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Oral Appliance Therapy (OAT) Cases

Each applicant must submit a total of fifteen (15) documented oral appliance cases, distributed as follows: five (5) detailed cases and ten (10) spreadsheet cases. Diagnostic sleep studies for all of the fifteen (15) cases must have been conducted no more than five (5) years prior to when the oral appliance was delivered. Applicants must be the direct and primary patient care provider for oral appliance therapy from start to finish for each case submitted.

Pre- and post-treatment sleep studies for all fifteen (15) cases must be conducted by either a full overnight in-lab PSG or home sleep apnea test (HSAT) that is administered by a sleep center or physician and interpreted by a board-certified sleep physician. Post-treatment HSATs may be administered by the dentist if it is within their scope of practice as determined by their state dental licensing board and documentation is provided from the local treating physician that verifies that for each case the physician requested that the dentist administer an HSAT for follow-up purposes. Documented verification from the local treating physician must be signed and dated. Sleep study reports must demonstrate that a board-certified sleep physician interpreted the results of the study.

Applicants may use either the AHI or the RDI for sleep studies conducted by a full overnight in-lab PSG. Applicants may use either the AHI, RDI or REI for sleep studies conducted by a HSAT. The same measure (AHI, RDI or REI) must be used for both the pre and post treatment sleep studies for each case. The AHI, RDI or REI for all fifteen (15) cases need to meet the criteria over the total night (REM and non-REM combined). Split night studies may be acceptable for either the diagnostic study or the follow-up studies, as long as they meet the criteria as outlined in these guidelines. Pre and post-treatment sleep study reports should consist of the summary page and data pages that include the date of the sleep study and patient’s date of birth, both circled. However, if the summary page includes all of this information, the data pages do not need to be submitted. The AHI, RDI or REI, and lowest oxygen saturation levels or O2 saturation time spent at or below 90%, must be circled on each sleep study report so they can be quickly and easily identified. Additionally, each document must be clearly labeled, with the case number and brief description (for example: case #1 pre-treatment PSG or HSAT, case #1 post-treatment PSG or HSAT, case #1 follow-up visit #1, case #1 follow-up visit #2, etc.).

To demonstrate knowledge of more than one oral appliance, applicants must use at least two (2) distinct oral appliance designs that have different types of advancement mechanisms from one another. Appliances being utilized in each case must be FDA-approved for treatment of OSA and meet the AADSM’s published definition of an effective oral appliance [JDSM 2014].

I. Criteria for five (5) detailed cases

The five (5) detailed cases which are presented in their entirety must be of patients who are first time users of oral appliance therapy and successful responders with a pre-treatment AHI, RDI or REI of ten (10) or greater and a post-treatment AHI, RDI or REI that is reduced in half and less than ten (10) along with subjective relief of symptoms.

The Detailed Cases Summary Template found on the ABDSM website must be used to summarize the data for each case. In addition, the following documentation must be included for each of the five (5) cases:

  • Typed synopsis stating the date of the initial visit, patient’s date of birth, chief complaint, history of present illness, pertinent past medical history, clinical and radiographic examination, diagnosis, treatment, results, and disposition. Reasoning for use of the chosen appliance must be included.

  • Copies of sleep study reports documenting pre-treatment presence of OSA and post-treatment follow-up by either full overnight in-lab PSG or home sleep apnea test (HSAT). Documentation must show that all pre-treatment and follow-up sleep studies were administered by a sleep center or the patient’s local treating physician and interpreted by a board-certified sleep physician. The AHI, RDI or REI must be circled on the summary page on each sleep study report. The post-treatment sleep study must occur no earlier than one (1) month post-insertion. Pulse oximetry is NOT an acceptable form of sleep testing for these cases. Combination therapy cases are NOT acceptable.

  • Documentation that confirms the oral appliance was effective in managing the patient's sleep disordered breathing, by having the patient's local treating physician sign the OSA Management with Oral Appliance Therapy Template.

  • Copies of sleep study reports documenting the lowest pre-treatment and post-treatment oxygen saturation levels or Osaturation time spent at or below 90%, which must be circled.

  • Documentation of at least three (3) face-to-face follow-up appointments, the third appointment being at least three (3) months post oral appliance insertion. Email and telephone correspondence with the patient, as well as patient completed surveys, do not qualify as follow-up appointments. Documentation of follow-up visits must include copies of dated clinical notes in SOAP format.

All patient information, with the exception of the patient's date of birth (which must be circled), is confidential and must be redacted and protected from view prior to the submission of an applicationThis applies only to patient information (i.e. names, addresses, phone numbers, social security numbers, etc.) and does not apply to physician names or sleep center information. The physician names and sleep center information must be clearly visible and legible.

In addition to the above, each applicant must submit the following for each of the five (5) cases. All photographs must be in color and of good quality. They may be submitted in .jpg format on a USB flash drive. Radiographs and photographs must be individually dated and presented in the order below. Photographs which do not meet these requirements or where objects are not clearly identifiable will not be acceptable rendering the application incomplete. Do not send any additional photographs, radiographs or CBT scans other than what is requested in these guidelines. See the examples of the requested x-rays, intraoral and study model photographs and order in which materials must be presented.

