Morning Aligner (MA) for Oral Appliance Therapy (OAT) 

Exam before fabrication of MA

• Check bite to make sure the posterior is hitting on both sides with articulating paper
  
• If not, then note in chart and alert the doctor before proceeding
  
• Fabricate BEFORE trying in the MAS

Fabrication

• Either cut the MA material into a section about 1” long, or get a teaspoon of thermocryle
  
• (with Kevlar beads (Tan))
  
• Heat the MA material (over 160 degrees) until soft and pliable. Make sure not too hot.
  
• Mold onto upper anterior teeth from canine to canine. Push up in the back palatal area
  
• and mold onto the front.
  
• Have patient bite down hard until they feel back teeth touching. Have them push the MA
  
• against the front teeth with their tongue. Mold from the front with your fingers. Note that
  
• this will probably bite through the MA material in certain points. That is OK.
  
• Let cool and remove
  
• Once totally cool, reinsert and use articulating paper to confirm posterior teeth are
  
• touching with MA in place
  
• Instruct patient to use this every morning after taking out the MAS. Wait 5 min after
  
• removing the MAS before inserting the MA.
  
• Note in chart that you fabricated and gave instructions, and esp warned the patient that if
  
• they do not do this, they will get tooth movement (in treatment section – “browse”).

Patient Instructions

• Put into mouth 5 -10 minutes after the MAS is removed upon waking up
  
• Chew down onto the MA until the back teeth are hitting together
  
• Easy to do in the shower as it helps relax the muscles
  
• Rinse off after use and allow to dry

Follow-up appointments

• Check for posterior contacts with articulating paper
  
• If not contact, ask patient if they have been using the MA every day and for how long
  
• Insert the MA and use articulating paper to confirm contacts
  
• If no contact, then remake MA
• If no contact without the MA, then give bit tabs for 3 weeks and have them return for new MA
• Note all these findings in the chart