ADJUSTABLE DENTAL HINGE SYSTEM AND METHOD FOR MANDIBLE POSITIONING

A dental device adapted to provide forward relative positioning of a mandible of a patient including: a mandibular tray formed to the patient's mandibular dentition including a mandibular attachment wire encased within an outer circumference of the mandibular tray; a maxillary tray formed to the patient's maxillary dentition, the maxillary tray including a maxillary attachment wire encased within an outer circumference of the maxillary tray; and a pair of hinge devices coupled to the mandibular tray via the mandibular attachment wire and coupled to the maxillary tray via the maxillary attachment wire, each hinge device including a housing having an inner channel and a telescoping member movable within the inner channel to change a length of the hinge device to enable forward mandibular advancement, the telescoping member including precise circumferential grooves.

BACKGROUND

Sleep apnea continues to be a common risk factor for high blood pressure, heart attack, and stroke. Continuous positive airway pressure (CPAP) or an automatic positive airway pressure (APAP) device forces a patient's airway open during sleep by a flow of pressurized air into the throat. A patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine that generates the required air pressure to keep the patient's airways open during sleep. In addition, an APAP machine will automatically titrate the air pressure as needed to minimize apneas and hypopneas. Advanced models may warm or humidify the air and monitor the patient's breathing. Although CPAP and APAP therapy is effective in reducing apneas, many patients find the therapy extremely uncomfortable and fail to continue using their CPAP machines on a nightly basis, especially in the long term. Further, it is not clear that CPAP therapy reduces hypertension or cardiovascular events in patients who do not have daytime sleepiness; however, the lack of benefit may be partly due to noncompliance with therapy.

Alternatively, custom-fitted sleep disorder devices are available and designed to help patients sleep soundly and continuously, while reducing the effects of sleep apnea. Patients with sleep apnea and snoring issues are individuals with unique issues making a one treatment fits all type device impossible. Thus, additional options are needed for reducing obstruction in airway paths of patients to treat sleep apnea and snoring so that patients can choose an option that is most comfortable for them and therefore allows them to follow through with treatment on a more consistent basis, thereby improving treatment results.

SUMMARY

One or more embodiments are directed to a dental device adapted to provide forward relative positioning of a mandible of a patient including: a mandibular tray formed to the patient's mandibular dentition including a mandibular attachment wire encased within an outer circumference of the mandibular tray; a maxillary tray formed to the patient's maxillary dentition, the maxillary tray including a maxillary attachment wire encased within an outer circumference of the maxillary tray; and a pair of hinge devices coupled to the mandibular tray via the mandibular attachment wire and coupled to the maxillary tray via the maxillary attachment wire, each hinge device including a housing having an inner channel and a telescoping member movable within the inner channel to change a length of the hinge device to enable forward mandibular advancement, the telescoping member including precise circumferential grooves on a rod portion. In one or more embodiments, each of the mandibular tray and the maxillary tray include a pair of metal posts at a forward location relative to the hinge device to enable a pair of elastic bands to releasably couple the mandibular tray to the maxillary tray. Each hinge device further includes a first attachment structure extending from the housing for pivotably connecting the housing to the mandibular attachment wire and a second attachment structure extending from the telescoping member for pivotably connecting the telescoping member to the maxillary attachment wire.

In one or more embodiments the pair of elastic bands form a triangle on each side of a patient's mouth by coupling to each of the pair of metal posts and to the first attachment structure.

In an embodiment, an adjustable screw stop is positionable within the inner channel, wherein the inner channel is threaded, to block the telescoping member at a minimum length of the device. In an embodiment, at least a portion of a length of the inner channel is threaded and the stop is a nylon-coated set screw with threads mateable with the threads of the inner channel so that the stop is advanceable along the threads of the inner channel to select the minimum length. In an embodiment, the telescoping member is cylindrical in cross-section and the housing is cylindrical in cross-section.

In an embodiment, a proximal end of the telescoping member extends from the housing and a distal end of the telescoping member is moveable within the inner channel and a cross-section of the distal end of the telescoping member is larger than a cross-section of the proximal end of the telescoping member. The inner channel narrows at a proximal end for a last 1.5 mm of the inner channel so as to block movement of the telescoping member when the distal end of the telescoping member, which has a 1.25 mm larger at a last portion, contacts the narrowed proximal end of the inner channel.

