How do I know if my mandibular advancement device fits?

For referring dentists ordering MADs from a dental lab, fit verification starts at delivery. The device should seat passively without finger pressure and resist gentle removal without flexing or distorting. If the appliance rocks on molars or lifts anteriorly during function, the impression or digital scan likely captured air pockets or the bite registration was taken outside the patient's comfortable protrusive range. That is a remake scenario, not an adjustment scenario.

Protrusion calibration matters as much as occlusal seating. Most protocols initiate at 50-60% of maximum mandibular protrusion and titrate forward in 0.25-0.5 mm increments over 4-8 weeks based on symptom response. A well-fabricated titratable MAD lets the clinician advance or retract the jaw position chairside without sending the device back to the lab. If the titration mechanism binds or skips positions, the hardware tolerance is the problem.

Soft tissue tells the story quickly. Blanching of the gingival margin under the tray flanges, soreness concentrated on one or two teeth rather than distributed across the arch, or a morning open bite that does not resolve within 20-30 minutes are each red flags. The first two usually indicate a fit or extension issue the lab can address by adjusting flange depth on the working model. The third, persistent morning open bite beyond 6-8 weeks, warrants re-evaluation of vertical dimension at the design stage.