We need upper and lower models. If the models cannot be hand-articulated, we recommend that the dentist sends a bite registration in centric occlusion.

EMA custom advancement options are virtually infinite and have unlimited lateral movement.

We recommend that the dentist check how far the patient is able to move their mandible protrusively. A protrusive bite is mandatory in cases wherein:

  • The patient’s capability to move their mandible into the protrusive position is limited
  • The patient’s mandible shifts to one side or the other
  • The patient has an existing appliance set to a specific protrusive position wherein our lab must duplicate the anteriorization

Strap length is based on the same principle as Silent Nite®: the shorter the strap, the more the mandible is advanced. The color of the strap determines how elastic the strap is. Hooks are set at 25 mm apart, from upper to lower on both sides.

Standard setup for EMA is +4 mm. EMA will be shipped with the following setup:

  • 10 total sets of straps, two per set
  • Yellow *medium* Strap #1 attached to the appliance.

Included will be the following sets:

  • White *soft* #1
  • Yellow *medium* #1 (one on the appliance, one extra)
  • Blue *firm* #1
  • Yellow *medium* #2
  • Blue *firm* #2
  • Yellow *medium* #3
  • Blue *firm* #3
  • Blue *firm* #4
  • Blue *firm* #5

Four firmness options, each available in five lengths each:

  • Strap Firmness Options: White soft, Yellow Medium, Blue Firm, Clear Extra Firm
  • Strap Length Options: #1-21 mm, #2-19 mm, #3-17 mm, #4-15.5 mm, #5-14 mm

Recommended Delivery Instructions:

  • Try the upper and lower appliance on separately to check fit and comfort and to make sure there is no gingival impingement.
  • EMA feels snug for the first 3-5 minutes. If pressure on one tooth stands out after 5 minutes, carefully relieve it with a large burr.
  • Check the posterior bite planes for an even occlusion. If either side is high, grind conservatively until both sides occlude evenly.
  • Seat the upper appliance and have the patient move the mandible forward and bite down into the lower appliance until it snaps in place.
  • Question the patient on comfort of both the appliance to the teeth as well as to the TMJ.
  • Instruct your patient to call the office the day after wearing the appliance for the first time. Commonly reported initial side effects resulting from the mandibular repositioning include clenching resulting in sore teeth, TMJ sensitivity and increased saliva flow. These symptoms should abate significantly or disappear completely within ten days. If pain is severe or persists, please advise appliance may need additional adjustment and should be returned by Dr with new impressions to evaluate.

Recommended Cleaning Instructions:

  • Brush and floss your teeth before placing the appliance in your mouth.
  • DO NOT soak the appliance in mouthwash, denture cleaner or alcohol. DO NOT place in hot or boiling water or expose to excessive heat (such as direct sunlight), as this will distort the appliance.
  • Rinse well with water before and after use and store dry.
  • Clean appliance with soap and warm water ONLY.
  • If it becomes loose, tight or causes you any discomfort, contact your dentist immediately.

Questions regarding insurance/technical information on snoring and apnea:

American Academy of Dental Sleep Medicine -
Patients calling regarding anti-snoring devices or referrals to dentists that specialize in oral appliances for snoring and apnea can be directed to the website above.

Note: For medical insurance carriers to cover this oral appliance therapy, an overnight sleep study and a referral from a physician are usually required.

The dentist/physician has to diagnose the patient with sleep apnea, then submit a brief narrative of the diagnosis to the insurance company. In the narrative, the type of removable appliance they are prescribing for treatment should be explained.

Indications / Contraindications

The EMA custom appliance can be used for any patient with either a full or a partial set of natural teeth. The remaining teeth should have sufficient height of contour for the device to gain retention at the gingival third. Edentulous ridge must be fully captured in the impression.

The EMA custom appliance cannot be used with fully edentulous patients. It can be fitted to a partial denture only if it has adequate retention and the patient sleeps with it in place (this is not recommended by the American Dental Association). The EMA custom appliance cannot be used in cases of myofacial dysfunction, arthropathy of the temporomandibular joint and advanced periodontal problems. Obesity, alcohol or other sedatives may affect the performance of the device. It cannot be used for patients wearing braces and should not be used as a bleaching tray.


No preparation necessary.


No cementation necessary.


5 Days In-Lab

Rush Cases : All rush cases must be prescheduled by calling 800-944-7874 before the case is shipped. Time of pickup and delivery may affect turnaround time.