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Taking the registration - an important step for making a mandibular advancement splint (MAS) for snoring or sleep apnoea

22 Apr 2016

The registration is an important clinical step in order to achieve optimal results with oral appliance therapy.

An inadequate registration at the record taking visit can result in the following problems for the patient:
 

  • The mandible may be inadequately advanced to achieve an optimal result and the patient will run out of adjustment in the MAS. This will require an extra laboratory procedure.

  • The mandible may be too far advanced, particularly if there is a history of a temporomandibular disorder, and it may trigger painful symptoms.

  • The vertical dimension may be too far open resulting in difficulty for the patient achieving an adequate lip seal.  The resultant mouth breathing and dry mouth can be a significant problem for the patient. Studies also show that opening the vertical excessively reduces the effectiveness of the MAS in reducing the sleep apnoea.

  • The midlines of the upper and lower jaws can be positioned too far laterally in the registration procedure, resulting in an appliance that causes patient discomfort and perhaps triggering temporomandibular symptoms

 
Taking these factors into account during the registration procedure will go a long way in achieving optimal results and minimising side effects.

A specifically designed instrument is indispensable for taking an adequate registration.   While there are many theories and instruments available, the one I use in my practice is the George Gauge.  The registration using the George Gauge is simple, usually taking less than five minutes, and is used by the majority of leading clinicians and researchers in the field.
 
A question I’m often asked is what degree of protrusion should the mandible be set in the registration?
 
In my clinical practice, the degree of initial advancement is set somewhere between 50-75% of maximum mandibular protrusion.

It is closer to 50% if the patient is:

  • Young

  • Not overweight

  • Snoring only or has mild sleep apnoea

 
It is closer to 75% if the patient is:

  • Obese

  • Has more severe sleep apnoea

 
The general principle is that if the patient is just a snorer, or has mild sleep apnea, the aim is to advance the mandible the minimal distance forward that gets rid of the problem.  If the patient has severe sleep apnoea, and particularly with medical comorbidity, the aim is to advance the mandible as far as is tolerable.

There are a number of videos on You Tube demonstrating how to use a George Gauge.

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