instructions for fitting

The upper arch impressions require the impression material to extend up to the anterior vestibule. An easy method for capturing the upper vestibule is to use a Monoject 35 CC syringe with catheter tips (#888-1) as an alginate syringe to inject alginate into the anterior vestibule and then taking the alginate impression of the upper arch. This will easily capture the upper vestibule region for the construction of the upper flange.

Take a bite registration with the mandible advanced 70-80% maximal protrusion and 3-4 mm interincisal opening.

Step 1. . Upper Splint Fitting
	Remove the device from the container. There are two parts, the device itself and the upper splint. Begin by fitting the upper splint over the upper dental arch as you would for a periodontal splint or an orthodontic retainer. If the splint is too tight use a crown cutting scissors and shorten the length of the material in the area that feels tight. The most common area is the labial region in the canine and incisor teeth region.

Step 2. OASYS Oral/Nasal Airway System™ Fitting

There are two possible materials used in the construction of the base of the OASYS: Heat sensitive material (Variflex or Clear Splint) or dual laminate soft inner layer.

For the heat sensitive material only (Variflex or Clear Splint) place the OASYS Oral/Nasal/Airway System™ device in warm tap water to soften the heat sensitive base material (Variflex or ClearSplint).

The dual lamiate base is fitted over the lower teeth and seated.

The OASYS Oral/Nasal/Airway System™ device is oriented for insertion. Have the patient open their mouth and seat the lower segment over the lower arch. With your index fingers over the occlusal surface of the lower portion of the device seat the device onto the teeth as one would seat a lower splint. If there are undercuts preventing this seating one can try to heat the base material in warmer water to fruther soften the material or if necessary remove undercuts with an acrylic bur on a slow speed hand piece or a lab motor. Continue to adjust the fit until the device fits firmly in place. It should have secure fit without too much pressure on any individual area.

Trouble shooting.

Problem: Can’t position the device over the teeth without inserting the upper portion fully in place.
Answer: In this case it is necessary to guide the upper portion in front of the upper teeth and under the upper lip and then instruct the patient to bring their mandible forward to align the teeth with the base of the lower section and bite into place into the lower dental arch.

Problem: The fit is too loose.
Answer: Perform a direct reline of the base.
The heat sensitive material (Variflex or Clear Splint) accepts a direct bond to orthodontic acrylic. With the dual laminate material one must first remove the soft inner layer to expose the hard plastic layer which accepts bonding of orthodontic acrylic.
Mix clear orthodontic acrylic (we have found that Dentsply orthodontic acrylic works well for this function) to a loose creamy consistency and load the inside of the lower portion with just enough material to spread and provide a thin coat of acrylic (usually about 1/3 of the volume). Allow the vapors to dissipate for about 10 seconds. Place the device into the mouth and seat firmly onto the teeth. Hold it it in place for 60 to 90 seconds. It is very important not to leave it in too long which would allow the acrylic to completely set up. Remove and check for proper impression of the teeth without any pull away of material or tearing from an undercut. It is often a good idea to reseat once more prior to final processing of the acrylic.

Place in warm water, or preferred, a pressurized pot for about 5 minutes to precess the acrylic.

Reduce any obvious undercuts and repeat fitting. If the base was originally heat sensitive, it will now be a hard acrylic inner surface that will no longer be heat sensitive and therefore it will no longer be necessary to heat prior to finsertion.

Step 3. Positioning the upper segment.
		Give the patient a hand mirror to begin their training for the insertion of the device. After seating the base onto the lower teeth, the upper shield should be positioned in front of the upper arch by bringing the mandible into the forward position so that the leading edge of the upper shield is in front of the anterior teeth and then closing down the mandible until the device is fully seated. Next, position the nasal buttons into place under the lips. With the device seated fully and the mandible closed down in place, have the patient insert their index finger into the corner of the lip and bring the lip lateral and over the nasal labial button on one side and then repeat on the other side. An alternative is to seat the device by angling one nasal labial button into position under the lip and then rotating the device into position over the lower arch. Now snap the OASYS Oral/Nasal/Airway System™ base into place over the lower teeth and then with the index finger bring the opposite side of the lip over the button. Remove the device by having the patient open the mandible enough to create a space to lift the device off the lower teeth and lift the OASYS Oral/Nasal/Airway System™ up at the lower front corners of the base using their finger nail edge of the thumbs to apply the lifting force. .

Step 4 Adjusting the mandibular position .
	Adjustments of the OASYS Oral/Nasal/Airway System™ can be made with the device in place in the mouth or in hand. With the OASYS Oral/Nasal/Airway System™ in place in the mouth one must be able to locate the hex-head of the adjustment screw and be able to engage the wrench into the head of the screw at the corner of the patient's mouth. Using the small end of the provided wrench on the hex-head of the locking screw, turn the screw a half turn to loosen the lock collar (only enough to loosen the lock collar on the wire and being careful not to over-loosen the screw so as to avoid it coming off the ring). Because of the natural give of the device the patient is usually instructed to move the mandible forward to the most forward position. Push the upper shield back firmly against the upper anterior teeth and bring the locking collar forward against the metal tube and lock down the adjustment screw with the wrench using finger pressure only until the screw is firmly locked down onto the wire. Repeat this on the other side. If the adjustment is to be made in hand outside of the mouth determine the amount of adjustment needed while the device is seated in the patient's mouth before making the adjustment in hand., Have the patient move the mandible as far forward as possible and note the amount of repositioning that you want to achieve. Remove the device from the patient's mouth. Note the position of the front 90 degree bend of the body wire or the position of the end of the wire to the base. Loosen the hex-head lock one half turn and push the shield back the desired amout. Hold that position, bring the locking collar forward against the metal tube, and close down the locking screw using only finger pressure to secure the firm lock. .

Step 5 Nasal dilator button positioning

The "sweet spot" to position the nasal dilation is half way between the edge of the nostrils and the commisure of the lips and just lateral to the nasiolabial folds. This applies a lateral stretch on the nasal valve area at a 45 degree angle. ENT physicians stretch the skin externally lateral to the nose to perform the Cottle Maneuver which dilates the nasal valve in a similar manner to test for nasal resistance.

The initial adjustment can be made with the device in hand to estimate the position as a starting point. Further adjustments can be made directly in the mouth by having the patient open their lips (keeping their mouth closed into the device) enough to allow you to introduce your index finger through the lips and bend the button in the desired direction. Next, check the amount of stretch on the tissue and adjust to get a moderate stretch without causing the patient discomfort in the correct position.

Have the patient breath through the nose for a few minutes. This should become easier after a brief period of use.

If you have instrumentation to measure the nasal volume such as Acoustic Rhinometry, the initial readings should be made prior to fitting with the after treatment readings made after a few minutes of usage to appreciate the effect.

Patient education is an important part of the treatment. All dental devices are foreign objectsto to which the patient must become accustomed. Ideally a person would breathe easily all night long without any type of aid. Dental devices are the gentlest and kindest treatment for this serious disorder that has great potential to lead to many life-threatening diseases.

Patients will usually be very happy to use the OASYS Oral/Nasal/Airway System™ device when they see its advantages and when they appreciate that this device is opening the nose and throat at the same time. Showing them the effect though instrumentation or on the graphs provided are great educational tools for you to use. However, if you do not have the instrumentation, by simply having the patient feel the ease of breathing through the nose will create a greater appreciation for this treatment.

A very few patients have trouble adapting to the nasal dilators and they can be removed and the OASYS Oral/Nasal/Airway System™ used as a pure mandibular repositioning device..

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INSTRUCTIONS FOR IMPRESSIONS AND BITE REGISTRATION