A treatment option for snoring and mild to moderate obstructive sleep apnea, most oral appliances work by supporting the jaw in a forward position to help maintain an open upper airway during sleep. Qualified dentists work with sleep physicians to develop custom-made oral appliances.
According to the American Academy of Dental Sleep Medicine, oral appliance therapy is covered by many medical insurance plans.
This guide compares oral appliances side-by-side on parameters including warranty, materials, PDAC verification, how it works, fitting, adjustment, and supporting study.
|Company||Oventus Medical||Airway Management Inc||Apex||Dream Systems Dental|
|DynaFlex||DynaFlex||Glidewell||Great Lakes Dental|
|Luco Hybrid OSA Inc||OravanOSA||Panthera Dental||ProSomnus Sleep|
|Quiesco Health||SICAT GmbH & Co KG||SML-Space Maintainers|
|SomnoMed Inc||Tomed GmbH||Tomed GmbH||True Function Laboratory||Whole You|
|Appliance||O2Vent Optima||dreamTAP w/ AccuTherm||Kava Dorsal||OASYS Oral / Nasal Airway|
System (Optional Tongue
|Milled Dorsal||Milled Herbst||Silent Nite Sleep Appliance||Telescopic Herbst Sleep|
Appliance in Hard Acrylic
|The Luco Hybrid OSA|
|Oravan Herbst||Panthera D-SAD||ProSomnus [IA] Iterative|
Advancement Sleep and Snore Device
|ProSomnus [CA] LP|
Sleep and Snore Device
|ProSomnus [PH] Precision Herbst Style Sleep and Snore Device||The Silencer with Halstrom Hinge||OPTISLEEP||Clear Sleep Appliance||SomnoDent Avant||SomnoGuard AP Pro||SomnoGuard SP Pro||TrueDorsal||Respire Pink Micro|
|Warranty (days)||1,095||365 or optional extended 1,095||730||365||1,095||1,095||730||90 (metal); 730 (body)||1,695||365||1,095||1,095||1,095||1,095; 1,825 (Medicare patients)||1,825 (hinge); body varies||730||365-730||1,095||730; body varies||730; body varies||730||1,095|
|Indications||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring, Bruxism||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring||Mild-Moderate OSA, Snoring|
|Thermal Acrylic, Laminate, Cobalt-Chromium Alloys||Biocompatible|
Polymer, Hard Acrylic, Laminate, Thermal Acrylic, Gluten-free Acrylic
|Biocompatible Polymer, Cobalt-Chromium Alloys, Hard Acrylic, Laminate, Thermal Acrylic, BPA Free||Hard Acrylic||Hard Acrylic||Biocompatible|
Polymer, Ethylene-Vinyl Acetate, Thermal Acrylic
|Hard Acrylic||Cobalt Chromium Alloys, Hard Acrylic||Laminate, Stainless Steel||Biocompatible Polymer||Control-cured|
|Hard Acrylic, Thermal Acrylic, Ivocap Acrylic-elastomer||Biocompatible|
Polymer, Hard Acrylic
Polymer, Hard Acrylic, Laminate
Polymer, Control Cured Acrylic
|Laminate, Hard Acrylic, Stainless Steel||Laminate, Hard Acrylic, Stainless Steel||Laminate, Hard Acrylic, Ethylene-Vinyl Acetate, Milled PMMA||Laminate, Hard Acrylic|
|PDAC Verified||Yes||Yes||No||Yes (Hinge only)||No||Yes||No||No||No||Yes||No||No||No||Yes||No||No||No||No||No||No||No||No|
|How Does the Oral|
|Removable bands allow for mandibular|
advancement in 1 mm increments. The
addition of an integrated airway promotes
airway stability by expanding the velopharynx,
reducing soft palate collapse and, in the
presence of nasal obstruction, provides a
conduit to manage mouth breathing.
|DreamTAP w/ AccuTherm advances and stabilizes the jaw, preventing the|
tissues of the tongue and airway from collapsing. It corrects any slight tray
imperfections during the patient’s visit
using only warm water.
|Kava Dorsal utilizes a mandibular advancement dorsal screw mechanism.||OASYS Simplicity is a mandibular|
advancement with the labial shield. The Standard OASYS with Nasal Dilators improves nasal breathing and repositions the tongue with tongue buttons.
|The forward advancement of the lower jaw of this mandibular advancement|
device helps to gain airway opening.
|The forward advancement of the|
lower jaw helps to gain airway opening.
appliance. Connectors on right and left buccal side will pull the mandible in protrusion to open up the airway. 6 adjustable settings.
|By repositioning and holding|
the mandible in a more
protrusive position, it holds
the tongue forward and the
airway open. (The Herbst is
a registered trademark of
|Uses a patented forward bite to activate the masseter inhibitory reflex to treat sleep bruxism while managing OSA and UARS symptoms. The only FDA cleared treatment of sleep apnea with concurrent sleep|
|The device opens the patient’s|
airway through advancement of
the mandible using an adjustable
telescopic Herbst mechanism.
