lab technician working on the case. It's a very satisfying feeling for both the patient and the dentist. For the patient, it means immediate comfort and ease of use. For the dentist, it reflects their expertise and a satisfied patient. This sense of accomplishment and trust is a key reason why sleep dentists prefer certain devices when treating their patients for sleep apnea. These favored devices provide consistent results, ensuring patients receive the best care, improving their sleep health and overall wellness.

When a dental doctor orders an appliance for their patient, they consider several factors to ensure the appliance meets the patient's needs and treatment goals.

- How severe is the patients condition. Mild, moderate, Severe OSA. Is it bruxism or aTMJ disorder, all dictate the type of appliance required.
- Comfort and fit: The appliance should be custom-fitted to the patient’s mouth to ensure both comfort and ease of use. Comfort is a crucial factor in achieving patient compliance.
- Quality of materials used in the making of the appliance. Durability and biosafety of the materials are essential.
- Efficacy and compliance: The appliance must effectively address the patient's condition, whether it's maintaining an open airway for sleep apnea patients or preventing teeth grinding for those with bruxism.
- Adjustable: Custom oral appliances must be flexible enough to accommodate changes in the patient's condition or treatment needs over the course of their therapy.
- Anatomy: The unique structure of each patient’s teeth, jaw, and oral cavity must be taken into account to ensure proper fit and function.
- Maintenance: Oral appliance should be easy to clean and maintain functionality
- Patient Considerations: The patient’s lifestyle, comfort preferences, and any specific requests or concerns must be considered to start the correct course of treatment.

Orthodontic Technicians - A better choice for your sleep apnea appliance
Allow me to explain the difference between a dental technician and a certified orthodontic technician!. The orthodontic technician has been trained in the art of passive retention and not moving teeth, understanding the importance of keeping things in place and keeping everything together without movement. The dental technician doesn’t have a lot of experience in the art of wire work with passive acrylic that is laying up against the teeth gently.

One of the great misnomers in our field “ ball clasps move teeth”

An orthodontic technician realizes that wire is round and it has memory so it must be rolled rather than bent on a continuous plane; because if you go off the plane, you create a movement in the wire which also creates pressure in the wire (a spring ). This pressure, even ever so slightly, will move teeth. That’s why when people say that ball clasps move teeth, I think that is problematic coming from someone who has not been properly trained and certified as an orthodontic technician and/or the appliances the provider has used where this previously happened to their patient were made by a dental technician who is not experienced in wire work.

Ball clasps do not move teeth
One of the great misnomers in our field “ ball clasps move teeth” Ball clasps do not move teeth, not when they are properly bent. The properly made wires keep things in place. They maintain things, and they do not move teeth. From my decades of experience, I have told so many people in my life that when I hear about ball clasps moving teeth, it is incorrect, and I reiterate that it’s the lack of training of the non- orthodontic technician who doesn’t know how to bend a proper ball clasp. Improperly bent ball clasps will cause movement of the tooth/teeth.

Wiring is Round
The wire is a straight piece of wire (metal) with a ball on the end which must be rolled on a continuous plane, not bent or twisted, but rolled. I can’t stress enough the point that a wire is round and it must be rolled. Trained orthodontic technicians know how to add a proper kink, to prevent the wire from naturally wanting to straighten itself out because it has memory. This is why the certified orthodontic technician is the best choice for making sleep appliances, they have been properly trained in the art of wire work where in most cases the dental technician is not as experienced.

The Certified Orthodontic Technician
The trained orthodontic technician possesses extensive experience and knowledge in wire work on appliances. They understand that the wires must provide proper retention and comfort for the patient. Ensuring comfort is crucial, as it is closely linked to patient compliance and the overall long-term success of the oral appliance treatment.

Understanding the path of draw and undercuts are design qualities that we deal with on a daily basis at Gergen’s Orthodontic Lab. I personally train all technicians with my decades of expertise to ensure they learn the correct methods when making orthodontic and sleep appliances.

I come from a long line of dental professionals; as a matter of fact, three generations worth. My family told me not to get into ortho, but it is my passion and my legacy. Family and friends have often told me, “There’s no money in it and you can’t make money in an Ortho Lab.” Despite their advice, I believed in myself and loved doing orthodontic technician work. For that reason, I ignored what I was being told, pushing forward with what I loved doing, launching Gergen‘s orthodontic lab in 1985.

Master of the Mandible
With my expertise in combining orthodontic principles, wire bending, and mastering the art of designing and crafting sleep appliances, I am proud to be regularly consulted by doctors from around the world regarding their patient cases.

Experience Matters
A leading expert in our field, Dr. Jerry Hu, believes that my appliances made his patients feel much more comfortable and therefore, much more compliant to nightly use, which is the key to long term success. In the past, Dr. Hu has seen super rigid appliances, such as control cured PMMA break or fracture and often, patients would complain of the extreme tightness and pressure. Even advanced materials, such as medical-grade 6 material designed by milling software, cannot compare to the art and experience of a certified orthodontic technician in achieving the right level of comfort, retention, and durability for patient cases. When I entered the industry, there were very few labs focused on sleep, and even fewer that integrated orthodontic supplies or had knowledge of their proper use. Experience in this art truly matters.

Acrylic
Even the type of acrylic used is different with a certified orthodontic lab. With our experience in using cold acrylic, our lab ensures that nothing is pressed. Our lab doesn’t pack anything like dentures. We use completely different acrylic and different processing methods. As a result, experience with cold acrylic is something that non-orthodontic technicians often lack. At Gergen’s Orthodontic Lab, we do not face these issues. I personally ensure that all my technicians receive proper instruction, sharing my decades of knowledge and expertise to provide them with solid training.

Many labs lack this type of experience and do not have someone like me personally training their technicians. Without my decades of experience, love, and passion for the work, they are unable to provide the same quality appliances as Gergen’s Orthodontic Lab.

Expansion Devices
Furthermore, as for the “new” expansion devices for treating airway and sleep apnea, it’s really new. It’s not been around for a very long time. I recently had dinner with Dr. Paul Serano, and we were kind of jokingly, saying we were treating sleep apnea on children in the 80s.using the “occlusal characters Corrector”. Today we use three-way expanders. We level the occlusion, and expand the palates concentrically not merely transverse; and if one thinks about it, Dr. Dave Singh of Stanford University has proven to us that this type of treatment on adults also expands and enlarges the adult airway. The “Y” split 3 way Schwartz type of appliance makes the airway larger. I told Dr. Singh, "Hats off to you; it’s pure genius to perform expansion on adults. I would have never thought of that."

We have extensive experience in this area, which is why certified orthodontic technicians, who are skilled in working with these wires and forces, are the right choice for airway and sleep cases.

Gergen’s Orthodontic Lab
I have dedicated my entire career to this field, which is why dental doctors trust Gergen’s Orthodontic Lab with their patient cases for airway, orthodontic, and sleep appliances. A notable leader, Dr. Felix Liao, recognizes the necessity of working with our certified orthodontic technicians. Dr. Liao emphasizes the importance of proper training, as using expansion devices incorrectly can be very dangerous. It's crucial to incorporate stops in an expansion appliance to prevent continuous expansion. Dentists must be adequately trained, and reputable groups such as the American Sleep and Breathing Academy, Vivos, and Dr. Liao’s training programs provide this essential education. Dr. Liao recently reminded me that I was working on these techniques with Orthodontist legend Dr. Robert Ricketts over 30 years ago. “It was then I realized I go back so far, I'm in front of me!”.

David Gergen
Gergen's Ortho Lab
602-478-9713
gxployer@aol.com