Dr. Morgan’s Preferred Appliances
We use a variety of oral appliance designs to best suit your individual needs. Design selection does matter, based on Dr. Morgan’s 25 years experience!
Narval is a well-tolerated appliance providing a highly effective therapy for sleep apnea and snoring. Over a decade, and with more than 10,000 patients, we’ve advanced the kinetics to make Narval one of the least intrusive appliances available. Each Narval is custom designed to suit individual needs.
Like other appliances, Narval can be gradually adjusted to increase the effect while maintaining comfort. With one of the widest adjustment ranges available, Narval can be fine-tuned to your condition.
A clinical study by Vecchierini (2008) measuring the effect of treatment showed that 94% of patients had high rates of compliance within six weeks, and rapid and significant improvement in sleepiness, quality of life, and sleep quality.
Geraads and the General Hospital Pneumologists College (2010) studied effectiveness and tolerance after a year of treatment, showing significant improvements in sleepiness and fatigue, even for patients with severe OSA. Only 6% of patients dropped out of treatment due to tolerance issues.
The Herbst appliance has proven effective for chronic snoring and mild to moderate OSA sufferers. The Herbst can be fabricated from hard acrylic, from thermo-active materials, and from soft materials, and allows patients to move their jaws laterally and vertically without disengaging the appliance.
If the initial position does not provide the anticipated relief from snoring, there are two options for moving the lower jaw forward. Indeed, the ability to move the lower jaw forward quickly, easily, and accurately is the Herbst’s greatest advantage. This involves simple manipulation of the rod/sleeve plunger mechanism. Vertical opening is adjustable and there is limited freedom of lateral movement for the mandible.
The Adjustable PM Positioner uses materials and a design that minimize office chair-time and allow the patient to adjust the jaw position under the dentist’s supervision. Research studies have shown that this appliance is successful in treating 77% of patients with moderate obstructive sleep apnea.
Made of Bruxeze™—a special acrylic material that softens in hot water to provide a combination of comfort, strength, and retention—this appliance fits over all maxillary and mandibular teeth. Adjustments are simple, using an expansion screw on each side. The design permits limited lateral and protrusive movement to maintain jaw comfort, and its simplicity makes it well suited for patients with limited dexterity or eyesight.
The SUAD is custom-made from a heat-sensitive acrylic, and reinforced by a metal framework, including a piston and tube. Jaw position can be adjusted by using small rings that slide over the piston in front of the tube, each ring advancing the jaw the width of the ring.
Small rubber bands keep the jaw from falling open during the night, although the patient is able to partially open the mouth for improved comfort. One of the most durable appliances for patients who grind or clench their teeth during sleep (bruxism), the SUAD is comfortable on the teeth, allowing good freedom of movement of the jaw.
The Thornton Adjustable Positioner (TAP®) uses two custom-made trays which snap over the upper and lower teeth and hook together. The design is based on the same principle as cardiopulmonary resuscitation (CPR), that the airway must be opened to allow air to pass through the throat.
The TAP® holds the lower jaw forward so it does not shift or fall open during sleep. This prevents the airway from collapsing. The more you pull your jaw forward, the more your airway will open. The TAP® is the only mandibular advancement device that can be adjusted easily by the patient or practitioner while in the mouth. This feature allows patients to control their treatment, fine-tuning their treatment position at home for maximum results.
The SomnoMed MAS consists of custom-made upper and lower dental trays with a unique patented fin-coupling component, which allows normal mouth opening and closing. The SomnoMed MAS™ is a highly effective solution for the majority of patients with mild to moderate OSA.
Patients report exceptional satisfaction with this device, due in part to a combination of hard and soft materials holding the teeth, and smooth surfaces against cheek and other soft tissues. In clinical studies of the Somnomed MAS 91% of patients reported substantial improvement in sleep quality, 87.5% of patients reported nightly use, and 96% of patients stated they would like to continue its use.
PHARYNGEAL TRAINING APPLIANCE (PTA)
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Patients often ask their sleep practitioner about natural and self-help solutions for snoring and OSA. This prompted Dr. Morgan to develop and patent the PTA appliance, which offers a convenient way for patients to perform targeted exercise and tone the muscles that maintain airway function. A limited number of investigations have shown that Pharyngeal exercise decreases sleep apnea and snoring. These studies had subjects perform specific tongue maneuvers, and strengthen muscles through singing, or learning to play the didgeridoo wind instrument.
This suggests that pharyngeal muscle tone may be improved through exercise, and selected patients may show a corresponding decrease in the severity of OSA. The PTA device is designed to make it simpler to exercise the pharyngeal muscles chiefly responsible for maintaining open airways. By mimicking the true action of the tongue in the up and forward direction under elastic resistance, the PTA trains these muscles, strengthening them to aid in airway recovery from apneas. Exercising with the PTA also influences resting tongue position by training the tongue to land in the correct posture in relation to the palate.
Dr. Morgan has recently published a book entitled Why The Long Face : A Story About Thumb-sucking to inspire and educate parents about the effects that thumb-sucking and other harmful habits have upon the balance in craniofacial growth and airway development.
The PAP Partner is a novel device invented by Dr. Morgan. The PAP Partner is an oral appliance designed to accompany the use of prescribed positive airway pressure devices, such as CPAP, APAP and BI PAP. The PAP Partner’s patented design works by positioning a patient’s tongue into a cradle, thereby sealing mouth leaks that are common when wearing nasal-type CPAP masks.
The tighter mouth seal and stabilized jaw position often make it possible to lower the CPAP pressure settings, improving comfort and adherence to therapy. This appliance is made from a medical grade silicone material that is soft and comfortable to wear, providing many years of use.
Apnea Guard is a temporary oral appliance for OSA treatment. It is worn for up to 30 nights, and used to determine an efficacious jaw position that can be prescribed and transferred to a custom appliance. Its function is similar to establishing a pressure setting for CPAP. Fitting takes less than 15 minutes.
The Apnea Guard protocols educate both dental and non-dental staff on various aspects of oral appliance therapy. The protocols provide information used to determine when a patient can fit themselves with assistance of non-dental staff, or when they have a pre-existing condition that requires fitting by a dentist. The protocols provide tools to help distinguish between expected side effects and complications which may require a consultation.
THE DNA APPLIANCE
Traditionally, specially trained orthodontists use fixed braces to apply forces to straighten crooked teeth. While much of this treatment is successful, relapse can occur after treatment, meaning that a patient’s teeth will move back to their original position. The reasons for relapse are complex and remain incompletely understood. However, the entire human genome has now been sequenced, and we now know that certain genes are involved in moving teeth. Teeth are naturally designed to move, for example, tooth eruption in a normally-growing child. Provided that a patient’s natural genetic potential allows for complete growth and development, there should be room for all of the teeth arranged in a beautiful smile!
Even in adults, we have the potential to influence changes in the position of teeth and the bone they rest in. This means we have a potential for developing the craniofacial bones and the upper airway, which is often underdeveloped. Underdevelopment produces a smaller airway that is vulnerable to collapse during sleep, causing snoring and sleep apnea. The DNA appliance is designed to treat adults by producing a definitive improvement in the size of the upper airway.