Practitioner FAQs

Acrylic / thermoplastic devices
Advantages:

• Tolerated by the patient
• Material has some inherent flexibility
• Materials softer than enamel and porcelain therefore unlikely to scratch porcelain
• Inexpensive
• Produced locally and limited reliance on advanced clinical recording techniques

Disadvantages:

• Often poor compliance by patients
• Bulky devices, encroachment into tongue space
• Increased vertical jaw opening beyond free way space may lead to mouth breathing and a dry mouth
• Appliances cannot be sterilised, cannot be put in very hot water, often become smelly, unsightly and difficult to clean.
• Materials are porous and harbour oral microflora
• A very hit and miss distribution of loading over the teeth especially where there is wear or deterioration of the materials used.
• A plaque trap possibly aggravating periodontal breakdown
• May have limited scope for adjustments anterior posterior and horizontal
• Often soft tissue as well as tooth borne
• Often fixes the TM Joints unless a two part device is used
• Limits normal saliva flow around the teeth and gums

All metal Somnowell device
Advantages:

• Low bulk, limited if any encroachment into tongue space
• Minimal vertical jaw opening allowing lip to lip oral seal
• Can be sterilised in an autoclave and cleaned in a dish washer
• Material is impervious to oral microflora
• Is tooth borne not tissue borne
• Very good patient compliance due to comfort
• Aesthetically once in situ very pleasing
• Patients can take medication and liquids without taking appliance out
• Can talk with appliance in
• Adjustable
• Inexpensive in the long term
• Long life expectancy of device
• Allows free flow of saliva when in place
• A tight snug fit once in place
• Chrome device most unlikely to cause the displacement or loss or movement of teeth
• Can act as a splint where the teeth are periodontally compromised distributing occlusal loads and parafunctional forces

Disadvantages:

• Exacting clinical record taking requirements (availability of facebow, high precision impression materials, and bite recording)
• Dependence on off site laboratory production
• Tricky to insert / remove until patient gets used to the device
• Raised patient expectations
• Initial costs
• If the dental anatomy alters, e.g. major restorative work is undertaken, a remake of part or all of the device may be required

We need well extended highly accurate impressions, a forward postured bite, and a facebow recording. We provide all Somnowell Practitioners with comprehensive training materials and support led by Visiting Professor Simon Ash the Somnowell inventor.

Yes. We have regular live courses in Europe that are personally led by Professor Ash. Please keep in touch with regards to live course dates for North America. Please express your interest using our Contact form.

We are keen to develop a small network of appropriately trained clinicians in different parts of each country we operate in and promote the development of successful multi-disciplinary teams.

This is not something that we currently do with any of the Somnowell Practitioners.

The Somnowell Chrome is made from nickel and molybdenum free alloy. There may be a small amount of nickel contained within stainless steel. However in 15 years this has not proved to be a problem.

There are several reasons.

1. To maximise retention.
2. To maximise the opportunity for clasps and undercuts. Please note it is an active device and not a passive device like a denture.
3. To avoid unwanted tooth movements. Therefore there is a clasp or rest on most of the teeth except the incisors.
4. To distribute the load as far as possible.
5. There are occasions when the clasps may be used to support vertical elastics.
6. When removing the device, patients often prefer to apply finger pressure to several points on the device.

We charge a standard fee for the Somnowell regardless of the number of clasps.

The device is constructed to the postured bite and records that are supplied by the dentist thus it is critically important that these clinical measurements are accurate and appropriate for your patient. The adjustment tool supplied is used for adjusting the length of the piston rod. In most instances the supplied adjustment is set to allow forward advancement only. If you wish to set the lower jaw back this must be conveyed to the laboratory with the original order.

Intra Oral scanning using CAD Cam technology is now recommended. We can now accept your open STL files. This replaces the need for impression taking, which may help to minimise the risk of distortion, and possibly ensure a more accurate fitting device for your patient.

If you do not have intra oral scanning technology then we would need well extended highly accurate impressions, a forward postured bite, and a facebow recording. We provide all Somnowell Practitioners with comprehensive training materials and support led by Visiting Professor Simon Ash the Somnowell inventor.

Providing the patient has dental units in both arches or implants that could support a denture then it is likely that a Somnowell could be constructed. We judge each case on its merits and we would like to see the stone models and see if we can come up with a design. Please make sure the mouth is dentally fit and let the impression material fully set before removal from the mouth.

