By: Dr. Greg Manning, DDS, ASBAD
One of the newest offerings by SomnoMed is called the SomnoMed Avant; this device is of the latest digital workflow, milled, and one of the most easily delivered appliances for treating sleep apnea.
Having been diagnosed with obstructive sleep apnea myself over eight years ago, I have used many different appliances. In our dental office, we use HST equipment to do efficacy testing, so we can confidently say that these various appliances effectively treat my OSA. However, I found that I was constantly adjusting these devices for comfortability, fit, and effective use. This all changed when I switched to the Avant.
Our Office Background
We started treating sleep back in 2010. Our office was a brand new start-up in 2008, and we had a lot more time than we had patients. As we searched for ways to serve our community, we fell into dental sleep medicine. Over the last decade, we have built a significant DSM business responsible for helping thousands of people with their OSA.
Our practice has used almost every major appliance in the industry, and we started using the Avant not long after it came onto the market. Immediately, we noticed many vital considerations that made it a superior appliance to others we had been using. Let’s explore these considerations!
Benefits of Using the SomnoMed Avant
As we started using the Avant, we noticed that the appliance had some fantastic benefits, these were:
- Superior fit
- Amazing comfort
- Simple delivery
- User-friendly titration
Let’s jump into why these benefits are present and how they make a difference in our treatment compliance!
Superior Fit and Amazing Comfort
Since the appliance is milled and has SomnoMed proprietary material called SMH Bflex Material, the device is very minimal and incredibly comfortable.
SomnoMed defines this material in this way:
SMH BFlex is a proprietary soft polymer that is molecularly bonded to the acrylic device. The material will not delaminate or attract odors.
This soft liner makes the fit of the appliance very comfortable for patients. It reduces complaints of the appliance putting too much pressure on the teeth as well!
Additionally, since the appliance is milled, we see that the minimal design contributes to patient comfort. They don’t feel like there is a bulky retainer in their mouth.
Simple Delivery and User-Friendly Titration
The appliance being milled is made of high-quality acrylic; it’s stronger and thinner than other acrylic appliances; coupled with the BFlex material, it makes it minimal, durable, and very comfortable.
We find that most patients need little to no adjustments for the appliance upon delivery! This reduces the time that we spend delivering the appliance and helps the patient to be excited about the appliance right away; they don’t need the benefits of treatment to be persuaded that wearing the device is best for them. Comfort equals greater compliance.
Since we are considered a specialty practice in our area, we often see patients who make a significant drive to our practice. With the Avant, we no longer have to make them drive another hour (each way) to titrate their appliance because of the titration mechanism!
Mechanism For Titration
The appliance uses a titration method that is unique and that no other appliance uses. It uses a series of bands that attach to the posterior of the mandible and insert through a custom milled guide groove located at the incisor area of the anterior maxilla. These bands are set at different length intervals and can be changed to titrate the device in either direction. We are not asking to adjust small screws and mechanisms; it’s just a matter of going from band to band.
his mechanism (the posterior attachment on the mandible) allows for greater comfort because the mandibular vestibule is a little bigger than the maxillary vestibule (especially in the posterior). Unlike other appliances where the posterior attachment is on the maxilla, those attachments can push against the ramus of the mandible, causing discomfort. This is avoided by the mechanism for posterior attachments being on the mandible.
Titrating the Avant
Titrating the Avant is incredibly simple. Where each band attaches the appliance, there is a hexagonal shape that has an ovular opening. To remove the band, you have to match the opening to the posterior attachment. Once the band is removed from the custom milled guide groove, then you line up the band to remove it from the appliance.
Each band has a white stripe where it is ever-so-slightly thinner than the rest of the band. You will line this up with the custom milled guide groove and pull the band out.
In summary, the steps are:
Remove the band
- Remove the band from the posterior attachment
- Line up the band with the attachment
- Remove the band from the appliance
Place the next band
- Line white stripe of the band on the attachment
- Push the band on
- Attach band on the posterior attachment
These simple steps can be easily communicated to patients and have allowed us to do remote titration and (for competent patients) titrate the device themselves!
Special Use Case: “Winter Visitors”
Being located in Arizona, our practice has many older patients who reside in Arizona in the winter and somewhere more northern in the Summer! We refer to these patients as “winter visitors.”
This appliance is especially useful for snowbirds for two reasons!
- Remote titration
- Incredible warranty
As a patient is moved into treatment, we can instruct them via zoom or telephone to adjust their appliance! This means that we don’t have to introduce them to another provider or fly to Arizona just to titrate their appliance. Additionally, if something happens to the appliance, SomnoMed has a 3-year warranty!
I can order a replacement appliance using our digital impressions and mail it directly to the patients or us!
It takes the guesswork out of titration, and it provides peace of mind for patients!
Contraindications and Other Considerations
In our practice, we still use other appliances occasionally, but for the most part, we recommend the Avant. That being said, sometimes patients are not candidates for the Avant appliance. There are two primary reasons we don’t use the Avant:
- Edentulous patients
- Medicare
If a patient is using medicare, then the Avant is not an option for full coverage of their medicare insurance; in this instance, we would use the SomnoMed Herbst. Use the image below to learn more!
For the edentulous patient, we are going to use the SomnoMed Classic. Click here to learn more about the SomnoMed Classic.
Conclusion
As an apneic and appliance patient, I feel like the Avant is a fantastic appliance.
As a provider, I’m doing what’s best for my patients and my practice.
With the ease of fit and delivery, the comfort for patients, and the all-digital workflow, the Avant leads the way in today’s modern milled appliances.
You can contact SomnoMed and learn more about the SomnoMed Avant!
Dr. Gregory Manning was born and raised in the small town of Hooper, Utah and is fluent in Spanish. After earning his Bachelor of Science in microbiology at Weber State University in Ogden, UT, he received his Doctor of Dental Surgery from The Ohio State University in 2006. He has been practicing dentistry in our area since 2008 and vigorously pursues continuing his education in dental technology and sleep apnea treatment; he also teaches courses in sleep apnea to other dental professionals. He is a member of the American Dental Association®, the Arizona Dental Association, the American Academy of Dental Sleep Medicine and is a diplomat of the American Sleep and Breathing Academy. As a dentist Dr. Manning focuses on helping patients understand their dental needs and achieve their goals.
