Edition V19N04 | Year 2020 | Editorial Distúrbio Respiratórios e a Ortodontia | Pages 70 to 78
Treatment with intraoral appliances (IOAs) is not restricted to the delivery of the device. Adequate treatment involves an active phase during which an increasingly anterior position of the mandible is established. This process is called titration and can range from weeks to months, depending on the severity of the case, possible pain as a side effect of the treatment, and patient compliance. Two points must be considered during the initial titration phase of the device: One is how the patient will start using the device, also called the initial adaptation; another is the magnitude of mandibular advancement that must be applied to the device in its manufacture, called the initial advancement. The author’s experience shows that patients find it easier to undergo the initial adaptation if they are instructed to introduce the use of IOA gradually, increasing step by step the movement range of the temporomandibular joints. The initial advancement is determined on the day the protrusion bite is recorded and must not exceed 40 to 50% of the maximum advancement. From the moment that the patient starts using the device throughout the night, incremental advances must be instituted until reaching the candidate position for the ideal position. Adequate titration of the IOA for the treatment of OSAS is essential to obtain the best balance between patient compliance and magnitude of mandibular advancement, which in turn has a direct correlation in the effectiveness of therapy.