Where to Obtain Custom-Made Titratable Mandibular Advancement Devices
Patients obtain custom-made titratable mandibular advancement devices through qualified dentists with specialized training in dental sleep medicine, who work in collaboration with sleep physicians. 1
The Referral and Fabrication Process
Qualified dentists must provide these devices, not direct-to-consumer companies or general medical equipment suppliers. 1 The process requires:
- Initial referral from a sleep physician who has diagnosed obstructive sleep apnea through polysomnography or home sleep testing 1
- Evaluation by a dentist trained in dental sleep medicine to assess dental and periodontal suitability, including tooth location, morphological integrity, periodontal health, and occlusal analysis 1
- Custom fabrication using dental impressions or digital scans of the patient's teeth to create individualized upper and lower trays 1
Device Specifications Required
The device must meet specific technical requirements:
- Titratable in increments of 1 mm or less with a protrusive adjustment range of at least 5 mm 1
- Custom-made design engaging both maxillary and mandibular arches, as prefabricated devices are significantly less effective 1
- Capability to advance the mandible at least 50% of maximum protrusion, since non-advanced devices are ineffective and may worsen apnea 1, 2
Specific Device Examples
Several custom-made titratable MAD designs are used in clinical practice, including devices with:
- Anteriorly articulating components for appliance adjustment 1
- Attachments in the frontal teeth area for mandibular protrusion adjustment 1, 3
- Two lateral positioning attachments permitting incremental protrusion 1
- Lateral telescopic rods forcing anterior mandibular position 1
Recent evidence shows the SomnoDent® Avant™ achieved 75% treatment success versus 56% for the traditional wing-based SomnoDent® Flex™, demonstrating that device design significantly impacts outcomes. 4
The Multidisciplinary Team Approach
The dentist screens for sleep apnea but diagnosis and treatment efficacy verification must be performed by sleep physicians, even when the dentist handles device selection, positioning, and follow-up. 1 This collaborative model ensures:
- Sleep physician performs initial diagnosis and determines appropriateness of MAD therapy 1
- Qualified dentist fabricates and fits the device, starting at maximal comfortable protrusion 4, 3
- Titration over approximately 3 months using trial-and-error until symptom resolution or physical limits are reached 1
- Follow-up sleep testing by the sleep physician to verify treatment efficacy, as symptom improvement alone is unreliable 1, 2
Follow-Up Requirements
Patients require evaluation every 6 months for the first year and at least annually thereafter to monitor treatment efficacy and dental side effects. 1 Regular monitoring by both the dentist and sleep physician is essential, as bite changes can alter the degree of device advancement over time. 1
Common Pitfall to Avoid
Do not purchase over-the-counter or online "boil-and-bite" devices as substitutes for custom-made titratable MADs, as these prefabricated devices are significantly less effective and lack the precise titration capability required for optimal outcomes. 1