Visiting Professor Ash advises that mild class IIIs are not usually a problem providing the device can be made with occlusal balancing in the protrusive position. Severe class IIIs are more challenging. Patients must be made aware that there is a significant risk that in a class III malocclusion there is a greater risk of unwanted tooth movement and a permanent alteration in the jaw relations. In these cases the addition of a labial bow may be beneficial in resisting unwanted tooth movements. In a class III case, further jaw protrusion introduced by wearing any MAD may aggrevate the class III dental and dental base relation.

When analysing data from thousands of appliances we have found that under 2% are returned for framework repairs. If the patient has evidence of bruxism and or jaw parafunction, then this must be brought to the attention of the patient at the outset and of the laboratory.

See guarantee for more information.

The Somnowell Chrome appliances come with a 5 year guarantee against manufacturing defects.

If it appears to be a failure in manufacture then we replace without charge. However if the failure results from maltreatment of the appliance by the user, or distortion and damage due to patient bruxism or parafunction i.e. wear and tear, then this would be evident from distortion of the Somnowell Chrome in relation to the original stone models on which it was constructed, thus each case would be assessed on its merits, and it is very important that the patients retain and return any Somnowell Chrome with these previously original mounted models.

This is a common problem in plastic oral devices. The Somnowell chrome joint however is stainless steel embedded in cast chrome cobalt and is thus extremely strong. In recent independently reported tests on the joint the joints withstood 40 kilos of loading force (ref. mechanical test report number 752995 February 6th 2015). This type of failure is very rare.

When treating patients using the Somnowell Chrome device, the jaw relation is a forward postured position. In this position, the teeth function to anchor and retain the opposing jaw frameworks. In this postured position the intercuspal relations are irrelevant. For maximum patient comfort, the mandible needs to be postured forward in a symmetrical relation to the TM Joints aligned at right angles to the mid facial plane. The facebow registration records the relationship of the upper jaw to the skull and to the temporomandibular jaw joints. It also records the mid facial plane in relation to the upper teeth and jaw.

In Constructing the Somnowell chrome, the technical team split cast mount the stone models on the semi adjustable articulator. The Somnowell chrome is designed using the articulated models where the postured jaw relationship is replicated. The refractory models on which the actual appliance is made are also mounted on the semi adjustable articulator. The finished Somnowell Chrome is checked for occlusal balance, final adjustments, retention, fit and quality control using the split stone cast models mounted on the articulator before dispatch. In absence of a facebow registration and semi adjustable articulator, the technicians arbiterally mount the opposing models on plain line articulators.

Mandibular advancement appliances are unequivocally proven to control snoring and sleep apnoea. New NICE guidelines (www.NICE.org.uk) now recognise the role of adjustable mandibular advancement devices (MADs) in the treatment of obstructive sleep apnoea (OSA). The Somnowell was invented by Visiting Professor Simon Ash, a Specialist Orthodontist with over 30 years clinical experience and a special interest in sleep related breathing disorders and jaw and facial balance treatment.

We provide all Somnowell Practitioners with comprehensive clinical assessment instructions. Including a pre-consultation questionnaire, a clinical assessment form, and the industry standard Epworth Sleepiness Scale.

The Somnowell training, product, service, and support is personally led by Visiting Professor Ash.

Visiting Professor Ash works as part of a multi-disciplinary team and is a Fellow of the Royal College of Surgeons of England and an accredited Consultant and Fellow at the Royal College of Surgeons of Edinburgh. Furthermore, for many years Visiting Professor Simon Ash served as a Regional and Speciality adviser (North Thames) to the Royal College of Surgeons of England.

The Somnowell laboratory will follow basic design principles established by Visiting Professor Simon Ash , subject to te outcome of the survey findings and mounting on the semi-adjustable articulator. If the practitioner wants special features then where possible this is accommodated e.g. lingual bar rather than plate or palatal bar, or post palatal skeletal design, or relief of a tooth or area. As far as possible this is included in the price at the final discretion of Somnowell. The major connector in the lower arch is normally placed in the labio mental sulcus, however it may be necessary to place this lingual to the lower incisor teeth depending on the anatomy and the path of insertion. Sometimes we place a lingual connector and a labial retainer bow. The practitioner can express a preference. Variations from the standard design may incur extra laboratory work, a current list of additional extras is shown in our practitioner portal. An estimate for any additional work can be provide before the device is made.

