Doug Smail We have slowly but surely increasing our Sleep Appliance "practice within a practice", and I wanted to post a case and find out how many of you are doing OptiSleep as well as hear how we can all work together to make it better.
So far, our cases have done very well, and the patients love them. We still do a few non Optisleep appliances due to limitations in the system, but the Optisleep appliances fit so much better than anything on a model based system I only want to do those.
Here's a case I sent out today that we recently scanned:
Make sure to take time to send the scan to BeamReaders or make your own chart notes about what you see in the imaging. Here, we see arrows pointing to some potential (asymptomatic) condylar "bird beak" type of deformity on the anterior part of the condyle. We'll keep an eye on this. There is also an engorged nasal concha as well as a slightly deviated septum. We recommended that she use Flonase (OTC now) and see an ENT if she has persistent sinus pain or fullness, or nasal congestion. Everyone wants to go right to the narrowed airway, which is fine, be make sure you document anything else you see. If you have any quick questions, please post a screenshot and I, or even better, TK will give you some advice.
Here's just the pre treatment Sicat Air screen. Significant airway constriction in the oropharynx, and no nasopharyngeal or hypopharyngeal issues. Make sure that they position their tongues down and somewhat back to better approximate where the tongue would be while they're sleeping.
Then comes the George gauge. We set everyone at 60% of maximum protrusion. When we have Zephyr we'll make it custom, but for now we're trying to be consistent, and patients are tolerating it well so far. Please make sure you have 5mm of space between the arches, or you'll get the naughty note from the Sicat techs, since less than 5mm gives them insufficient room to make the appliance. With this in place, we take a new CBCT, and here we tell them to keep their tongue forward as will happen when you move the mandible (and the genial tubercle) forward. You can see that we got significant improvement in the airway space. I will say that there isn't always a huge red to green transformation, which worried us at first, but we've had great consistent clinical feedback from the patients as to how well they're sleeping so we worry less.
Hopefully some of you will post about your SicatAir experiences. We're hardly experts, but we keep on trying to get a better and smoother workflow.
