Adapting for an Anterior Open Bite
The delivery protocol and design of the SnoreHook Splint assumes that the patient's occluding relationship has a degree of incisal overlap, which then allows for the Hooking component to be the only "occluding" contact between the arches during its use.
However, when treating a patient with an Anterior Open Bite, the protocol of fabricating the mandibular tray on the patient's model will result in the Hooking mechanism being unable to engage with the mandibular CrossPlate.
In order to provide for posterior segment disclusion while the anterior Hooking mechanism is engaged with the mandibular CrossPlate, a modified direct-delivery protocol is required.
Here is an example of the AOB protocol:
Maxillary tray fabricated indirectly and delivered:
Fabrication of the mandibular tray indirectly on the model would result in, at a minimum, posterior contact. Furthermore, if the degree of anterior incisal opening were even greater, the indirect method would not allow the Hooking mechanism to engage the mandibular CrossPlate:
NOTE: The patient shown was being provided a SnoreHook for her clenching disorder. She did not have apnea. Her treatment required a method of clenching suppression in a slightly advanced position. The NTI device that she had been using allowed for the normal retruded clenching that the NTI allows for, but was uncomfortable for her. She had no pain when she clenched on her NTI in a slightly advanced position. The SnoreHook being delivered here is being used to treat her nocturnal clenching disorder.
In order to create the distal space to provide for posterior disclusion, segments of wooden tongue blades are adhered to the occlusal surface with a small amount of thermoplastic. External view:
Internal view prior to adapting with thermoplastic. Note how the CrossPlate is "tacked down" with thermoplastic:
Adapting the thermoplastic prior to insertion. Note the anterior thermoplastic does not cover the distal side of the CrossPlate so as to allow the Hooking mechanism to not bind or be blocked by the thermoplastic:
The next step is the most critical...
The practitioner now engages the CrossPlate to the Hooking mechanism, and instructs the patient to "bite up and forward" into the thermoplastic (best to practice a couple of times before the thermoplastic has been adapted). An abundant amount of thermoplastic in the anterior portion is necessary to engulf at least the incisal third of the lower incisors:
Allow the thermoplastic to begin to turn grey before moving. It can be submerged in cold water to hasten the hardening.
The lower device can now be tried in (without the maxillary tray in place) for comfort. If is binding, too tight, etc, "flame brush" the internals (only a couple of passes) to allow it to glide into place, then remove and insert a couple of times. Since the forces on the tray will be in a "forward" direction (the Hook pulling the CrossPlate), vigorous vertical retention is not necessary.
Showing the degree of anterior buildup with the thermoplastic. The greater the degree of AOB, the more thermoplastic there will be:
Final delivery: Insert the maxillary device, then engage and hold the mandibular device's CrossPlate against the Hook and instruct the patient to bite "up and forward" into the mandibular tray device. If there is any thermoplastic in this path of elevation to insertion (it is different than the vertical try-in path of insertion), remove and flamebrush the conflicting areas, then repeat the attempt while those areas have been softened.