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Instructions for Patients

How to bill insurance provider

1. Bill through MEDICAL INSURANCE, not Dental Insurance.

2. Use MED CPT code EO486.

3. We also recommend patient to submit a sleep study diagnosis to the insurance provider.

 

 

 

 

 

 

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Dentist Information

EndSnor™ appliance

Intended Use Statement: The EndSnor™ appliance, a dentist prescribed mandibular repositioning (MRP) device, is worn during sleep and is indicated for persons 18 years or older, who wish to reduce the incidence of snoring and/or mild to moderate obstructive sleep apnea. Before a dentist prescribes an EndSnor™ appliance for treatment, it is recommended that the patient receive a medical examination including a sleep study diagnosis, and a dental examination including cephalometric and tomography analysis to determine the need for an EndSnor™ appliance.

Precautions:

Dentists should consider the medical history of patients, including history of asthma, breathing, or respiratory disorders, or other relevant health problems, and refer the patient to the appropriate health care provider before prescribing the EndSnor™ appliance.

Safety and effectiveness in children under the age of 18 years old has not been established.

Duties of Dentist

1. Take maxillary and mandibular alginate impressions.

2. Pour impressions in dental stone immediately after taking impressions to minimize model distortion.

3. Decide if the patient will have enough retention with height of contour or if they will need to have retention created with the use of ball clasps due to lack of height of contour.

4. Take a wax bite with mandible end to end with maxillary incisors 4mm’s open. Be sure to maintain centric midline relationship when the patient moves into the end to end bite relationship.

5. Recommended to use a George Gauge Bite Fork when taking the wax bite to insure an accurate bite registration.

Note: Patients tend to deviate their jaw position when meeting resistance of the wax. You may need to take more then one wax bite. IT IS CRITICAL THAT MIDLINES ARE LINED UP PROPERLY AND ARE THE SAME AS WHEN THE TEETH ARE IN CENTRIC OCCLUSION!

6. Instruct patients that are being treated for mild to moderate sleep apnea to schedule a follow up appointment for a sleep study analysis while wearing the EndSnor™ appliance. Schedule a consultation between you and the sleep medicine physician to discuss the results.

Click here to print EndSnor™ RX form to ship with your case. To view the pdf form, you will need Adobe Reader 5.0 or higher.

Ship to Dockstader Orthodontic Lab, Inc. Call 1-800-433-7168 for shipping information.

 

Delivery of EndSnor™ Appliance to Patient

1. IT IS CRITICAL TO CHECK PATIENT WITH THE ENDSNOR™ APPLIANCE IN THE MOUTH THAT MIDLINES ARE LINED UP PROPERLY AND ARE THE SAME AS WHEN THE TEETH ARE IN CENTRIC OCCLUSION. IF NOT, TAKE NEW BITE REGISTRATION, IMPRESSIONS AND MODELS AND HAVE A NEW ENDSNOR™ APPLIANCE FABRICATED BY THE LAB! DO NOT DELIVER APPLIANCE TO PATIENT UNLESS MIDLINES ARE CORRECT!

2. Check acrylic buccal flanges, may need to adjust as fitting a denture if uncomfortable to patient.

3. Make sure retention is a snug fit, if not ball clasps can be added to create more retention.

4. Always deliver with the enclosed adjusting screw closed down all the way. Most patients will have their snoring eliminated at this setting. If that setting does not control snoring then place the adjustment key into screw and turn in the direction of arrow which will open vertical and bring the jaw forward creating more opening. Each adjustment of the screw is equal to .25mm.

IT IS IMPORTANT THAT THE NUMBER OF SCREW TURNS ARE PERFORMED EQUALLY ON BOTH SIDES TO EACH SCREW!

5. Instruct patient if reduction in the incidence of snoring and/or mild to moderate sleep apnea does not occur to contact you for instruction on how to turn the adjusting screw for mandibular adjustment. Require the patient to return to your office for an appointment the first time that a screw adjustment is necessary so that you can instruct them how to adjust screws properly.