Like the Oravan device, Oravan
Herbst has a truly open anterior
design, encouraging natural protrusion of the tongue.
|Custom-made by computer, the D-SAD holds the lower jaw in a|
forward position, increasing the
space behind the tongue, which
facilitates airflow and eliminates snoring. The jaw advancement
also prevents the obstruction responsible for OSA.
|ProSomnus [IA] utilizes vertically mated buccal posts to advance and hold the mandible forward to open the airway.||ProSomnus [CA] advances the arch using a split 90° post with embedded expansion screw. Total available range of 12.0 mm, 11.0 mm for advancement and -1.0 mm retrusion from original bite position.||The ProSomnus [PH] uses a continuous advancement|
protocol. Upper arch
connects via Herbst Arm to lower arch with an adjustment nut.
|Airway patency achieved through|
incremental advancement combined with vertical adjustability and lateral movement.
|The airway is kept open by protrusion of the mandible with a 2-part appliance. It allows for lateral movement and mouth opening.||Two BPA-free trays allow for lateral|
movement and maximum room for the tongue while advancing the mandible forward.
|The device functions as a mandibular|
repositioner, which acts to increase the
patient’s pharyngeal space during sleep.
|2-piece, adjustable mandibular advancement|
device. The part with the guide bar (“C-bar”)
characterizes the upper tray designed for
the upper jaw. The C-bar is the track for the
screw head of the lower tray and allows a
lateral movement of the lower jaw. The device
repositions the lower jaw forward and so
prevents the collapse of the upper airway.
|A 2-piece, adjustable mandibular advancement|
device with a connector on each side, it
repositions the lower jaw forward and so
prevents collapse of the upper airway.
|The upper splint has bilateral adjustable|
components made with orthodontic expansion screws that engage with the lower splint to advance the mandible.
|With shorter Herbst arms, the Respire Pink Micro increases comfort due to its smaller|
size. It minimizes contact of the hinge
on the lip area and reduces irritation on cheeks. A thin chrome framework version is also available.
|Fitting Description||3D printed to be tailored to the individual|
following physical or digital intraoral
impressions and bite registration. Dental models scanned and the device and protrusive position designed based on bite
|DreamTAP w/ AccuTherm has returned to custom-made devices from models. The AccuTherm liner allows a fit for every patient. The appliances use a single point of midline adjustment to prevent uneven bilateral adjustment. It|
includes 3 hook sizes that allow for a 15 mm range of adjustment with minimal hardware. Posterior stops, mouthshield, and vertical hooks available.
|The Kava Dorsal is seated by gently placing the upper arch first, then seating the lower arch in the|
patient’s mouth. Adjust the ball
clasp if necessary to properly seat
and secure the appliance in place.
Engage the dorsal fins to the Kava
advancement screw by bringing the lower jaw forward and gently closing down. Check occlusion for
desired occlusal contacts.
|Upper clear cushion seated first.|
Lower splint with anterior labial
repositioning shield is placed next. Scale tracks adjustments in 1 mm increments, using the OASYS Wrench for mandibular positioning
|After receiving a set of PVS or good|
working models, a custom fitted
Dorsal is fabricated exactly to the bite
registration that is provided by the
dentist to the lab. The appliance is
returned to the sleep practice, delivered to the patient, and adjusted by a
qualified dental sleep clinician.
|After receiving a set of PVS/digital|
working models, a custom milled
Herbst is fabricated exactly to the
bite registration. The appliance
is returned to the sleep practice,
delivered to the patient, and adjusted by a qualified dental
|Both upper and lower trays will be tugging on each other to get adequate mandibular|
advancement, so it needs to be snug and not too passive.
|The standard hard acrylic|
snaps into place. When
requested, retention clasps
can be added.
|No lingual acrylic to|
adjust; 2 ball clasps per
sextant. Only 2 contacts
of occlusion with the
|The Oravan Herbst is custom fitted to each patient by a dentist who takes impressions and bite registration. No anterior coverage means it will not interfere with anterior dental cosmetic work.||Compatible with intraoral scanning technology or regular|
dental impressions. Each case is designed on a proprietary software so retention can be adjusted individually. The D-SAD could be designed for horizontal protrusion as well
|The dentist typically inserts and confirms the fit and comfort of each arch independently and then together. Patients are instructed to place the device arches in as|
a single unit. Experience fast insertion due to the accuracy of the digital design and precision
|The dentist typically inserts and confirms the fit and comfort of|
each arch independently and
then together. Patients are instructed to place the device arches in as a single unit. Experience fast insertion due to
the accuracy of the digital design and precision manufacturing.
