ANSWERS

What is a mandibular advancement device?

A mandibular advancement device (MAD) is a custom-fit oral appliance worn during sleep that repositions the lower jaw forward by 4 to 10 millimeters. The forward posture opens the upper airway, reducing snoring and treating mild-to-moderate obstructive sleep apnea.

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How a Mandibular Advancement Device Works

A mandibular advancement device (MAD) is a two-piece oral appliance, upper tray and lower tray, connected by an adjustable mechanism that holds the mandible in a protruded position throughout the night. By advancing the lower jaw 4 to 10 mm (typically 60-70% of maximum protrusion), the device pulls the tongue base and soft palate forward with it, enlarging the retroglossal airway. The 2015 AASM/AADSM clinical practice guideline established oral appliance therapy as a recommended treatment for adults with mild-to-moderate OSA and for CPAP-intolerant patients across all severity levels.

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Is a mandibular advancement device the same as a snore guard?

Not exactly. A snore guard is a general term that includes both mandibular advancement devices and tongue-retaining devices, and some over-the-counter boil-and-bite products marketed as snore guards do not advance the mandible at all. A true MAD is custom-fit from a dental impression or intraoral scan, prescribed for diagnosed snoring or OSA, and built with an adjustable advancement mechanism. The clinical evidence supporting oral appliance therapy applies specifically to custom MADs, not the drugstore versions.

How long does it take to fabricate a custom MAD?

Lab turnaround for a custom mandibular advancement device typically runs 10 to 14 business days from when the lab receives the digital scan or impressions plus the bite registration. The variation depends on appliance type (milled monoblock builds faster than fin-style Herbst designs) and whether the case requires custom shade or hardware. Dani Dental's Sleep & Appliances workflow targets the lower end of that window when cases arrive via intraoral scan with a clean construction bite.

What are the contraindications for prescribing a MAD?

MADs are contraindicated for patients with fewer than 8-10 stable teeth per arch (insufficient retention), active periodontal disease, severe TMD, or full dentures without implant retention. Severe OSA (AHI above 30) is a relative contraindication; AASM guidelines still favor CPAP first-line at that severity, with oral appliance therapy reserved for CPAP-intolerant cases. A pre-treatment exam covering periodontal status, TMJ range of motion, and protrusive capacity (minimum 5-6 mm) screens out most poor candidates.

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