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Oral Appliance therapy was first endorsed as effective management of obstructive sleep apnea by the American Academy of Sleep Medicine in 1995. In 2005, the Standards of Practice Committee of the AASM updated the practice parameters for the use of oral appliances as appropriate first line therapy for snoring, mild and moderate obstructive sleep apnea. This includes up to 30-40 breathing interruption events per hour determined by overnight sleep test.

Most patients with narrowed airways will have increases in the volume of the airway and decreased resistance to airflow when the mandible is advanced. This is the fundamental principle of airway management, utilized in cardio-pulmonary resuscitation (CPR), where the tongue is moved from the airway by head and mandibular posture.

The base of the tongue is moved farther from the airway tissues to a position where contact and obstructions are less likely or unable to occur. Increased airway volume causes a slower rate of flow, which increases air pressure (Bernoulli's Principle), and increased tone is imparted to the tongue by the stretching of the masseter muscles.

Finally, as the hyoid bone is raised and advanced by the action of the digastric muscles, greater stability of the airway musculature is achieved and resistance to airflow is further decreased.


The Thornton Adjustable Positioner II (TAP II) alleviates snoring and sleep apnea by the same mechanical and physiological methods as the TAP. It allows the patient to adjust the degree to which the mandible is held forward, simultaneously allowing maximum comfort and effectiveness.

The TAP II is a custom-made two-piece appliance that snaps firmly over the upper and lower teeth. The design of the TAP II hardware differentiates it from the TAP appliance. The Front Assembly (adjustment mechanism) on the upper tray of the TAP is eliminated from the TAP II tray, as is the Lingual Bar on the lower tray. Instead, a Base and Hook assembly with an internal adjustment mechanism replaces the Front Assembly, and a Socket replaces the Lingual Bar. The Socket on the lower allows the patient more tongue space unlike the Lingual Bar, which limits the amount of space for the tongue. The tool used to adjust the Hook on the TAP II is an allen wrench "key" that is removable. The Hook Key is a simple tool designed to effortlessly fit into the adjustment screw of the Base and allow the patient to easily keep count of each adjustment turn.

The TAP II features include:

  • no Front Assembly protruding from the mouth
  • more tongue space
  • less visible in the mouth
  • a ball and socket design that allows for easier coupling in the mouth
  • parts that are made from 316 surgical stainless steel
  • an unbreakable hook

The TAP II is available with two significantly different linings, the TAP II ThermAcryl and the TAP II Triple Laminate (TAP II TL). The outer shells of both appliances are a thermoplastic orthodontic polycarbonate hard material.

Maxillary Element

Mandibular Element

Adjustment of TAP II TL

Common Final Treatment Postition


For patients that have a restriction of airflow at the nostrils, a different type of mandibular advancement may be considered. The OASYS uses pads of acrylic underneath the lips at the corner of the nostrils to stretch the opening and thereby reduce resistance to airflow. That reduction can effectively increase the overall air pressure of the airway. Combined with an adjustable mandibular repositioning system, the OASYS can effectively reduce the collapsibility of the airway, improving symptoms of snoring and obstructive sleep apnea.

To see the full range of oral appliance types and designs, we suggest you visit the website for the Academy of Dental Sleep Medicine (ADSM) - www.dentalsleepmed.org

Sleep Medicine Network promotes membership in the ADSM for its affiliate dentists.

Affiliate Dentist

5225 Tacoma Mall Blvd
Suite E-104
Tacoma WA 98409

253-473-6762 fax


This website reflects the personal opinions of the author and does not endorse any oral appliance, professional provider, medical insurance company or dental laboratory. Making decisions about your health and medical treatment must be made in conjuction with your own medical provider. The contents of this website are not to be construed as exhaustive or complete. Any omissions or oversights is unintentional. This site does not accept advertising.