Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 4

Details

Plan, design and manufacture custom mandibular advancement devices for the treatment of sleep apnea. Assess the device in the outpatient clinic and adjust with the patient and evaluate against treatment goals

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the key features of an effective mandibular advancement device?
• How will you evaluate the device’s effectiveness in the outpatient clinic?
• What will you learn about the assessment process for sleep apnea devices and patient comfort?
• What design features are critical for effective mandibular advancement and patient compliance?
• What materials and properties are required for use in the manufacture of mandibular advancement devices .
• How will you learn to adjust the device based on patient feedback and treatment goals?
• How will the patient’s skeletal relationship influence your device design (class I, II & II)?

In action

• During the planning, design, and manufacture of the mandibular advancement device, are you paying close attention to the specific requirements for treating sleep apnea? What immediate design or manufacturing choices are you making to ensure patient comfort and efficacy? When assessing and adjusting the device with the patient, are you mindful of their feedback and making immediate modifications?
• Is the design and manufacturing process leading to a device that you anticipate will be effective for treating sleep apnea? Are you facing any challenges in achieving the desired level of mandibular advancement or patient comfort during the manufacturing or adjustment stages? What immediate learning is occurring as you interact with the patient and fine-tune the device? How does this activity connect to your understanding of sleep apnea treatment and appliance therapy?
• If the initial device design or adjustments are not well-tolerated by the patient or do not achieve the desired outcome, what alternative design features or adjustment strategies are you considering in real-time? Do you need to seek guidance on different approaches to mandibular advancement devices? Are you ensuring that your assessment and adjustment of the device are within your clinical responsibilities?

On action

• Describe the planning and design considerations for the custom mandibular advancement device. Describe the manufacturing process of the device. What was involved in assessing the device fit and function in the outpatient clinic with the patient? What adjustments were required, and how did the patient respond? How did the device performance compare to the treatment goals for sleep apnea?
• What specific skills or knowledge did you develop or improve in planning, designing, manufacturing, and assessing mandibular advancement devices? What did you learn about the treatment of sleep apnea using such devices? Were there any unexpected challenges or successes during the process, particularly during patient assessment and adjustment? What did you learn from these? How effective was the evaluation of the device against the treatment goals, considering patient feedback?
• What areas for continued development have you identified in the creation and assessment of mandibular advancement devices? How can you apply the knowledge and skills gained to future sleep apnea cases? What resources or support might you need to further develop in this area?

Beyond action

• Have you revisited experiences of creating and adjusting mandibular advancement devices? How has your understanding of the patient interaction and iterative design process evolved?
• How have these experiences impacted upon your current practice in managing sleep apnea or other appliance-based treatments? Have you become more adept at patient assessment and device fitting?
• How might these experiences contribute towards your future practice in more complex sleep apnea cases or the design of other adjustable medical devices? What did you learn about biomechanics and patient comfort?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Prepare surgical treatment plans for complex head and neck surgery.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.