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Oral Appliances Used in Our Lexington, MA Office

We use seven different oral appliances in our office. The choice of which appliance will be used for each patient is based on many factors. These factors include severity of the apnea condition, patient's bite and jaw structure, size of the tongue and soft palate, presence of tooth clenching or grinding, jaw range of motion, health of teeth and gums, and many others. We will use our experience and expertise to help guide the patient to using the appliance that will be most comfortable and effective for that individual's situation. We have used many different appliances over the past several years, but currently we use:

The Narval CC

The Narval CC is a new generation of mandibular repositioning device (MRD) designed specifically for the treatment of adult obstructive sleep apnea (OSA). The patented Optimized Retention of the Mandible (ORM) articulation maintains the mandible in an advanced position leading to effective treatment and high compliance.

  • Computer-aided design (CAD) enables high degree of customization to suit the complex dental anatomy of each individual patient
  • Computer-aided manufacturing (CAM) using selective laser sintering of a biocompatible polymer material guarantees consistent, industrial-strength manufacturing
  • Use of polyamide for a slim, lightweight device that is highly resilient and durable


The SomnoMed MAS™ is an oral appliance, which fits over the upper and lower teeth, much like a sports mouthguard. Unlike a sports mouthguard, however, it is a precision-made, clinically-tested medical device, which is highly effective (in most cases) in preventing snoring and mild to moderate obstructive sleep apnea.

The medical term for your lower jaw is 'mandible' and an oral appliance worn over the teeth is a 'splint', hence the name SomnoMed Mandibular Advancement Splint, or SomnoMed MAS™.



Klearway thermoplastic appliance This is a thermoplastic appliance which must be heated in hot tap water every night (to make flexible) before it is placed in the Klearway mouth. It allows for some side-to-side movement of the bottom jaw and limited opening, so that water can be sipped without removal of the appliance. The adjustment hardware is on the roof of the mouth and it takes some time to get used to swallowing with material in that location. The patient is able to adjust the bottom jaw forwarded in very tiny 25 mm increments. The appliance is completely contained within the mouth, and though it makes the lips look a bit puffy, is completely hidden when in use.



Modified Herbst™

Modified Herbst hard plastic appliance This is a hard plastic appliance which has the adjustment hardware set on the cheek side of the molar teeth. It prevents side-to-side motion, but since the bottom jaw is held closed with small orthodontic rubber bands, opening the jaws is fairly easy. The modified Herbst is smaller than most appliances and has a long life span. It allows jaw movement in all directions but backwards. The patient can take medications, use an asthma inhaler or talk with this appliance in place. This appliance can be fabricated out of material that has no methylmethacrylate and is thus safe for patients who are allergic to this material.The modified Herbst is one of the 'yardsticks' used by other appliances seeking FDA acceptance. Patients who severely grind their teeth at night can crack this appliance.



E.M.A. appliance The E.M.A. is the thinnest and least bulky of all the appliances. It is similar to clear acrylic orthodontic retainers, and the 'hardware' (located to the cheek side of the molar teeth) consists of specially designed, patented elastic bands. This appliance moves the jaw forward in fairly significant steps, which may be difficult to tolerate. Some care must be taken to avoid breaking the lower portion when replacing the custom elastics. The EMA is well tolerated by patients who grind their teeth. It has no metal and can be used by patients with a nickel metal allergy.

Adjustable PM Positioner

Adjustable PM Positioner is a custom-made appliance constructed of a heat-sensitive acrylic that fits over the upper and lower teeth. The appliance is comfortable on the teeth and leaves added space for the tongue compared to other devices. It allows a small amount of jaw movement (4mm) so that the patient does not feel "locked into position". The adjustment mechanisms are on the cheek side of the appliance near the molars and allows for easy advancement of the jaw position to improve effectiveness of the device when it is indicated. This appliance is used most frequently in our office because of its ease of use, effectiveness and durability.

TAP Plus

TAP Plus is also a custom-made appliance that is made of a heat-sensitive acrylic that has a separate upper and lower portion that is connected in the front of the device by a hook and bar assembly. This device is comfortable on the teeth and allows good freedom of movement of the jaw. Therefore it is used frequently for patients who tend to grind their teeth heavily. Since the position of the jaw can be adjusted while the appliance is in place, it is also used for patients who have a certain jaw structure that would require that feature. As mentioned the front assembly is located near the tip of the tongue and it protrudes between the lips, so it may take a little bit more time to adapt to the device. However, most patients find it to be comfortable within the first 5-10 days.


Tongue Retaining Device (TRD)

Tongue Retaining Device (TRD) is a custom-made appliance made of a soft, pliable material that has a compartment in which the tongue is held in place by means of suction. This appliance is most frequently used for patients who have very few or no teeth. The TRD may require some time for the patient to adapt to having their tongue held in place, so a tongue exercise and adaptation program is started a few weeks prior to the date of insertion of the device. This appliance may be difficult to tolerate if the patient has trouble breathing through their nose.

Silent Nite, SnoreAid and Therasnore are other appliances currently used in the office. The Silent Nite is a smaller appliance that is very comfortable to wear and can be effective for patients who are primarily snorers or have very mild apnea. However it is less durable and has much less adjustability. The SnoreAid and Therasnore appliances can be fitted the day of the appointment, which is a great option for patients who need the appliance immediately (if they are leaving on vacation the next day, etc.). However these devices are much less durable and the Therasnore is bulky compare to other appliances.

The Adjustable PM Positioner , TAP Plus and Tongue Retaining Device are all FDA accepted for snoring and sleep apnea. The Silent Nite, SnoreAid and the Therasnore are FDA accepted for snoring only.
Our goal is to help you achieve quiet, restful sleep in order to improve your overall health and the quality of your life. Dr. David B. Rosen will listen carefully to your concerns, thoroughly evaluate your situation, and educate you about your problem and the possible solutions. Your care will be provided in a kind, caring environment. The treatment will be customized to your needs and provide you with the most effective oral appliance therapy available to resolve your snoring and sleep apnea problem.

Call our office today at (339) 970-0155 to schedule your appointment or request an appointment online by clicking here!


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