In an embodiment, the first attachment structure of each hinge device housing is a fin that extends downward toward the mandibular attachment wire relative to the housing when each hinge device is fixed in a mouth of a patient and the second attachment structure is a fin that extends upward toward the maxillary attachment wire relative to the telescoping member when the device is fixed in a mouth of a patient.

In one or more embodiments, the first attachment structure is produced independent of nickel by forming the housing with the via a metal injection mold process.

In one or more embodiments, the telescoping member and the housing are fabricated from one or more of a surgical grade metal and a thermoplastic resin.

In one or more embodiments, the maxillary tray includes a pair of nasal dilators, each nasal dilator including a button adjustably connected to the maxillary tray by one or more wires.

In one or more embodiments, the mandibular tray includes a pair of tongue lifters, each tongue lifter adjustably connected to the mandibular tray. Each tongue lifter coupled to the mandibular tray via a wire.

In one or more embodiments, the tongue lifters and the nasal dilators include thermoplastic material.

DETAILED DESCRIPTION

Referring toFIG. 1, one or more embodiments are directed to a dental device100adapted for sleep apnea including a maxillary tray102, nasal dilators104, maxillary attachment wire106, first attachment area108, hinge110, mandibular tray112, mandibular attachment wire114, rod118, and tongue lifters130. Dental device100provides forward relative positioning of a mandible of a patient via mandibular tray112formed to the patient's mandibular dentition including a mandibular attachment wire114encased within an outer circumference of the mandibular tray and a maxillary tray102formed to the patient's maxillary dentition, the maxillary tray including a maxillary attachment wire106encased within an outer circumference of the maxillary tray.FIG. 1is an embodiment using a hinge device in combination with other devices to treat severe sleep apnea, including congestion and airway blockage. Side hinges110provide 10 mm of possible advancement of a mandible and includes screws to enable 1-2 mm of retraction. Advantageously, the hinges hold a lower jaw forward during sleep while allowing a patient to open and close the mouth with some side to side movement. Thus, an aid to sleep apnea by opening an airway in the back of the throat and pulling a tongue forward. Unlike prior art hinge designs, which suffered from wobble and telescoping member118, one or more embodiments the front attachment fin, attaching to the mandibular tray the center point of the first attachment fin108is no more than 2.5 mm from the bottom of hinge110. Additionally, each of first attachment structure108and second attachment structure140attachment screws to enable elastic bands to optionally couple not only posts202and204, but to the first attachment fin as well (shown inFIG. 3).

As shown inFIG. 1, hinge device110is included as a pair of hinge devices, shown in detail inFIGS. 4-10, coupled to the mandibular tray112via the mandibular attachment wire114and coupled to the maxillary tray112via the maxillary attachment wire106, each hinge device110include a housing116having an inner channel and a telescoping member118movable within the inner channel to change a length of the hinge device110to enable forward mandibular advancement.

In one or more embodiments, the telescoping member118includes precise measurement indentations as shown inFIGS. 5-10, at, for example, millimeter distances apart. In one or more embodiments, the measurement indices include all or part of the entire circumference of the telescoping member rod. The measurement indices can be at each millimeter or other appropriate distance around the rod so that a patient can easily determine the amount of mandibular advancement caused by the telescoping action.FIGS. 5 and 6illustrate the indices510for measurement at millimeter distances, shown in dotted lines for reference purposes. Referring toFIGS. 7 and 8, a representation of the hinge device110illustrates circumferential grooves to enable a patient to identify the number of millimeters of advancement of the mandible.FIG. 7illustrates a fully inserted telescoping member118.FIG. 8illustrates a fully advanced mandible position for hinge device110showing telescoping member118fully extended. The combination of the circumferential grooves about at least part of a cross section of the telescoping member118that are equidistant and a curved entry to the housing of hinge110benefit a patient by allowing free movement of the telescoping member118within the housing without catching on an edge of the housing upon entry.

