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Asymmetrical protrusion in DSM appliance design

Based on the predominant finding of intercondylar asymmetry, the mandibular midline will most likely deviate to one side or the other in protrusive transitory movement, rather than follow a straight midline linear plane. Devices that limit transitory movement to a midline

linear plane may not have a sound scientific basis. An alternative device to register the maxillomandibular relationship for intraoral sleep appliances was discussed that does not restrict normal biologic movement.

A prospective clinical study whose design directly tests the actual trajectory of unrestricted transitory protrusive mandibular movement appears to be indicated. A prospective clinical study that tests the clinical efficacy of the bite shims versus one of the devices shown that directs protrusive transitory movement in a midline linear plane also appears to be indicated.

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