The TAP® 3 & TAP 3 Elite
The TAP 3 and TAP 3 Elite (Thornton Adjustable Positioner) are mandibular advancement devices for the treatment of snoring and sleep apnea. The TAP appliance is a custom-made, two-piece appliance that snaps firmly and comfortably over the upper and lower teeth, much like a sports mouthguard or retainer. Its basic function is to hold the jaw forward so the tongue and soft tissues of the throat do not collapse into the throat causing snoring and sleep apnea. The unique design allows the patient to adjust the degree to which the lower jaw is held forward, simultaneously allowing maximum comfort and effectiveness.
The TAP 3 offers the same results as the TAP and TAP II, and fits more comfortably in the mouth. The smaller hardware provides more room for the tongue and allows the lips to close. Developed with advanced dental technology, the TAP 3 improves breathing and eliminates snoring in over 95% of all patients. The appliance also effectively treats sleep apnea and reduces the impact of associated health risks without the need for surgery, CPAP or medication.
The TAP 3 gives dentists numerous options to create the best, customized treatment solution for their patients. Interchangeable hooks can accommodate Class I, II and III bites and increase the vertical distance between upper and lower teeth. As with any medical condition, it is recommended to consult with a trained sleep specialist before prescribing a sleep apnea appliance.
TAP 3 Advantages:
- Patient friendly
- Superior results
- Easy to fit
- Infinitely adjustable
- Precise control of advancement
- Interchangeable hooks
- Freedom of lateral movement
- More room for tongue
- Allows lips to close
The TAP 3 Elite is the latest addition to the TAP family. This updated alternative is the most effective oral appliance for the treatment of snoring and sleep apnea.
TAP 3 Elite Advantages:
- Greater durability
- Increased range of adjustment (by using three different hooks)
- Greater range of lateral movement
- More tongue space
- Better engagement of upper and lower trays due to improved hardware
TAP is a registered trademark of Airway Management, Inc.
Artistry and Technology in Digital Dentistry
Dentistry continues to move through a “digital revolution” with more restorative choices than ever to help you provide maximum care for your patients. These extensive material options offer the restorative practice a tremendous opportunity to provide optimum care from an esthetic, functional and disease prevention standpoint. However, this same multitude of information can also lead to confusion when deciding which option is the best for your patients.
Topics Will Include:
Material Selection in Digital Dentistry
- Digital impression overview, material properties, indications/contraindications, preparation, cementation, adjustment and polishing recommendations for today’s high strength all-ceramic restorations:
- IPS e.max® Layered
- IPS e.max Monolithic
- Porcelain to Zirconia (PFZ)
- BruxZir™ or BioZX2 Solid Zirconia
Snoring/Sleep Apnea Appliances
- Covering Myerson EMA®, TAP® 3/TAP 3 Elite, Z-Quiet® Pro-Plus and Narval™ CC Appliances
Implant Prosthetics Update – From Start to Finish
- Fixed Implant Restorative Packages
- Implant Screw-Retained BioZX2, BruxZir and IPS e.max
- Full Arch Screw-Retained Implant Bridge
- Removable Implant Restorative Packages – All-On-Four, Locator Overdenture, Spark Erosion Full and Partially Edentulous, DAL Implant Borne Bridge (IBB)
Date & Time:
Friday, February 13, 2015
9:00 am – 3:00 pm
Registration begins at 8:30 am. Breakfast and lunch included.
3550 East 86th Street
Indianapolis, IN 46240
5 Lecture CE Credit Hours
To register, call Katie Lewis at 1.800.227.4142
Cancellation Policy: Cancellations within 10 days of the program will result in a fee of 50% of the tuition cost. If DAL cancels the program, you will be reimbursed the full tuition amount.
Digital Duplication of the Anterior Guidance by Dr. John C. Cranham
Few things in dentistry are as rewarding as restoring someone’s smile back to optimum oral health. One that provides the patient with the esthetic result they were counting on, as well as a functional and biomechanical result that will serve the patient for years to come. While ceramics and restorative materials have been evolving at a very rapid rate, until recently the way we communicated critical contours to the laboratory has not. The goal of this article is to review the functional contours that must be communicated and to outline a more reliable way to provide the dental lab with the critical information required.
1.) Equal intensity stops in centric relation – The first tenant of any stable occlusion is for all the teeth in one arch to hit the teeth in the opposing arch at approximately the same time. Additionally, it is ideal if this can happen when the joint is at the most anterior-superior position in the glenoid fossa (centric relation).1 This will create a reproducible position, and one where the masticatory muscles will be the most harmonious.2,3,4 Equal intensity stops will balance whatever the force the patient can generate over the entire dentition, as well as create vertical stability of each tooth.
