MOSES BITE SHIMS
An Alternative Technique to X-Slant for Moses Appliances
especially for use in cases with edentulous posterior areas
Capturing the correct maxillo-mandibular relationship is the essential first step to attaining high efficacy use of The Moses® appliance. Clear shims are 1.5 mm and blue shims are 2.0 mm. The vertical dimension can be increased in increments of 0.5 mm.
Here are the basic steps:
Have the patient apply some lip balm to get a good lip seal
Determine Maximum Vertical: Start with two shims and stack the shims to the maximum vertical, whereby the patient can comfortably seal their lips.
Determine Protrusion: Separate the shims in half. If you have three shims separate two and one then flip them over so that you have the smooth sides of the shims contacting each other (male side up and male side down). Have the patient can slide the mandible forward for you to record the protrusive and lateral position.
Determine the Midline: As the patient slides forward, many times the midline shifts. This is normal. Most people have asymmetrical TMJs. Do not force the midline to an unnatural position where the centerline of 8/9 meet 24/25.
Once a comfortable position is determined, encase the shims with bite registration material and send to the lab with the arch impressions.