|The dentist typically inserts and confirms the fit and comfort of each arch independently|
and then together. Patients are instructed to place the device arches in as a single unit. Experience fast insertion due to the accuracy of the digital design and precision manufacturing.
|Standard.||The dentist inserts the OPTISLEEP and|
confirms fit, comfort, and mandible position.
|The appliance is seated by placing the upper and lower portions together. First seat the upper portion, then guide the lower portion and seat with finger|
|The device consists of two trays customized to fit over the upper and lower teeth, and the lower tray is held in a protrusive position by an advancement|
mechanism consisting of a strap attached to an upper anterior guide and two lower fixing elements.
|Dental impression of the upper and lower jaw.|
Construction bite registration and definition
of the initial protrusion for the lower jaw. For the thermoforming technique, thermoforming
discs with a thickness of about 2 mm and
a pressure forming unit are necessary. The
lower tray attachement with the screw housing
is fixed to the underside of the lower tray.
The upper tray attachment with the C-bar is
fixed to the upper tray. The upper and lower
jaw trays are connected to each other with an adjusting screw.
|Dental impression of the upper and lower jaw.|
Construction bite registration and definition of
the initial protrusion for the lower jaw. For the
thermoforming technique, thermoforming discs with a thickness of ~2 mm and a pressure
forming unit are necessary. The attachment
points for the metal knobs and wires are in the
lower jaw in the molar region and in the upper
jaw in the canine region.
|Place the upper tray in the patient’s mouth|
and press it up into place with your thumbs. Place the lower tray into the patient’s mouth and press down both sides using index fingers to ensure the fit on the teeth. Once both trays
are securely positioned, engage the fins by bringing the lower jaw forward. Removal: Remove the lower tray by using your thumbs
to pull the tray up and out. Using thumbs and
index fingers, pull upper tray down and out
|Place upper component (marked with both|
arrows on the side of the device) onto upper teeth by hand. Press up to ensure plate is
seated securely and fits comfortably. Place lower component onto lower teeth by hand. Press down on both sides to ensure plate is seated securely and fits comfortably.
Close the mouth once the upper and lower components are seated firmly. Ensure device’s flat planes are in even contact throughout the arch.
|Adjustment Description||Connector bands attach to custom placed lugs on each side of the upper and lower|
trays. Adjustable bands in 9 lengths (13- 21 mm) allow for 6 mm protrusion, 2 mm retrusion, in increments of 1 mm.
|Adjustments are made by the patient with the appliance in the mouth in 1/4 mm increments using an adjustment key. The clinician teaches a home titration schedule. DreamTAP can also be adjusted during a sleep study by a sleep tech.||Adjusted using an advancement screw and key. The advancement|
screw can be activated by turning
both the left and the right screw in the same upward direction. Each 90° activation advances
the mandible. 10 activations will advance the mandible 1 mm with
a maximum of 70 turns (7 mm)
|The anterior labial shield is on a|
sliding lock system. Pushing the
shield advances the mandible; pulling retrudes. Adjustment 8 -15 mm. Finger adjustment on the nasal dilators and tongue buttons.
|The DynaFlex Dorsal has 6 mm of|
mandibular advancement built into the device. The adjustment ratio is 10:1.
|The DynaFlex Milled Herbst has telescoping arms that can advance the mandible up to 5 mm. The advancements are|
made with a small key that is provided by DynaFlex. A singleor double-collar arm can be
|May need to switch out the 6 different connectors to get ample advancement of the mandible to open the airway.||Small increments using|
advancement shims, or
up to 5 mm with a 1 mm
retrusion using telescopic
|Titration is by 2|
orthodontic screws that
are turned with a key
(wire). Adjustable in 0.25
mm adjustments up to
|Insert the key into the adjustment mechanism located|
on the anterior mandibular component of the device. Can be advanced in small
increments up to 5 mm.
|A patented locking mechanism means rods can be replaced for titration. The new 3.0 Rod Pack includes 20 pairs of rods in 0.5 mm increments and lengths from 16 mm to 34 mm. The rods will not disengage during sleep nor elongate.||Remove an arch and insert the next arch in the series of advancement arches.|
Combinations of arches add up to a new titration increment. No
screws, mechanisms, or elastics required. Unlimited Advancement Arches can be ordered one at a time until satisfied.
|Includes 1 upper [CA] LP arch; 1 lower (L0) arch; 1 lower (L3) arch; lingualess anterior coverage; full posterior coverage; tapered posts; flat plane splint design with lingual and labial anatomical scalloping. Device starting position is set at bite when delivered. When the advancement is completed using|
the initial upper [CA] LP arch, the patient can swap in the lower (L3) arch. Note: Both the ProSomnus [CA] and [CA] LP Sleep and Snore Devices can be adjusted within a 12.0 mm total titration range.