2.) Posterior teeth the patient can’t rub (non-interfering posterior teeth) – One of the most important goals of any healthy occlusal scheme is to create a situation that the patient cannot run into their back teeth as they move in any excursive movement. It is important to note that if the condyle has the ability to move upward from the patient’s habitual occlusion, there will ALWAYS be an interference.5 Additionally if the lingual contours of the anterior teeth are not steeper than the patient’s posterior morphology, there will always be posterior teeth that bump and/or have the capacity to rub. This can be seen in working, balancing and/or protrusive movements. The primary reason back teeth should not contact in excursive movements, is because it dramatically increases the muscle activity, increasing the load to the dentition.6,7,8 Therefore, to decrease damaging occlusal load to ceramic materials on the anterior teeth (as well as the natural dentition), always make sure there is immediate disclusion of the posterior teeth when the mandible moves in any direction.9, 10
3.) Anterior guidance in harmony with the envelope of function – If one of the goals is to prevent the back teeth from rubbing, it is logical to assume that it is the job of the front teeth to provide the disclusion. While some are questioning the importance of the anterior guidance11, there is just too much scientific evidence already described in this article not to support its use. Simply stated, if the anterior guidance does not disclude the back teeth, then the capacity for back tooth contact in excursive movements and damaging muscle activity will be evident. It is simply risky to leave posterior interferences behind. However it is possible to make the anterior guidance too steep. Since the natural functional pattern of the patient during speaking and chewing is outside in, and not inside out12, the contours need to be customized intraorally to make sure appropriate contours are tested to verify harmony with the envelope of function.13 An anterior guidance that is too steep will lead to fremitus, migration of the teeth, wear and/or fractured anterior teeth/restorations. It is important to recognize that posterior disclusion and contours that are in harmony with the EOF, don’t have to be mutually exclusive of one another. The optimum occlusion has to have both. Dr. Peter Dawson first described a technique that establishes this in 1974.14
The optimum anterior guidance:
1.) Is steep enough to disclude the posterior teeth in any excursive movement.
2.) Is concave enough to be in harmony with the envelope of function.
It is critical for the restorative dentist to understand that when restoring anterior teeth, this precise concavity from the centric stop to the incisal edge position must be communicated to the dental laboratory. A digital protocol has now evolved to make this much more predictable than previous techniques.
A 51 year old male was referred to the practice for occlusal evaluation and the fabrication of a sleep apnea appliance. He had been diagnosed with mild sleep apnea by a qualified physician and had been unable to wear a CPAP device (Figures 1-7). His mouth was healthy biologically, with no active dental caries and no probing depths greater than 3 mm. He did have mild localized gingivitis and would need a couple of appointments with our dental hygienist.
Functionally, his primary sign of occlusal instability was occlusal wear. Teeth 6-11 and 22-27 exhibited through the enamel and into the underlying dentin. Tooth number 30 had a porcelain fused to metal crown with a fractured mesial lingual cusp. His first point was tooth number 2,3/30,31 (Figure 8) in centric relation (CR) with a large slide to his maximum intercuspation. He also had balancing interferences bilaterally and there was concern that his sleep apnea may be contributing to his occlusal wear. Ben complained of temporal headaches in the late afternoon and was aware of daytime clenching. Benʼs goals were to stabilize his bite, optimize his smile, and to be compliant with a sleep apnea appliance.
His treatment plan was created and placed into three phases.
Phase One: Treatment of Biologic Issues
The only biologic issue was the mild generalized gingivitis. The patient was scheduled with two visits with our hygienist.
- Appointment 1: Gross scale/Oral hygiene instructions
- Appointment 2: Prophy
Phase Two: Treatment of Functional Issues
Phase Two is about creating a functional stable base in which to build the definitive restorative dentistry. A combination of reductive equilibration to eliminate the interferences to centric relation, combined with additive equilibration utilizing composite resin to restore the incisal guidance, was the technique employed in this case (Figures 9-10).15,16 The goal was to create equal intensity contacts in centric relation, non-interfering posterior teeth (back teeth that can’t rub), and an anterior guidance in harmony with the envelope of function. In this phase, an obstructive sleep apnea orthotic was fabricated (TAP 3 device) and fitted for the patient (Figure 11). The patient desired to wait for a new insurance year (to maximize benefits) before proceeding to Phase Three. This worked out perfectly as it gave us time to test the new occlusion and to get the patient back to his sleep physician for a follow up sleep study. In the months that followed the occlusion remained comfortable, none of the resins fractured, and his headaches were eliminated. Additionally, we received a positive report from the sleep physician.