Referring toFIG. 2, in one or more embodiments, each of the mandibular tray and the maxillary tray include a pair of metal posts202,204at a forward location on each side of the patient, relative to the hinge device110to enable a pair of elastic bands206to releasably couple the mandibular tray112to the maxillary tray102.FIGS. 1 and 2illustrate use of the two posts on a left side of a patient. Each elastic band can also form a triangular shape302as shown inFIG. 3by including the first attachment structure with a screw304or stay within the structure functioning to hold the elastic band206to further prevent wobble or other unwanted movement of the hinge device110.

In other embodiments, as shown inFIG. 2, each hinge device110can include attachment screws208,210within one or more of the fin-like attachment structures to enable secure coupling to each of the maxillary102and mandibular112trays.

In one or more embodiments, each hinge device110can include a first attachment structure such as fin-like attachment structures208and210that pivotably connects the hinge110to the mandibular attachment wire114, and a second attachment structure210extending from the telescoping member118for pivotably connecting the telescoping member118to the maxillary attachment wire106.

Referring toFIG. 3, in one embodiment, dental device100is shown on a model300to illustrate that, in one embodiment, an appliance310can have elastic302form a triangle around the first attachment area304to reduce wobble of hinge110. Also shown is telescoping member area308and second attachment area306.

Referring toFIG. 4, each hinge device110can further include a stop screw410as an elastic stop band or metallic stop screw adjustably positionable to selectively limit movement of the telescoping member within an inner channel of the housing.

In one or more embodiments, the stop410is positionable within the inner channel to block the telescoping member118at a minimum length of the device. In an embodiment, at least a portion of a length of the inner channel is threaded and the stop is a nylon-coated set screw with threads mateable with the threads of the inner channel so that the stop is advanceable along the threads of the inner channel to select the minimum length. In an embodiment, the telescoping member118is cylindrical in cross-section and the hinge110is cylindrical in cross-section.

In an embodiment, a proximal end of the telescoping member118extends from the hinge110and a distal end of the telescoping member118is moveable within the inner channel and a cross-section of the distal end of the telescoping member118is larger than a cross-section of the proximal end of the telescoping member118. The inner channel narrows at a proximal end of the inner channel (mandibular attachment end) so as to block movement of the telescoping member118when the distal end of the telescoping member118contacts the narrowed proximal end of the inner channel.

In an embodiment, referring toFIGS. 1-3, the first attachment structure of each hinge110is a fin-like structure holding an attachment screw-like member208304, as shown inFIGS. 2 and 3. In one or more embodiments, the first attachment structure208,304coupled to the hinge110includes a circular attachment member, such as a screw within the opening of the hinge110first attachment opening208,304, connected to the mandibular attachment wire114when each hinge110is fixed in a mouth of a patient.

In one or more embodiments, a second attachment structure210,306is a fin that extends upward toward the maxillary attachment wire106,310relative to the telescoping member118when the device is fixed in a mouth of a patient. In one or more embodiments, as shown inFIGS. 1-10, the first attachment structure208,304is closer to the hinge110than the second attachment structure210,306to prevent wobble and maintain stability within a patient's mouth. Importantly, in one or more embodiments, from the bottom of the hinge device to the center point of the first attachment structure208,304is no more than 2.5 mm in distance from the edge of hinge110.

To further reduce wobble, as shown inFIG. 2andFIG. 3, elastic bands206,302can be configured to connect the maxillary tray102to the mandibular tray112in a triangular pattern formed by the maxillary tray post204, the mandibular tray post202, and around the first attachment structure screw304. The first attachment structure screw304can include an elastic member integrated with the attachment screw, or be part of a metal injection molding process or the like. As one of skill in the art will appreciate, the placement of the elastic bands302can also be positioned as part of the hinge110as appropriate to increase stability of the hinge110. In one or more embodiments, as shown inFIG. 3, the pair of elastic bands302form a triangle on each side of a patient's mouth by coupling to each of the pair of metal posts and to the first attachment structure304. As shown inFIG. 3, an elastic band302is shown coupling to a pair of posts and to a stay inserted into the center of first attachment structure304.

In one or more embodiments, the first attachment structure208,304is produced independent of nickel by forming the housing with the via a metal injection mold process.

In one or more embodiments, the telescoping member118and the housing110are fabricated from one or more of a surgical grade metal and a thermoplastic resin.

