Is a trial period for a Prosomnus MicrO2 necessary? Reason I ask is I could not get used to a new Dream TAP which kept my mouth partially open causing a dry mouth. Had to return it. I've successfully worn a EMA for 5 years with no problems. Problem my dentist is running into is that Prosomnus will not allow for any trial period and my orthodontist has no experience with the MicrO2.
I am a dentist working in dental sleep medicine. The latest iteration of the Micro2 is the IA model. The standard configuration has a flat biting surface allowing the mouth to be fully closed to block air flow. Please understand that this device does allow you to open and close the mouth. If your mouth voluntarily hangs open, then you will get air flow through the mouth. It can be optionally equipped with metal-free hooks that allow the mouth to be kept shut with orthodontic elastics and you might want to consider getting those. Arthur B. Luisi, Jr.,D.M.D.
Dr Luisi, Thank you for the information on the MicrO2. FYI my mouth stays closed while wearing the EMA.The EMA has done a great job for over 5 years of eliminating my mild sleep apnea while being relatively comfortable to wear. Is the fitting for the MicrO2 more difficult than the EMA? I feel like I'm being led into the EMA with connectors because of unknowns/uncertainties re the MicrO2. If I was fitted with the EMA and the dream TAP without any difficulties, does it seem reasonable to assume the same for the MicrO2? (Note I had to return the Dream TAP only because it kept my mouth open enough to cause drooling and or dry mouth issues.) Other than your expertise which you freely share I have no way of knowing what the outcome will be if I choose the MicrO2. All I know is I'll have to pay for the lab fee for the EMA if the MicrO2 doesn't work out. Are there any other major issues I need to be aware of before deciding? Thank you again!
Actually, your situation is quite interesting in that we need to figure out the most practical solution for you. Of the three appliances, the EMA is the simplest in design, the thinnest, and the most light weight design. You would already be aware of the problems with the connectors stretching, breaking, and needing relatively frequent replacement. It is also the least durable design of the three, but appears to have been adequate for your purposes. The Micro2 is the newest design of the three and , so far, the feed-back that I have gotten is that it is very comfortable to wear--- significantly more comfortable than the DreamTap. Obviously, I don't know the pricing in your area, but, usually, the EMA is substantially cheaper than the other two-- and it should be. I think a good case could be made for you to stand pat with what has worked for you in the past and just go back to the EMA again. However, you need to decide just how much of a pain the EMA connector problems have been to you and whether or not you want another dose of them. So far, the precision design of the Micro2 has made it very easy for me to fit-- the easiest ever. However, it does have lateral wings in the cheek areas to control the mandibular protrusion that make it quite a bit bulkier in that area than the EMA. So far, my patients have not complained about it, but that could possibly be a problem area for you. In summary, I think that the Micro2 would be an easier transition from an EMA than the DreamTap was and would be a good calculated risk as a way to ditch the connectors. However, we humans each have our own idiosyncrasies and one can never be completely sure without trying. Arthur B. Luisi, Jr.,D.M.D.
The EMA recently obtained FDA clearance for new straps that are durable and do not require frequent replacement. I have had patients in EMA's for many years and the shell has stood up well. One problem with both TAP and EMA is that more than 10 laboratories fabricate them, each with a slightly different way of doing them. It took me a long time to find the 5 different laboratories I use to make oral appliances for me. B. Gail Demko, DMD
Dr. Demko, I totally agree about the problem of uneven quality of the same oral appliance from different labs. The way I solved it with the Taps is to only use the master lab, that is Airway Lab in Dalllas, Texas. They design the appliances there and all the top officials are on site. They seem to have a pretty decent handle on quality control, although there still is the infrequent lapse. I tend to go with the parent company for each appliance and not the franchises. I have done a few EMAs over the years for patients who had them previously and liked them, but it is not my favorite. I have cited the strap problem, which may now have been corrected. I also found that the buttons that hold the straps not to be that robust and tend to break off at times. Also, the strap adjustments are at one mm intervals, which is pretty coarse. The Taps adjust at . .25 mm intervals and there are others that adjust in as small as .10mm intervals. In all fairness though, the Micro2 also adjusts at 1mm increments and I have done O.K. with that, so maybe the coarse adjustment intervals aren't that big a deal. Not sure. Arthur B. Luisi, Jr.,D.M.D.
A belated thank you to Dr Luisi.Based on your insight provided by the previous responses above, I've decided to go with the MicrO2. My primary goal for leaving the EMA was and still is to upgrade to less maintenance/problems. My orthodontist agrees that there should not be any problems with fitting or adjusting the appliance and cost is not an issue. Will post my experience in due time.
It just occurred to me that, in this entire discussion, noone has brought up the most important innovation that the Micro2 IA brings to the table. It makes adjusting the appliance simple, intuitive, and foolproof. I tend to be a very practical person. Many OSA patients are elderly and not particularly sharp mentally(pre-treatment). They are tired and sleepy. With devices with mechanical adjustment systems, they often tend to struggle--- do I turn the key clockwise or counterclockwise?, how many turns per night?, oops, I lost my count, have I turned it five times, or eight times?, I am I going backwards or forwards, and on and on. With the Micro2, if you want to go forward 1mm, you take out the tray with the big ONE on it and put in the tray with the big TWO on it. Couldn't be easier. Not one of may patients has had trouble with adjustments. This is no small thing. Arthur B. Luisi, Jr., D.M.D.