Patient Warning:

1. The stainless steel parts contain Nickel (Ni). A prolonged and frequent contact may cause skin irritation and other allergic reactions in patients sensitive to nickel.

2. The acrylic is made with Methyl Methacrylate. A prolonged and frequent contact may cause skin irritation and other allergic reactions in patients sensitive to Methyl Methacrylate.

3. If you have an allergic reaction, remove your EndSnor™ appliance immediately and contact your dentist that prescribed your EndSnor™ or your personal physician for instructions on how to treat the allergic reaction.

Contraindications: The EndSnor™ appliance is contraindicated for patients who:

  • have central sleep apnea
  • have severe respiratory disorders
  • have loose teeth or advanced periodontal disease
  • are under 18 years of age

Risks:
Possible Side Effects

Use of the EndSnor™ appliance may cause:
Temporary Side Effects

  • Obstruction of oral breathing, remove appliance immediately if this occurs
  • Pain or soreness in the temporomandibular joint
  • Dry mouth or excessive salivation
  • Itraoral gingival or dental soreness
  • Temporary change in bite after appliance is removed in the morning
 

Potential Long Term Side Effects:

  • Temporomandibular Joint (TMJ) Dysfunction
  • Permanent change in bite
  • Tooth movement or changes in dental occlusion
  • Loosening of dental restorations

Directions for Patient Use:

1. Instruct patient to insert EndSnor™ appliance before going to sleep.

2. Instruct patient to grasp EndSnor™ appliance by the labial bar.

3. Labial bar must be on the bottom, lined up with lower teeth.

4. Instruct patient to hold EndSnor™ appliance by the labial bar, open mouth and insert appliance, acrylic end first.

5. Instruct patient to bite down into EndSnor™ appliance to seat appliance in mouth.

6. Instruct patient to remove EndSnor™ appliance by opening their mouth, grasp labial bar wiggling gently from side to side to release appliance retention. Once retention is released, remove from mouth.

7. Instruct patient if they experience any possible side effects, remove EndSnor™ appliance immediately and contact you to discuss the side effect and what actions you should take.

8 . Instruct patient if reduction in the incidence of snoring and/or mild to moderate sleep apnea does not occur to contact you to setup an appointment for instruction on how to turn the adjusting screw for mandibular adjustment.

Patient Care of EndSnor™ appliance:

1. Instruct patient, after removing EndSnor™ appliance, place it in their appliance box that they received when you deliver the EndSnor™ appliance or a container that allows the whole EndSnor™ appliance to be submersed in either orthodontic appliance cleaner or denture cleaner. Instruct patient to follow the directions on the cleaner box.

2. Instruct patient before using their EndSnor™ appliance to rinse it for a minimum of 2 minutes under cold running water to remove all appliance cleaner residues.

Patient Follow up:

1.Schedule patient for an appointment the day following the EndSnor™ appliance delivery. Use this appointment to address patient concerns and to assess and make adjustments to appliance if needed. Use this appointment to determine if screws need to be adjusted and to instruct patient in the proper way and when to turn the screws.

2. Schedule patient appointment for one month after delivery of EndSnor™ appliance.

3. Schedule next patient appointment according to your appointment protocol.

4. Instruct patient to contact you immediately if they have any side effects or concerns.

5. Instruct patients that are being treated for mild to moderate sleep apnea to schedule a follow up appointment for a sleep study.


For technical assistance:
Contact Rob Bausman
Email: rbausman@endsnor.com

EndSnor is trademarked and the design legally protected.

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EndSnor™ is presented exclusively by EndSnor, LLC, a Fresno, CA based company. EndSnor, LLC exclusively contracts all manufacturing of the EndSnor™ snore & mild to moderate obstructive sleep apnea solution to Dockstader Orthodontic Lab, Inc., also a Fresno based, full service dental lab.

 

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