Cases


Oral Appliance Therapy (OAT) Cases

Criteria for All Cases
Additional Criteria for Detailed Cases
Additional Criteria for Spreadsheet Cases
 

Applicants must prepare their cases in an organized manner. Documents must be legible, oriented appropriately, dated, labeled, and sequenced correctly according to the Application Outline (located at abdsm.org/case_resources). All photographs must be in color, of good quality, and submitted in PDF format. Photographs which do not meet these requirements or where objects are not clearly identifiable will not be acceptable rendering the application incomplete. All radiographs, whether digital or scanned analog, must be submitted in PDF format. All radiographs and photographs must be individually dated with the date of exposure. It is preferred that dates are electronically stamped, rather than hand written or typed. Please note that for applications received on or after January 1, 2020, only electronic date stamps will be accepted, with the exception of analog radiographs which may continue to include a handwritten or typed date. Only the documentation identified in these guidelines should be included with the application. Additional materials, such as additional photographs, radiographs, patient questionnaires, and physician prescriptions, are unnecessary unless specifically requested by the Board of Directors.

Case documentation must be submitted in a digital format on a USB flash drive mailed to the ABDSM via traceable carrier (i.e. FedEx, UPS, etc.) to insure against loss. Do not send case documentation by email or any other remote file transfer method. Mail flash drives to:

ABDSM
1001 Warrenville Road, Suite 175
Lisle, IL 60532

Case Study Criteria
Each applicant must submit a total of ten (10) documented oral appliance cases, distributed as follows: five (5) detailed cases and five (5) spreadsheet cases. The following criteria applies to all ten (10) cases.

Applicants must be the direct and primary patient care provider from start to finish for each case submitted.

All patients must be first time users of oral appliance therapy and at least eighteen (18) years old at the time of oral appliance delivery.

To demonstrate knowledge of more than one oral appliance, applicants must use at least two (2) distinct oral appliance designs that have different types of advancement mechanisms from one another. Appliances being utilized in each case must be FDA-cleared for treatment of OSA and meet the AADSM’s published definition of an effective oral appliance [JDSM 2014]. Combination therapy cases are not acceptable.

Pre- and post-treatment sleep studies must be conducted by either a full overnight in-lab PSG or home sleep apnea test (HSAT) that is administered by a sleep center or physician and interpreted by a board-certified sleep physician. Pulse oximetry is not an acceptable form of sleep testing for these cases. Pre-treatment HSATs administered by a dentist will not be accepted under any circumstances. Pre-treatment sleep studies must have been conducted no more than five (5) years prior to when the oral appliance was delivered unless the local treating physician verifies in writing that a newer study is unnecessary.

The same type of test does not need to be used for the pre- and the post-treatment studies. The post-treatment sleep studies must occur no earlier than one (1) month post-insertion. Post-treatment HSATs may be administered by the dentist if it is within their scope of practice as determined by their state dental licensing board and documentation is provided from the local treating physician that verifies that for each case the physician requested that the dentist administer an HSAT for follow-up purposes. Use the MD Verification for Follow-up HSAT template located at abdsm.org/resources to document this. Sleep study reports must demonstrate that a board-certified sleep physician interpreted the results.

Applicants may use either the AHI or the RDI for sleep studies conducted as a full overnight in-lab PSG. Applicants may use either the AHI, RDI or REI for sleep studies conducted as a HSAT. The same measure (AHI, RDI or REI) must be used for both the pre- and post-treatment sleep studies for each case if available. If not available, the following criteria apply:

If RDI was used for the pre-treatment study, then RDI must be used for the post-treatment study.
If either REI or AHI was used for the pre-treatment study, then either REI, AHI or RDI may be used for the post-treatment study

The AHI, RDI or REI for all ten (10) cases need to meet the criteria over the total night (REM and non-REM combined). Split night studies may be acceptable for either the diagnostic study or the follow-up studies, as long as they meet the criteria as outlined in these guidelines.

Pre- and post-treatment sleep study reports should consist of both the summary page and data pages that include the date of the sleep study and patient’s date of birth, both circled. However, if the summary page includes all of this information, the data pages do not need to be submitted. The AHI, RDI or REI, as well as lowest oxygen saturation levels OR oxygen saturation time spent at or below 90%, must be circled on each sleep study report so they can be quickly and easily identified.

IMPORTANT: All patient information, with the exception of the patient’s date of birth (which must be circled), is confidential and must be redacted and protected from view prior to the submission of an application. This applies only to patient information (i.e. names, addresses, phone numbers, social security numbers, etc.) and does not apply to physician names or sleep center information. The physician names and sleep center information must be clearly visible and legible. If any personal patient information (other than birthdate) is visible, the cases will not be reviewed and the flash drive will be returned to the applicant.

