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What can one do if a mandibular advancement device (MAD) is too large or voluminous for one’s mouth?

In the case of select MADs (SomnoFit, SomnoGuard series) it is possible to remove the material with the aid of a knife (especially to reduce the MAD’s height). When doing so, pay attention to the following specifications:

– As long as the MAD is only being selectively adapted (i.e., only the bothersome parts that cause irritation/discomfort are being removed), the overall stability of the MAD should not be affected. This, however, does depend on the size of the part that you wish to trim or remove altogether. As a rough guideline: This is not an issue if the selected part is not wider than a tooth. Furthermore, trimming the front by the incisors should be less difficult than further back by the molars (= they are central to firmness of the fit and fixation of the MAD).

– In order to avoid sharp edges: Make a clean cut (e.g., with a carpet knife), followed by rounding it off with a nail file. Another alternative (which should be done cautiously) is to: Reheat the MAD and – dab and remould the sharp part with a fingertip (manual moulding). This, however, carries the risk of the MAD deforming again.