Inside Dentistry
November 2019
Volume 15, Issue 11

Minimizing Follow-Up Chairtime for Sleep Dentistry

Ryan O’Neill, DMD, on Dentsply Sirona’s Orthophos SL with MATRx plus™ from Zephyr Sleep Technologies

Without a doubt, the single most valuable asset of my dental sleep medicine practice is my chairtime. One of the reasons that implementing oral appliance therapy into my practice was initially appealing to me was the limited amount of chairtime required. Fast forward a couple of years into treating sleep-related breathing disorders, and I quickly realized that the follow-up appointments could become very time-consuming. After an oral appliance has been delivered, the follow-up appointments are used to perform "titrations." A titration is a small microadvancement, usually from 0.1 mm to 1.0 mm in the mandible, that attempts to achieve an ideal "therapeutic position," which is where the patient's comfort and the appliance's efficacy are in equilibrium. In an effort to reduce my chairtime, I decided to recalibrate my follow-up protocol.

At that time, I was already using the Orthophos SL cone-beam computed tomography (CBCT) system daily in my sleep practice to create patient awareness, communicate with referring providers, and even order the OPTISLEEP oral appliance through the software. The time that I saved by receiving the oral appliances in less than 10 days was significant, but I still had frequent and tedious follow-up appointments.

Then, I discovered the MATRx plus at-home sleep apnea testing device. The MATRx plus took the guesswork out of determining the initial position of the mandible during therapy. Only 60% to 70% of patients with obstructive sleep apnea will be effectively treated with an oral appliance. The MATRx plus helps me identify the other 30% to 40% of patients who we refer to as "nonresponders" as well as determine the most ideal mandibular position for the 60% to 70% who demonstrate a positive response.

So, how does it work? Patients take the MATRx plus home with them for a 2- to 3-night sleep study. A target protrusive position is determined during nights 1 and 2, and then that position is tested during night 3. In other words, the sleep study has both a diagnostic and theragnostic component. When patients return to your office, you have all of the information that you need in order to treat them. There are even sleep physicians available who can remotely diagnose patients with obstructive sleep apnea as well as generate oral appliance prescriptions for dentists who plan on billing medical insurance for appliances.

I believe that the future of sleep medicine is in take-home sleep studies that leverage machine learning and artificial intelligence to simplify the complexity of oral appliance therapy. Dentsply Sirona's Simple Sleep Solution saves dentists time, which allows them to spend more time doing the things that they love.

Key Takeaways

1. Treating sleep can add value to any practice, but it is important to have systems in place that limit follow-up chairtime

2. Together, Orthophos SL and the MATRx plus at-home sleep test conserve time and eliminate guesswork in treating sleep apnea

3. With the diagnostic benefit of CBCT, theragnostic at-home sleep tests allow dentists to confidently select the optimal position of the mandible in an oral appliance

4. CBCT technology gives dentists the ability to screen for obstructive sleep apnea as well as visualize pretreatment and posttreatment changes in the airway

About the Author

Ryan O'Neill, DMD
Tennessee Family Dental
Nashville, Tennessee

Manufacturer Information
Dentsply Sirona

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