Documentation that confirms the oral appliance was effective in managing the patient’s sleep disordered breathing must be provided for each successful responder of the ten (10) cases by having the patient’s local treating physician sign the OSA Management with Oral Appliance Therapy Template found on the ABDSM website at abdsm.org/case_resources.

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Criteria for Five (5) Detailed Cases
The five (5) detailed cases which are presented in their entirety must be of patients who are successful responders with a pre-treatment AHI, RDI or REI of ten (10) or greater and a post-treatment AHI, RDI or REI that is reduced in half and less than ten (10) along with subjective relief of symptoms.

The Detailed Cases Summary Template found on the ABDSM website at abdsm.org/case_resources must be used to summarize the data for each case. In addition, the following documentation must be included for each of the five (5) cases:
• Typed synopsis stating the date of the initial visit, patient’s date of birth, chief complaint, history of present illness, pertinent past medical history, clinical and radiographic examination, diagnosis, treatment, results, and disposition. Reasoning for use of the chosen appliance must be included.
• Copy of the pre-treatment sleep study
• Copy of the post-treatment sleep study
• OSA Management with Oral Appliance Therapy Template found on the ABDSM website at abdsm.org/case_resources
• Documentation of at least three (3) face-to-face follow-up appointments, the third appointment being at least three (3) months post oral appliance insertion. Email and telephone correspondence with the patient, as well as patient completed surveys, do not qualify as follow-up appointments. Documentation of follow-up visits must include copies of actual dated detailed clinical notes in SOAP format. An example of an acceptable follow-up note is available at abdsm.org/case_resources.

In addition to the above, each applicant must submit the following radiographs and photographs for each of the five (5) cases, all of which must be individually dated and presented in the order below. Examples of the requested x-rays, intraoral and study model photographs, and order in which materials must be presented may be found at abdsm.org/resources. Digital impressions will be accepted, however, candidates must save their original bite registration and obtain physical models from the lab in order to make required images. Digital pictures of the dentition produced by the scanner are not accepted.

• Pre-treatment, dated radiographs, either panoramic or full mouth series. Radiographs must be taken before, and not more than three (3) years prior, to when the oral appliance was delivered.
• Three (3) dated pre-treatment intraoral photographs of the patient’s dentition, using lip and cheek retractors, consisting of the following:
- 1 anterior view in occlusion
- 1 right lateral view in occlusion
- 1 left lateral view in occlusion
• One (1) dated anterior photograph of the patient’s dentition with the appliance in place.
• Seven (7) dated photographs of study models. The study models must be intact, trimmed and made prior to oral appliance fabrication. Photographs of damaged models will not be accepted and will render the application incomplete. Study model photographs must consist of the following:
- One (1) photograph of the full occlusal view of the casts sitting back-to-back on the bench top
- Three (3) pre-treatment photographs of hand articulated models in occlusion on the bench top consisting of the following:
- 1 anterior view of articulated casts
- 1 right view of articulated casts
- 1 left view of articulated casts
- Three (3) pre-treatment photographs of casts with the initial protrusion bite registration in place consisting of the following:
- 1 anterior view with the bite registration
- 1 right view with the bite registration
- 1 left view with the bite registration

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Criteria for Five (5) Spreadsheet Cases

The Spreadsheet Cases Summary Template found on the ABDSM website at abdsm.org/case_resources must be used. The following information must be reported on the template for each of the five (5) cases:
• Patient age at time of initial oral appliance insertion
• Patient date of birth
• Patient gender
• Date of the initial visit, appliance insertion and pre- and post-treatment sleep studies
• Name(s) of the interpreting board-certified sleep physician(s)
• Pre- and post-treatment AHI, RDI or REI
• Pre- and post-treatment lowest oxygen saturation levels OR oxygen saturation time spent at or below 90%
• Oral appliance design utilized
• Follow-up sleep study type (full overnight in-lab PSG or HSAT)

Of the five (5) spreadsheet cases, three (3) cases must involve patients with OSA who have a pre-treatment AHI, RDI or REI of fifteen (15) or greater, and the other two (2) cases must involve patients with a pre-treatment AHI, RDI or REI of ten (10) or greater. A minimum of three (3) of the five (5) patients must be successful responders with a post-treatment AHI, RDI or REI that is reduced in half. A maximum of two (2) cases may involve patients who were non-responders as long as a written explanation is provided to describe possible reasons why the treatment was unsuccessful.

The following documentation must be included for each of the five (5) spreadsheet cases:
• Copy of the pre-treatment sleep study
• Copy of the post-treatment sleep study
• OSA Management with Oral Appliance Therapy Template found on the ABDSM website at abdsm.org/case_resources. This documentation is required for successful responders only.