The Somnowell is constructed using the records supplied by the Dentist and the Somnowell is guaranteed to fit these models. If the device fits the models on which the device was made but does not fit the mouth this indicates a distortion in the impression taking stage and a recasting / remake fee applies. The requirement for the dentist to supply really accurate records cannot be over stressed. A remake fee will be charged where a remake results from impression distortion and will depend on whether the whole or only part of the device needs to be remade. The main cause of impression distortion results from premature removal of the impression from the mouth. Always allow a full two minutes per impression. Intra oral digital scanners linked to CAD CAM are a recommended alternative to dental impressions

The Somnowell laboratory and Professor Ash design the Somnowell following basic design standards subject to outcomes of the survey findings and mounting on a semi-adjustable articulator. If the practitioner wants special features then where possible this is accommodated e.g. lingual bar rather than plate or palatal bar, or post palatal skeletal design, or relief of a tooth or area. As far as possible this is included in the price at the final discretion of Somnowell. The labial connector is sometimes placed lingually depending on the anatomy and the path of insertion. Sometimes we place a lingual connector and a labial retainer bow. The practitioner can express a preference.

If a single arch needs to be changed then providing accurate contemporary records are supplied and the original split cast mounted models are returned then wherever possible a single arch will be remade. However each case has to be judged on its merits and on some occasions a complete remake may be advised. The estimated cost of this work can be provided once the records are received by the Somnowell Laboratory.

It is important that the mouth is dentally fit and any restoration or other dental work is completed prior to taking the records for the Somnowell. Some allowance can be built into the design if this is advised on the Laboratory Order Form. However, there are a number of ways of dealing with crowns or inlays.

One way is for the dentist to ask their crown and bridge laboratory to supply a Duralay coping. The dentist places the Duralay coping on the prepared tooth and then places the Somnowell appliance into place. The dentist then adds additional Duralay with a paintbrush technique using separate powder and liquid, to build up the contour of the coping to accurately fit the adjacent Somnowell framework. The modified Duralay coping is sent to the lab for casting and finishing as usual. The dentist fits the new crown ensuring it accommodates the Somnowell appliance.

Another alternative is for an overall silicone impression with the adapted Duralay coping and Somnowell appliance in place to be sent to the lab. The technician will place the original trimmed die into the coping and then cast a working impression. The technician will then be able to check the fit of the adapted Duralay coping to the Somnowell appliance and will be able to accurately adapt the contour of the coping before casting and finishing. As the technician has a master impression with the Somnowell appliance he/she will also be able to check the fit of the completed restoration on the model, before returning the completed restoration to the practitioner.

When treating patients using the Somnowell Chrome device, the jaw relation is a forward postured position. In this position, the teeth function to anchor and retain the opposing jaw frameworks. In this postured position the intercuspal relations are irrelevant. For maximum patient comfort, the mandible needs to be postured forward in a symmetrical relation to the TM Joints aligned at right angles to the mid facial plane.

The facebow registration records the relationship of the upper jaw to the skull and to the temporomandibular jaw joints. It also records the mid facial plane in relation to the upper teeth and jaw.

In constructing the Somnowell Chrome, the technical team split cast mount the stone models on the semi adjustable articulator. The Somnowell Chrome is designed using the articulated models where the postured jaw relationship is replicated. The refractory models on which the actual appliance is made are also mounted on the semi adjustable articulator. The finished Somnowell Chrome is checked for occlusal balance, final adjustments, retention, fit and quality control using the split stone cast models mounted on the articulator before dispatch. In absence of a facebow registration and semi adjustable articulator, the technicians arbiterally mount the opposing models on plain line articulators.

Note, for the Somnowell clear we do not rely on a facebow and construct the device on a plain line articulator. Occlusal balancing is limited to the postured bite registration position only.

Other plastic mandibular advancement devices do not take a facebow record, and the models are not placed on a semi-adjustable articulator. The resulting devices are often reliant on the patient's adaptive capacities to cope with the inherent inaccuracies. This may be sufficient for short-term plastic devices, but it will not suffice for the Somnowell Chrome. The Somnowell Chrome seeks to provide the patient with optimum comfort over a long period of time, whilst eliminating complications and problems in treatment delivery.

