Four simple steps to provide your patients with an Oravan™:

Step 1 – Medical history and patient assessment

Conduct or update a full medical history, which may include the following questions:

• Do you snore?
• Do you feel tired during the day?
• Has anyone observed you stop breathing during sleep?
• Have you ever had a sleep study?
• Do you have high blood pressure?
• Have you been diagnosed with sleep apnea?

Step 2 – Impressions and bite registration 

• The Oravan requires accurate impressions of the maxillary and mandibular arch. Follow complete instructions for taking impressions and bite registration included in the following document: (Impressions / Bite Registration Form).
• Once the impressions are poured and the stone has set completely, pack each model with bubble wrap protection along with the bite registration, OravanOSA prescription sheet (Oravan Rx Form), and the payment form (Oravan Payment Form) to the below address. Here, it will be checked and sent directly to our FDA registered Lab. You can also email any forms to us at info@oravanosa.com.

OravanOSA
769 Northfield Avenue, Suite 160
West Orange, New Jersey, 07052

Step 3 – Patient delivery of the Oravan™

• Always inspect both top and bottom pieces upon receipt for any potential damage from shipping, and clean the device before fitting on the patient.
• Select the maxillary piece first and fit onto the patients upper arch. If there is any resistance, do not force the appliance into position.
• Instead, check the ball clasps first to determine if there is any obstruction. If needed, adjust the ball clasp by moving it to the buccal. Sometimes, one will need to remove some of the acrylic behind the ball clasp with a small round burr to gain movement of the clasp. If any acrylic is obstructing the fit, mark and adjust as needed.
• Repeat the same process for the lower.
• The appliance should seat firmly and securely, with no rocking or pressure on the tissue or teeth.
• Once the appliance is fitted, let the patient sit with the appliance in the office for at least five minutes to insure patient comfort.
• Have the patient bite together to check that posterior surfaces are in balance. Use articulating paper to insure posterior occlusion.
• Have the patient practice seating the appliance by placing the maxillary component first and mandibular second. When removing the appliance it is easiest to remove the mandibular first and then the maxillary.
• At first visit, have the patient schedule an appointment for titration and fitting check in two weeks during which time the patient will continue in initial position set from lab.

Step 4 – Titration and follow up

• The key objective is to move the mandible with the least amount of protrusive movement allowing for the maximum result.
• When the patient returns, ask if symptoms have abated. If the answer is yes, you should have the patient scheduled for a sleep test. If the patient responded no, titrate the Oravan as follows:
  • The appliance can be titrated by inserting the key into the adjustment mechanism that is located on the posterior maxillary component of the device.
  • Turn the key in the direction of the arrow to move the appliance forward. Each 90 degree turn is 1/10 of a mm and the appliance can be advanced to a total of 6 mm. We suggest giving it 2, 90 degree turns, as long as the patient does not report any TMJ symptoms. Make sure to move both sides equally.
  • Schedule patient for follow up visit in 10 days at which time you may advance the Oravan 2, 90 degree turns. Continue every 10 days until patient reports symptoms have been abated or to a maximum of 6 mm.