- Appointment 3: Equilibration, IFL resins 22-27,6-11, impressions OSA appliance
- Appointment 4: Deliver OSA appliance, fine tune equilibration
- Appointment 5: Adjust OSA appliance, complete equilibration-refer back to sleep physician for confirmation of improvement
Phase Three: Restorative Dentistry (Placement of Permanent Crowns)
With the mouth stable biologically and functionally, the restorative phase of treatment should be uneventful. The teeth that will need to be restored are teeth 22-27, 6-11 and 30. Because the teeth are in an esthetic and functional optimum position, we can do these sextants in any order. The patient elected to begin with maxillary anterior teeth.
Phase Three began with new diagnostic impressions, facebow, centric jaw relations records and photographs. Their purpose was to do one final study of the occlusion and the esthetic contours. Slight alterations were made to the esthetic contours (diastemaʼs and line angles), while every effort was made to preserve the tested lingual contours. Teeth 6-11 were prepared with utilization of preparation reduction guides. A two cord technique was utilized and a final impression was taken, and a master model poured (Figure 12). Provisional restorations were created and cemented. Steps were taken to verify the functional goals previously described (Figures 13-15).
With all of the effort that has been taken to customize the patient’s anterior guidance, and ultimately create an optimum occlusal scheme, how we communicate these contours to the dental laboratory is extremely important. Previously techniques have been described to cross mount the die model with a doctor and patient approved provisional model. The use of silicone putty to fabricate a labial matrix was utilized to precisely duplicate the incisal edge position.17 Whereas acrylic resin or light cured composite can be used to create a custom incisal guide table to facilitate the precise duplication of the lingual contours of the maxillary anterior teeth.18,19 While the author, along with many others, have utilized these modalities successfully for many years, there are times where predictability can be an issue. If the maxillary master casts and the provisional models are not mounted in the exact position in space, the incisal edge position, and lingual contours will be wrong. This can and will create problems with some patients. Problems can include prolonged occlusal adjustments, all the way to the replacement of some or all of the restorations.
Today the use of digital technology can make this duplication much easier. The restorative dentist goes through the exact same process of making a final impression and creating properly contoured provisional restorations as well as making an impression of the provisional restoration. The laboratory will then scan the master model as well as the approved provisional model. The lab will then “marry” the images so that they can see the exact three dimensional contours over the digital master cast (Figures 16-17). These restorations can then be virtually designed, ensuring from the centric stop to the incisal edge position that the critical contours are duplicated (Figure 18). It should be noted that if doctors are using one of the digital impression scanning systems, the final impression and the approved provisional can be easily scanned. This will save a step in the dental laboratory. From this point the laboratory can either mill the copings, or use a 3D printer. In this case the copings were printed (Figure 19). This facilitated the utilization of a micro cutback technique on the facial to enhance the esthetic result. The resin copings were then invested, and the crowns were pressed using the IPS e.max all ceramic system.
Figures 20-24 illustrate the final result. The restorations were bonded to place using Mulitilink self-etching cement, and then were finished and polished. It should be noted that this technique resulted in almost no occlusal adjustments. Minor finishing and polishing in a few areas was all that was required.
Our articles were written by some of the top dental clinicians in the United States. These pieces provide you with useful information about today’s most innovative and proven restorative products and techniques.
“Better Esthetics, Biology and Strength can be standard when balancing three clinical and laboratory factors…Margin Placement, Margin Design and Coping Design with new Captek Nano materials.”
This article, written by Dr. Robert Lowe of Charlotte, NC, discusses perfect margin placement for maximum esthetics and health.
“Porcelain Laminate Veneer Therapy – Ultra-thin veneer options using no-prep or partial-prep philosophy.”
This article, written by Dr. Gary Radz of Denver, CO, discusses the ethics and advantages of no-prep and partial prep veneers.
“Achieving Occlusal Stability”
This article, written by Dr. Glenn E. DuPont of Saint Petersburg, FL, discusses the requirements for occlusal stability and the systematic protocol for achieving it.
Featuring Dr. John Cranham
The first issue of our DAL News & Education series includes an article by Dr. John Cranham entitled “Lithium Disilicate: A Viable Replacement for Traditional PFM’s.” The newsletter also includes product profiles on IPS e.max restorations and Valplast flexible partials.
Featuring Dr. Leonard Hess
This issue includes an article by Dr. Leonard Hess entitled “DuraFlex – The New Premium Flexible Partial Denture.” The newsletter also includes articles on the Equipoise System, bite splints, the TAP 3 Elite Appliance and full contour monolithic zirconia restorations.