We have not found this to be a problem. Several thousand Somnowell Chromes have been supplied and Visiting Professor Ash believes the lower front teeth do not over erupt because the device should be worn during sleep periods only. However, the design can be altered to your requirements.

You are able to advance the appliance beyond edge to edge, using the protrusion nuts. In cases like this we would suggest you take a bite that is a bit further than edge to edge. For patients with a lot of bruxism / parafunction, we recommend thickening the chrome work so is just chrome to chrome in the buccal segments, so the patient then grinds chrome to chrome. Indeed with all appliances, including retainers, patients are told and advised that they should wear the upper and the lower appliances to protect against inadvertent wear.

Every effort is made to avoid inadvertent wear. The dentist should examine for evidence of bruxism and parafunction and include this information in the laboratory request form. It is strongly advised that in these risk patients, patients are made fully aware of any possible risks to their teeth, during parafunction and bruxism the jaws can behave most peculiarly. It is advised to request occlusal balancing of the Somnowell Chrome in these cases. If the device is distorted or damaged by jaw parafunction or bruxism then the patient must stop wearing the device. Damage to the device caused by parafunction or bruxism is not included in the warranty. 

https://somnowell.com/contraindications/

We use our own laboratories to design and construct every Somnowell device. We can accept orders from all over the world and ship the Somnowell devices directly to the Somnowell Practitioners. The patient records we need to construct the Somnowell device should be sent directly to the Somnowell laboratory.

As long as the patient remains dentally fit and takes good care of the Somnowell Chrome it should last indefinitely.

The Somnowell Chrome is guaranteed against manufacturing defects for 5 years, however Visiting Professor Ash's first chrome cobalt mandibular advancement device was fitted in 1998 and is still in use.

The lifespan of the piston rod depends on how well the appliance is maintained. They can be simply be switched if necessary.

The Somnowell clear is guaranteed against manufactiuring defects for one year. This device is inteneded as a training transition device leading to the provision of a Somnowell Chrome. As with all acrylic and thermoplastic oral devices, these are only designed to be of a transitional temporary nature.

The Somnowell Clear is contraindicated in patients who mouth breathe and those who have jaw parafunction or Bruxism. In patients with jaw parafunction, the muscular and oral forces applied to the devices will cause these to fracture usually where the stainless steel fixing part joins the thermoplastic. Such breakages are not included in the device warantee.

The Somnowell is constructed and set to the postured jaw relation as supplied by the Dentist. There is usually an additional 5 mm adjustment possible by altering the adjustment nuts. The dentist must specify if they wish to be able to retard as well as further advance the lower jaw.

Yes this is possible but the device may need additional posterior support blocks which are an additional lab cost. If the dentist feels that the clinical situation could support a chrome partial denture then the Somnowell Chrome should be OK..

In Class 2 div 1 cases the Somnowell Chrome is usually very successful.

However the practitioner must look at the following;
1. With the jaw postured forward, is there a large posterior open bite - if so the case may need additional acrylic or chrome buccal support blocks to give posterior stability of the device in the protrusive bite relation.
2. In the protrusive position can the patient achieve and maintain lip competence and an anterior oral seal?
3. Are the teeth very protrusive, is retention likely to be an issue?
4. The Dentist needs to assess the transverse jaw and tooth relationships in the planned jaw protrusive relationships for cross bites, scissor bites and over erupted teeth which might limit lateral jaw and protrusive jaw movements.

Yes we have made successful Somnowell Chromes for class 2 div 2 cases but these can be difficult and often need additional chrome or acrylic posterior bite platforms to deal with the posterior lateral open bites that occur once the lower jaw is protruded. We can better assess this once the records tarrive. When taking the postured bite an edge to edge bite registration should be avoided as this may lead to enamel trauma.

See Contraindications for more information.

We recommend the practitioner specifies where the prosthetic teeth are and if they wish to have any bypassed or not clasped by the lab. However if the device is fitted correctly and removed correctly then once in situ the device is static and should not displace individual prosthetic units. If the prosthetic units are unstable or loose then indeed they may be due for replacement and in this case the patients mouth would be "dentally unfit".