In an embodiment, a system adapted to limit relative positioning of a mandible and a maxilla of a patient comprises a pair of devices (hinge110) connectable between the mandible and the maxilla and positioned on opposite sides of the dental arches of the mandible and the maxilla. Each of the devices include a hinge110including an inner channel and a telescoping member118movable within the inner channel to change a length of the device. Each device further comprises a first attachment structure208,304extending from the housing of hinge110for pivotably connecting the hinge110to one of the mandible and the maxilla and a second attachment structure210,306extending from the telescoping member118for pivotably connecting the telescoping member118to the maxilla. Each device further comprises a stop adjustably positionable to selectively limit movement of the telescoping member118within the inner channel.

Referring toFIGS. 4-10a hinge device is shown with an adjustable, telescoping member is attachable to the maxillary and mandibular trays shown inFIGS. 1-3in position relative to each other. The device ofFIGS. 4-10is attachable via attachment structures that can be pivotably connected to dental trays. Such mounting structures can vary, and can be fixedly attached to the dental trays or removably attached to the dental arches. For example, such mounting structures can include fixed orthodontic wires to braces or to removable maxillary and mandibular dental trays, preferably though not necessarily thermoplastic and selectively insertable or removable. In an embodiment, the hinge system can comprise two devices positioned on opposite sides of the maxillary and mandibular dental appliances.

Each of the hinge devices ofFIGS. 4-10are shown independent of the attachment screws shown in the void space of the first and second attachment structures (holes). As one of skill in the art will appreciate, different attachment members can be used to attach the hinge device to the maxillary and mandibular trays.

The device inFIGS. 4-10includes a hinge110having an inner channel.FIG. 4illustrates an embodiment of the hinge device in a closed position.

FIG. 5illustrates an embodiment of the hinge device in an open position.

FIG. 6illustrates an embodiment of the hinge device separate with a

The inner channel is shown inFIGS. 6-10. The hinge110is positioned anterior to a telescoping member118shown inFIGS. 5 and 6with measurements for insertion shown in dashed numbers for reference purposes only. As shown,FIGS. 5 and 6includes a housing116having a substantially cylindrical cross-sectional shape, although as described below, in other embodiments, the housing116can have some other cross-sectional shape. A fin-like first attachment structure extends from the hinge110and allows the hinge device110to be pivotably connectable to the mandibular dental tray114formed to the dentition of a patient. The first attachment structure208,304can be a fin-like extension that can be integrally formed with the hinge110via metal injection molding or separately attached via soldering to the housing.

In one embodiment, the first attachment structure208,304is no more than 2.5 mm to the center point of mandibular fin to the bottom of the hinge110, and no more than 5 mm from the bottom edge of the housing of the hinge device110to the bottom of the front fin. As described above, with reference toFIG. 1-3, first attachment structure208,304includes a substantially circular eyelet for attachment to the mandibular dental tray112via a connector wire114that allows the hinge110to pivot smoothly about a connector via rotation. Pivoting occurs with the relative movement of the mandible and maxilla both with posterior and anterior movements of the mandible relative to the maxilla that occur with shifts in the setting of the teeth, and also with the opening and closing of the mouth during eating, speaking, etc.

Referring toFIG. 6, in one or more embodiments, an inner channel of the housing116includes screw threads for screw410extending from the anterior end of the housing116along at least a portion of the inner channel toward the posterior end of the housing116into the telescoping measured structure. The posterior-most end of the housing116has a narrowed (i.e. necked) section at the beginning of hashes shown with numbers510shown in dashed line for illustration purposes only with an internal cross-section (e.g., an internal diameter, where the housing is a tube) that is narrower than the rest of the inner channel. The narrowed section is forward of a patient's mouth and acts as a blocking structure limiting motion of the telescoping member118within the inner channel, thereby defining a maximum length of the hinge device110.

