Clinical dentistry by Michael C. DiTolla, DDS, FAGD
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IntroductionThe TAP is based on the same principle as cardiopulmonary resuscitation (CPR): The airway must be opened to allow for air to pass. A constricted or collapsed airway causes snoring or Obstructive Sleep Apnea. The TAP works by holding the lower jaw in a forward position so that it does not fall open during sleep and cause the airway to collapse. This helps to clear the airway, reducing snoring and improving breathing.Figure #1Seat upper and lower TAP elements individually and check for pressure points. Areas needing adjustment can be relieved using a #15 Bard Parker or an acrylic bur. Leave the TAP slightly over-retentive. -
Figure #2The patient should learn to insert and remove the TAP while both elements are connected. To seat the mandibular element, press down firmly on the occlusal portion until it is completely seated in place. -
Figure #3The TAP is set to the patient's centric bite record. Confirm there are no posterior contacts when centering or in excursive movements. Remove any premature contacts using an acrylic bur. -
Figure #4The best way to remove the TAP is by loosening the posterior area first. Confirm that the patient is capable of seating and removing both elements at the same time. -
Figure #5Recline patient and anteriorize the TAP by 3 mm, turning the knob clockwise. Each turn equals 0.5 mm. Limit one full turn per night. Record this and any future turns in the patient's chart. -
Figure #6After removal of the appliance, use the leaf gauge to stretch the muscles to restore occlusion. Make sure the patient is informed to perform this exercise each morning. -
Figure #7Assessment of the occlusion and patient progress should be scheduled. Patients should be instructed to always bring their TAP appliances to appointments. -
Figure #8Good oral hygiene and proper appliance care are essential to maximizing the lifespan of the TAP device. Make sure the patient is fully informed of the TAP care compliance. -
Figure #9After one month of using TAP without adjustments, the knob can be removed. A separate TAP Locator Nut assembly is needed to loosen the front assembly from the hook. -
Figure #10While maintaining the hook position, unscrew the front assembly counterclockwise and screw the Locator Nut onto the hook. Seat the Locator Plate onto the upper element and tighten the screw. -
Figure #11Cut the hook flush with the Locator Plate, using a separate disc and rubber points to smooth. Round the corners of the Locator Plate with an acrylic bur, adding acrylic as needed to smooth the interface. -
Figure #12Your patients should now feel comfortable with and be able to close their lips together with TAP in place. If the device needs further advancement, the hook and front assembly can be replaced.