  • Pre-treatment, dated radiographs, either panoramic or full mouth series. Radiographs must be taken before and not more than three (3) years prior to when the oral appliance was delivered.

  • Three (3) dated pre-treatment intraoral photographs of the patient’s dentition, using lip and cheek retractors, consisting of the following: 1 anterior view in occlusion, 1 right lateral view in occlusion, 1 left lateral view in occlusion.

  • One (1) dated anterior photograph of the patient’s dentition with the appliance in place. 
  • Seven (7) dated photographs of study models. The study models must be intact and trimmed. Photographs of damaged models or submission of stone models will not be accepted and will render the application incomplete. Study model photographs must consist of the following: 

    One (1) photograph of the full occlusal view of the casts sitting back-to-back on the bench top

    Three (3) pre-treatment photographs of hand articulated models in centric occlusion on the bench top consisting of the following: 1 anterior view of hand articulated casts, 1 right view of hand articulated casts, 1 left view of hand articulated casts

    Three (3) pre-treatment photographs of casts with the initial protrusion bite registration in place consisting of the following: 1 anterior view with the bite registration, 1 right view with the bite registration, 1 left view with the bite registration

II. Criteria for ten (10) spreadsheet cases

The Spreadsheet Cases Summary Template must be used. The following information must be reported on the template for each of the ten (10) cases:

  • Patient age at time of initial oral appliance insertion
  • Patient date of birth
  • Patient gender
  • Pre-treatment AHI or RDI or REI
  • Post-treatment AHI or RDI or REI
  • Pre-treatment lowest oxygen saturation level or pre-treatment Osaturation time spent at or below 90%
  • Post-treatment lowest oxygen saturation level or post-treatment Osaturation time spent at or below 90%
  • Oral appliance utilized
  • Follow-up sleep study type (full overnight in-lab PSG or HSAT)

Of the ten (10) spreadsheet cases, all must be first time users of oral appliance therapy, five (5) cases must involve patients with moderate to severe OSA who have a pre-treatment AHI or RDI of fifteen (15) or greater, and the other five (5) cases must involve patients with a pre-treatment AHI or RDI of ten (10) or greater. A minimum of seven (7) of the ten (10) patients must be successful responders with a post-treatment AHI or RDI that is reduced in half along with subjective relief of symptoms. A maximum of three (3) cases may involve patients who were non-responders as long as a written explanation is provided to describe possible reasons why the treatment was unsuccessful.

The following documentation must be included for each of the ten (10) spreadsheet cases:

  • Copies of sleep study reports documenting pre-treatment presence of OSA and post-treatment follow-up by either full overnight in-lab PSG or home sleep apnea test (HSAT). Documentation must show that all pre-treatment and follow-up studies were administered by a sleep center and interpreted by a board-certified sleep physician. The AHI, RDI or REI must be circled on the summary page on each sleep study report. The post-treatment sleep study must occur no earlier than one (1) month post-insertion. Pulse oximetry is NOT an acceptable form of sleep testing for these cases.

  • Copies of sleep study reports documenting and circling the lowest pre-treatment and post-treatment oxygen saturation levels or Osaturation time spent at or below 90%.

  • Documentation that confirms the oral appliance was effective in managing the patient's sleep disordered breathing, by having the patient's local treating physician sign the OSA Management with Oral Appliance Therapy Template. This documentation is required for successful responders only.

All patient information is confidential and must be redacted and protected from view prior to the submission of an application. This applies only to patient information (i.e. names, addresses, phone numbers, social security numbers, etc.) and does not apply to physician names or sleep center information. The physician names and sleep center information must be clearly visible and legible.

III. Surgery Cases (Optional)

A maximum of three (3) upper airway surgical cases may be substituted for no more than three (3) of the five (5) OAT cases. Surgery cases are not accepted for the spreadsheet cases. Surgical procedures utilized must be well documented in the OSA literature (peer reviewed journals and/or textbooks). All of the above OAT case specifications are required, including pre- and post-operative supporting documentation, with the following modifications:
  • A typed Operative Report, which must include the date and site of the procedure, the applicant listed as the primary surgeon, the specific procedures performed, indications for the operation (i.e. OSA data and other failed therapies, as applicable), and a detailed description of the operation.

  • A concise rationale for the surgical procedure(s) (i.e. how the patient’s site(s) of upper airway obstruction is addressed) included in either the case synopsis and/or the Operative Report.

  • The results of at least one (1) appropriate published imaging modality such as lateral cephalometry (obtained at end-tidal volume, with cephalometric analysis to include measurements of SNA, SNB, PNS-P, PAS, MP-H and Go-Pog), nasopharyngolaryngoscopy, MRI, CT scans and acoustic reflection, to document upper airway changes pre- and post-operatively.

  • Panoramic radiographs, study models, and full dentition photographs (only for skeletal advancement surgery).

  • Full face photographs (only if there is a significant change in facial appearance).

The supporting documents described above should be duplicate copies and will remain in the ABDSM archives for a limited period of time. All supporting documents become property of ABDSM. The ABDSM will dispose of these supporting documents at a later date, to be determined by the ABDSM. Applicants are instructed to keep all original documents in their patients’ records.