How is a MAD fitted?

The clinical workflow begins with bite registration at a defined protrusion point. Most labs require either PVS impressions or STL files from an intraoral scan, plus a protrusive bite record. That record encodes how far forward the mandible will be held. A difference of even 1-2 mm in registration affects both comfort and efficacy, so accuracy at this stage determines how much chairside adjustment the delivering dentist will need.

Fabrication varies by appliance design. Dual-arch devices like the Herbst or EMA style are constructed with separate upper and lower trays linked by connectors that allow lateral movement while maintaining the registered advance. Monobloc designs lock the bite more rigidly. Dani Dental fabricates MADs from the digital file or physical impression within the agreed turnaround window, with titration hardware built in so the patient can self-adjust in 0.25 mm increments post-delivery.

For general dentists managing sleep patients, the fitting appointment is typically 20-30 minutes: seating the appliance, confirming occlusal contact, and walking the patient through titration. Labs that include clear titration instructions with each case reduce the callback rate. Because compliance drops sharply when a device is uncomfortable in the first two weeks, fit precision from the lab is not a finishing detail. It is the primary clinical outcome driver.