Laboratory fabrication of The Moses® and the Moses® Elite appliances involves a preliminary step to block out all undercuts (both hard and soft tissue) before the appliance is processed. Generally, both appliances can be inserted immediately but occasionally slight adjustments are needed. A colored disclosing indicator such as Occlude® by Pascal Co., Inc. is sprayed on the interior surfaces where the appliance would contact teeth and tissue. Where there is an interference the colored indicator spray is removed. Interferences are removed with a small egg-shaped acrylic bur on a slow speed handpiece. It is very important that patients be able to easily and smoothly insert and remove the appliance by themselves. Patients should be carefully queried to make sure the appliance is not irritating their soft tissue before they leave and are instructed to come in immediately for adjustment if they develop a sore spot, jaw pain or sore teeth.
The Moses® and the Moses® Elite appliances have an advancement screws on each side of the appliance for mandibular advancement. Each turn of these screws from bar to bar advances the mandible approximately 1/8 mm. Six millimeters of anterior movement is possible. Dr. Moses advances very conservatively; four to six turns of the key at two to three week intervals until the patient reaches maximum medical improvement. In the rare occurrence that the patient experiences facial pain or jaw pain, it is recommended to advance just a few turns of the key on the side of the pain to stretch and calm the muscles.
The Moses® Elite
The body of The Moses® Elite appliance is fabricated with Visiclear® which is more flexible and stronger than methyl methacrylate. It is possible to change the vertical dimension of The Moses® Elite in the office. Methyl methacrylate can be added to the existing methyl methacrylate that houses the maxillary bicuspids and molars covered by the maxillary retainer. Methyl methacrylate does not bond to Visiclear®.