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Insertion Appointment

Verify clasp locations on the Klearway™ appliance and record the amount of opening of the screw with a ruler. Instruct the patient to insert the appliance by first submerging it in a container of hot tap water, or to hold the appliance under running hot water only as hot as the patient's fingers can tolerate. Instruct the patient to not heat the appliance by any other means as they may irreversibly damage it. Insert the appliance into the mouth and press the upper rim up onto the upper back teeth. Have the patient close the lower teeth forward into the lower portion of the appliance and bite firmly. To remove the appliance, instruct the patient to push up on the edges of the lower rim with both thumbnails. Once the lower rim is off the teeth, instruct the patient to grasp the edges of the upper back portion and pull down (not forward) which will dislodge the appliance from the mouth. Instruct the patient not to remove the appliance by simply opening the mouth since the wirework may be permanently distorted. To clean the appliance, advise the patient to use a stiff toothbrush and any toothpaste and to thoroughly brush inside the tooth portion of the appliance as well as the smooth outside surface and to use the same brush to clean the screw. It is not necessary to keep the appliance soaking in water during the day. Advise the patient to use a denture cleanser tablet, if required, to help remove stains and to keep the appliance fresh. Do not soak the appliance in mouthwash, as it will permanently soften the thermosensitive acrylic.


One-Week Follow Up

Record the amount of opening of the screw with a ruler. Check for jaw muscle discomfort and any sore teeth. If the patient experiences significant jaw discomfort, turn the screw in the reverse direction to decrease the amount of mandibular protrusion until the patient is comfortable. Relieve the acrylic around any sore or uncomfortable teeth. Some patients may experience a sense of the teeth not touching completely in the morning. This usually disappears within an hour or so. In addition, they may experience an excessive amount of saliva for the first month or so. If significant jaw or joint discomfort occurs, advise the patient to stop turning the screw until their next visit. If the discomfort has not subsided in one or two days, have the patient call the office immediately.


One-Month Follow Up

Record the amount of opening of the screw with a ruler. If the patient wears the appliance every night and is comfortable, instruct the patient to activate the appliance two times per week until the next appointment. Each turn or activation will move the lower jaw gradually forward in 0.25mm increments which has a direct effect on the three-dimensional size of the airway. Insert the tip of the key into the hole on the right side of the screw. Turn or push the key towards the left. There is an arrow marked on the metal screw to show the correct direction. Once the key is turned once from one side to the other, remove the key. A new hole will appear on the right side and will be used for the next turn later in the week. If the key is removed before the new hole appears, the patient will be unable to place the key in the new hole the next time. Always remove the key after turning. Turning the key back to the right side will close or retract the screw rather than open or advance it. Verify that the appliance has not been distorted or opened vertically. The anterior shelves should be in contact to prevent any mandibular rotation during sleep. A headgear plier may be used to vertically close the posterior arms of the screw to ensure contact of the sliding shelves. Record the amount of opening of the screw at each appointment and record it in the patient’s chart. All intraoral screws self close so the patients must also be instructed how to measure and record the amount of opening on a regular basis. A take home chart with the amount of advancement suggested by the time of the next appointment is a useful patient aid during titration.


Titration Appointment

If the patient reports a cessation of snoring and/or a resolution of symptoms, further advancement of the mandible may not be required. The screw must be tied off with stainless steel ligature wire or filled in with cold cure acrylic to prevent closure of the screw and retraction of the mandible. The patient should be referred back to their physician and/or sleep specialist for assessment at this time.


Every Six-Month Follow Up Thereafter

If the oral appliance has been shown to be effective and the patient is comfortable, every six-month recall appointments should be scheduled. At each appointment, check the status of the occlusion and verify that the appliance has not been distorted.

For Dentists and Physicians

Clinical Videos


Informed Consent Form

Long Term Consent Form


Technical Notes for the
Klearway™ Appliance

For Patients

Video Demonstration

The Epworth Sleepiness

Patient Instructions for the
Klearway™ Appliance