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Fabrication, Delivery, and Titration Instructions for the
SnoreHookDiscluder
FDA approved for the treatment of snoring and mild to moderate obstructive sleep apnea

"The SnoreHookDiscluder is the ideal (and only) trial appliance for snoring and obstructive sleep apnea.  It is inexpensive, simple to deliver, comfortable, and can be used long-term as well!"
                   -Barry Glassman, DMD
                                        Diplomate, American Academy of Dental Sleep Medicine
                                        Sacred Heart Hospital Sleep Disorder Center                   

A dentist can fabricate and deliver a SnoreHookDiscluder (SHD) without the assistance of a professional laboratory  ("do-it-yourself" style), or he can employ Keller Lab to provide the completed components that facilitate the simple delivery of the SHD (compare the two protocols).   Although the do-it-yourself technique precludes any laboratory fees, Keller Lab's fee for the SHD components are minimal compared to the fees for other snoring devices (the SHD does not require any machined or titanium hardware). 
Steps that are bordered in red can be provided by Keller Lab.

Generously block out the undercuts of maxillary and mandibular models.
Make vacuum form trays with .06" plastic sheet on each model...
...drill "extrusion port" holes at the interproximal areas.

On the mandibular tray, using orthodontic resin, add a "wall" of acrylic, sloping from incisal to apical, from canine to canine.
Keller lab will provide a "channel" on the maxillary tray, to help guide the SHD element...

...but it is not an absolute required step for the do-it-yourselfer (but will facilitate delivery)

To create a SnoreHookDiscluder Element (above left), modify a Standard NTI-tss Matrix

The Inverted SHD should conform to the mandibular wall.  Keller Lab will provide an SHD element with an extended Discluding Element segment (above), for ease of handling.
(preview photo of final design) Although the SHD element conforms to the opposing mandibular wall, it will be bonded to the maxillary central incisal edge

Prior to the patient's arrival, load only the incisal third of the trays with ThermoPlasticBead (TPB) material (shown in its cooled state...see video clips below for procedure) .
By sending Keller Lab full-arch PVS impressions (or maxillary and mandibular models), Keller will provide...



...prepared maxillary and mandibular trays, pre-loaded with TPB material, and an SHD element.
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To prepare the TPBs shown in the video at the  left, immerse in hot water until they coalesce into a clear putty.



Video to the right:
Loading the incisal third of the trays with warm TPB putty prior to the patient's arrival.



--

 

Video to the left:
Immersing the TPB-filled trays into hot water to allow for insertion and adaptation.

Keller Lab will provide the trays pre-filled with the ThermoPlasticBead material

 


Video to the right:
Initial insertion and adaptation.
   
Trim away the "wrap around" material that is apical to the gumline. This area is soft and resilient upon initial removal, but upon cooling it will be rigid and "dig in" to the mucosa.

 


Video below:
"Setting the Hook"

 

  
Place orthodontic acrylic within the channel, and have patient bite on the DE portion of the SHD Element while in a protrusive incisal relationship.
 
Allow to cure for a minute, then remove entire tray with SHD Element curing in place (above left).  Upon curing, remove handle extension, sculpt and polish excess acrylic

TITRATION

Prepare an Enhancement Tab (ET) using a section of the suckdown sheet used to make the trays. Keller Lab will provide ample ET's (examples at right)
To increase the vertical dimension, use orthodontic resin to bond an ET to the horizontal Discluding Element of the SHD.
To increase the advancement of the mandible, bond an ET to the anterior side of the descending vertical hook component of the SHD.

To reduce the degree of mandibular advancement, first bond an ET to the posterior side of the vertical hook component (to maintain its strength through bulk) , then reduce the anterior side as needed.
A finished SHD.  Note the TPB material that has extruded through the extrusion ports and locked the material in place.
The same subject, with a reduced vertical dimension.

PROTOCOL STEPS FOR EACH TECHNIQUE
Keller Lab
1.  Send impressions (or models) to Keller Lab
2.  Warm pre-loaded trays, insert in patient's
     mouth, allow to set for a minute, pump
     on-and-off, remove and let cool in cold water
3.  Adhere SHD element to maxillary tray as
     patient bites in an incisal relationship

 Do-it-yourself
1.  Make vacuum-form trays over blocked-out
     models.  Provide extrusion ports
2.  Add an acrylic wall to the ligual/incisor side of
    the mandibular tray
3.  Fabricate an SHD element from scratch, or by
     altering a Standard NTI Device.
4.  Load each tray with ThermoPlasticBead
     material, allow to cool.
4.  Warm pre-loaded trays, insert in patient's
     mouth, allow to set for a minute, pump
     on-and-off, remove and let cool in cold water
5.  Adhere SHD element to maxillary tray as
     patient bites in an incisal relationship