Oral Appliance therapy was first endorsed as effective management of obstructive sleep apnea by the American Academy of Sleep Medicine in 1995. In 2005, the Standards of Practice Committee of the AASM updated the practice parameters for the use of oral appliances as appropriate first line therapy for snoring, mild and moderate obstructive sleep apnea. This includes up to 30-40 breathing interruption events per hour determined by overnight sleep test.
Most patients with narrowed airways will have increases in the volume of the airway and decreased resistance to airflow when the mandible is advanced. This is the fundamental principle of airway management, utilized in cardio-pulmonary resuscitation (CPR), where the tongue is moved from the airway by head and mandibular posture.
The base of the tongue is moved farther from the airway tissues to a position where contact and obstructions are less likely or unable to occur. Increased airway volume causes a slower rate of flow, which increases air pressure (Bernoulli's Principle), and increased tone is imparted to the tongue by the stretching of the masseter muscles. Finally, as the hyoid bone is raised and advanced by the action of the digastric muscles, greater stability of the airway musculature is achieved and resistance to airflow is further decreased.
Thornton Adjustable Positioner (TAP) Appliance
The Thornton Adjustable Positioner III (TAP III) is a mandibular advancement device for the treatment of snoring and sleep apnea. Developed with advanced dental technology, the TAP III improves breathing and eliminates snoring in over 95% of all patients. The TAP III effectively treats sleep apnea and reduces the impact of associated health risks without the need for surgery, CPAP, or medications.
The TAP III is a custom-made two-piece appliance that snaps firmly over the upper and lower teeth. The design of the TAP III hardware differentiates it from the TAP appliance. The Front Assembly (adjustment mechanism) on the upper tray of the TAP is eliminated from the TAP II tray, as is the Lingual Bar on the lower tray. Instead, a Base and Hook assembly with an internal adjustment mechanism replaces the Front Assembly, and a Socket replaces the Lingual Bar. The Socket on the lower allows the patient more tongue space unlike the Lingual Bar, which limits the amount of space for the tongue. The tool used to adjust the Hook on the TAP III is an allen wrench "key" that is removable. The Hook Key is a simple tool designed to effortlessly fit into the adjustment screw of the Base and allow the patient to easily keep count of each adjustment turn.
The TAP III features include: • no Front Assembly protruding from the mouth • more tongue space • less visible in the mouth • a ball and socket design that allows for easier coupling in the mouth • parts that are made from 316 surgical stainless steel • an unbreakable hook
