Step-by-step clinical protocol for the fabrication and titration of a bibloc mandibular advancement device: a...

Adult obstructive sleep apnea-hypopnea syndrome (OSAHS) is a major public health concern requiring multidisciplinary management, from diagnosis to therapeutic decision-making. While continuous positive airway pressure (CPAP) remains the standard treatment for severe OSAHS, long-term adherence is often suboptimal. Mandibular advancement devices (MADs) are now recommended as first-line therapy for mild to moderate OSAHS without comorbidities, and increasingly considered for patients with more severe forms who are intolerant to CPAP. Custom-made bibloc MADs are among the most commonly prescribed oral appliances, and their effectiveness depends greatly on the accuracy of the clinical steps involved in their fabrication and adjustment. However, many sleep physicians and prescribers are unfamiliar with these steps, which can compromise treatment outcomes and device tolerance.

This article provides an illustrated, step-by-step clinical protocol for the design, fabrication, insertion, and titration of a custom-made, titratable bibloc MAD, illustrated with the Somnodent™ Flex as a representative example. Emphasis is placed on technical accuracy, reproducibility, and collaboration between sleep and dental professionals.

The protocol details each stage of clinical implementation, from impression taking to follow-up adjustments, highlighting key parameters influencing device comfort, tolerance, and therapeutic efficacy.

This guide aims to help both dental practitioners and non-dental prescribers better understand MAD workflows, thereby improving interdisciplinary management, and treatment outcomes for patients with OSAHS.