|Uses a continuous|
advancement protocol. Upper arch connects via a Herbst Arm to the lower arch with an
adjustment nut allowing for small incremental adjustments in a range from –1.0 mm to 6.0 mm.
|Advancement through a range of 10 mm, adjustable in 1 mm increments.|
Vertically adjustable through changing
connecting stylus pin.
|Adjustments are done by changing the connectors, which are provided together with the OPTISLEEP. There are 10 pairs|
in total, providing an incremental range from 1.0 mm to 10.0 mm.
|The Clear Sleep provides up to 7 mm of advancement and uses a series|
of connector straps that can be
interchanged to move the mandible
forward in 1 mm increments.
|SomnoDent Avant is adjusted by switching out the strap for another strap with a different length.||By turning the adjusting screw with the adjusting|
tool, a lower jaw advancement of 0 to approx.
10 mm can be infinitely adjusted (depending
on the length of the screw used: 12, 16, or 20
mm). Thereafter a locknut is fixed against the
|Two connectors of equal length connect the|
upper with the lower jaw tray. The lower jaw
advancement can be infinitely adjusted from
~-3 to +7 mm (and more) by turning the screws between the connectors with the spanner.
Connectors without screw in different sizes are also available.
|The dentist can advance the TrueDorsal using the orthodontic expansion key enclosed with the device. A patient can also advance the device, if needed, under the care of the dentist. Full 360°|
turn 0.8 mm. ¼ turn (every time a new hole
appears) = 0.2 mm. Maximum advancement is = 6 mm.
|The micro arm will advance up to 3 mm. For further titration, unscrew the fixing element on the upper device using the hex key, turn the adjustable component on the Herbst arm back to the starting point (zero turns).|
Using the key, connect the Herbst arm to the
anterior fixing element on the upper device
for up to additional 3 mm of advancement
Maximum protrusion is 3 mm = 48 quarter
turns. Do not titrate over 3 mm.
|Upper-Lower Connection||Connected.||Connected by hardware during use.||No connected.||Not connected.||Not connected.||Connected with stainless steel|
hardware); others not.
|Not connected.||Connected.||Connected.||Not connected.||Not connected.||Connected.||Connected.||Connected.||Connected.||Connection of the upper and lower tray|
by a strap attached to an upper anterior
guide; adjustable with a range, by increments of 1 mm, from – 1.0 mm to
+8.0 mm; design features both lateral
movement and vertical opening.
|Supporting Study||Lavery D, Szollosi I, Czyniewski S, et al. Safety and efficacy of a novel oral appliance|
in the treatment of obstructive sleep apnea. JDSM. 2017:4(3); 57-63.
|Hoekema A, Stegenga B, et al. Obstructive sleep apnea therapy. J|
Dent Res. 2008;87(9):882-7. More studies at tapintosleep.com dentist/peer-reviewed-studies
|Not provided.||Shrivastava D, Bixby JK,|
Livornese DS, et al. Efficacy of
oral appliance therapy in the
treatment of severe OSA in
CPAP-resistant cases. Sleep
|Not provided.||Not provided.||Borrie F, Keightley A, Blacker S, Serrant P. Mandibular advancement appliances for treating sleep apnoea/hypopnoea syndrome. Evid Based Dent. 2013 Mar;14(1):27-8.||Not provided.||Not provided.||Sutherland K, et al; on behalf of the ORANGE Registry. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014;10(2):215-27.||Not provided.||Hu J, et al. Case report: The MicrO2 Sleep Device. DSP. Summer 2015:24-7. Remmers JE, et al. Clinical study: a feedback-controlled|
mandibular positioner identifies individuals with sleep apnea who
will respond to oral appliance therapy. JCSM. 2017;13(7). Vranjes N, et al. Assessment of potential tooth movement and bite changes with a hard-acrylic sleep appliance: A 2-year clinical study. JDSM. 2019;6(2)
|Seltzer N, et al. Case report: Using a precision milled,|
continuous advancement, oral appliance with symmetric titration to treat all severity levels
of obstructive sleep apnea. DSP. Spring 2019:22-4.
|Not provided.||Raphaelson MA, et al. Oral appliance|
therapy for obstructive sleep
apnea syndrome: progressive
mandibular advancement during polysomnography. Cranio. 1998;16(1):44-50.
|Not provided.||Not provided.||Not provided.||Not provided.||Not provided.||Not provided.||Not provided.|
Information for this guide based on data submitted by custom oral appliance marketers. Sleep Review strives for accuracy in all data but cannot be held responsible for claims made by marketers. All custom oral appliance marketers get one listing at no charge. Advertisers are offered multiple listings. All custom oral appliance options may not be included. We plan to update this guide twice a year. Email sroy[at]medqor.com to be considered for the next update.