The document provides an engineer's perspective on the new dreamTAP dental appliance. It summarizes the key upgrades from previous TAP appliances, including increased tongue space by moving the hardware out of the tongue area, a force spreading bar to distribute pressure across molars, and a range of 15mm of mandibular protrusion and 10mm of lateral excursion. The dreamTAP also uses a chromium cobalt alloy for its hardware rather than stainless steel, and has two bar options - a quick release bar or Medicare bar. Overall, the engineer argues that the dreamTAP represents a significant upgrade and improvement over previous TAP appliances, with proven efficacy for treating sleep disordered breathing.

1. An Engineer’s Perspective

2. The new dreamTAP – An Engineer’s perspective
by Patrick Tessier; BSME, MBA
In 2016, Airway Management released the latest version of the famous
TAP appliance. For those of us in the DSM world, this appliance is a
significant upgrade in a 20-year evolution of the TAP brand.
As a Mechanical Engineer, as well as, the founder and former owner of
the largest dental lab in the Northwest, I tend to use an engineering
framework to look at dental appliances.
When I was first shown the dreamTAP prototype, I was instantly
smitten. Airway had fixed all the issues with the previous versions and
more. In fact, it looked like this “dreamTAP” could be one of the most
successful devices in the history of Dental Sleep Medicine. I’d like to
share my analysis of the device and why I am a huge fan of the dreamTAP.
TAP Fundamentals
For over 20 years, the TAP appliances have been proven to function, very well. Over 36 peer reviewed
studies have demonstrated efficacy in treating sleep disordered breathing. The fundamental design
works.
 Single point adjustment
This feature allows the patient, or doctor, to
advance the mandible as needed with by
twisting the screw. Most alternative devices,
require the user to advance two screws equally.
Should one be advanced more than the other,
the mandible is forced to one side, which can
lead to TMD. This actually happened to me and
was very painful.
 Prevents open mouth breathing
It is clear in the literature that allowing the jaw to open makes the condition worst, in almost every case.
This is prevented with the single hinge in the anterior and is considered one of the primary reasons the
TAP appliances perform better than appliances that allow the jaw to swing open.
 Medicare approved
The Centers for Medicare and Medicaid Services’ (CMS) apparently agrees with the TAP design. The TAP
devices are approved for Medicare reimbursement. Most appliances that allow the jaw to open at night

3. are not approved. Since this represents a significant portion of the patients, prescribers can be
confident that the dreamTAP is covered under the broadest range of insurance plans.
New Hardware Features
 Increased Tongue Space
The biggest and most easily recognized improvement is moving the hardware out of the tongue space.
The bars are located facial to the anterior teeth. Instead of the upper tray pulling the lower forward, the
lower pushes against the upper. Compared to the previous TAPs, the hardware has been flipped and
moved it out of the tongue space.
 Force Spreading Bar
The new dreamTAP has another unique
engineering feature. The hook pushes against
a bar in front of the anterior teeth. The shape
of the bar transfers this point load to the
posterior arch of molars. By doing so, the
force can be shared by the largest root forms
in the mouth.
 15mm of Protrusion range
The dreamTAP achieves this by incorporating 3 hooks used in a 5mm advancement screw housing, for a
total of 15mm. This feature allows the dentist to adjust the device to the optimal protrusion, regardless
of the initial bite. The device never has to be returned to the lab to reset the hardware.

4.  10mm of Lateral Excursion
Indicated for lateral bruxers, dreamTAP has the largest side to side excursion in the market. About
10mm in the anterior and nothing to prevent lateral excursions in the posterior. No fins, adjustment
screws or bars. Many practitioners feel that this ability to move the mandible allows for a healthy TMJ.
It’s dental yoga!
 Chromium Cobalt alloy (Cr-Co)
Stainless steel hardware is the industry standard. The dreamTAP is the first device that uses custom Cr-
Co alloy hardware. The same alloy used in dentistry for decades as NP PFMs or partial denture
framework. They are metal injection molded, a costly process with very tight tolerances. No Nickel, No
Beryllium, No steel or ferrous alloy. Completely bio-compatible and very strong. 100% American made.

5.  Quick Release Bar vs Medicare Bar
The dreamTAP has two bars: A thick one (1.3mm dia.) and a thin one (0.8mm dia.). The Quick Release
version uses the 0.8mm bar up front for the hook. This allows the patient to disengage the device, while
in the mouth, by protruding about 1mm. The patient can insert or remove the device, one arch at a
time.
The Medicare build places the thicker bar up front with a small reduction on one side of the appliance.
This allows the patient to engage the hook, prior to placing the entire device in the mouth. The device
will not disengage by accident per the Medicare E0486 rules.
Summary
The dreamTAP has the appropriate name. The simplest and most effective appliance for the broadest
range of patients. An overnight success story, 20 years in the making.