As shown, inFIG. 6, the telescoping member118is a telescoping member (rod) having a larger (e.g. flared) external diameter anterior end that is arranged in the tube. The telescoping member can move within the inner channel of the housing116in a posterior direction until contacting the narrowed section toward a front of a patient's mouth having a diameter smaller than the anterior end of the telescoping member118. The narrowed section impedes further posterior movement of the telescoping member and prevents the telescoping member from slipping through the posterior end of the housing116and separating from the housing116. In one embodiment, the telescoping member118is initially placed into the housing116from a forward position, extended through the housing116until the larger circumference of the back end of the telescoping member118meets resistance in the housing. The second attachment structure, i.e., maxillary attachment (fin) is then soldered or formed by injection molding with the telescoping member118.

The hinge device telescoping member118with the second attachment structure210,306becomes the posterior-most component in a patient's mouth and includes the telescoping member118that slides telescoping back and forth through the hinge110. In an embodiment, the telescoping member118can be arranged within the housing116by inserting the telescoping member118into the anterior end of the inner channel of the housing116and urging the telescope member118through the posterior end of the inner channel, positioning the telescoping member118so that it extends out of the posterior end of the housing116. A second attachment structure can then be coupled by soldering the telescoping member positioned within the inner channel. The second attachment structure extends from the telescoping member118and allows the hinge device110to be pivotably connectable to the maxillary dental tray as shown inFIGS. 1-3.

Referring toFIG. 7, hinge110is shown in cross section, showing telescoping member118fulling inserted into housing116.FIG. 8illustrates telescoping member118at a fully elongated position within hinge110.FIG. 9illustrates hinge110in cross section with telescoping member fulling inserted in housing116and with stop screw410inserted.FIG. 10also illustrates hinge110with telescoping member118fully elongated outside housing116, with stop screw410fulling inserted. Stop screw410, which can be adjustably positionable to selectively limit movement of the telescoping member within the inner channel. In an embodiment, the stop screw410can comprise an adjustment screw threaded and coated with a liquid nylon, such a Nylok™ into the anterior end of the tube and advanced along the inner screw thread of the tube. In one embodiment, the stop screw410meets but cannot exceed a fully inserted telescoping member (rod). Thus, the rod meets but does incapable of pushing the stop screw from the housing. When the rod (telescoping member) is moved forward in the tube, the anterior-most end of the rod will meet the adjustment screw (FIG. 6), which creates a stop. In one or more embodiments, the adjustment screw is at least 3 mm in length.

In one embodiment, the lower mandibular tray110is prevented from moving in a posterior direction relative to the upper maxillary tray via the adjustment set screw410but allows forward or anterior movement of the mandibular tray because of the telescoping member118ability to slide in a posterior direction in the tube.

FIG. 10illustrates a curved entry1002to the housing116to enable ease of sliding and to prevent the telescoping member118from catching on an edge of the housing116as it enters or retreats from the inner chamber of the hinge110.

As shown inFIGS. 4, 5 and 6, the adjustment set crew410has an internal hex receptor for an Allen wrench to turn the screw. When turned to move posterior in the tube it changes the position of the stop making the hinge adjustable and the telescoping member118ability to move freely in the posterior direction makes it telescopic. In other embodiments, some other type of mating feature can be used for advancing and retreating the adjustment set screw.

The housing, telescoping member, attachment structures and stop screw can each include a metal, or some other suitable material, for example a thermoplastic resin such as polyetheretherketone (PEEK), and the like, or a combination of materials. In one embodiment, as mentioned above, the housing and the first attachment structure can be integrally manufactured or separately manufactured and subsequently attached. For example, in one embodiment, the first attachment structure208,304and the housing116are manufactured using metal injection molding to advantageously limit the amount of nickel in the final hinge device caused by soldering. Further, the housing116and the first attachment structure208,304can include the same or different materials, or combinations of materials. Further, in alternative embodiments, the telescoping member (rod)118and the second attachment structure210,306can be integrally manufactured or separately manufactured and subsequently attached. Further, the telescoping member118and the second attachment structure210,306can include the same or different materials, or combinations of materials. Selection of materials can be based on myriad different concerns, including whether the device is to be attached to fixed orthodontic wires or a removable, soft material.

In one or more embodiments, the telescoping member118can be the anterior-component connected with the maxillary dental arch and the housing116can be the posterior-component coupled with the mandibular dental tray112. In other embodiments, the telescoping member118can be the anterior-component connected with the mandibular dental tray112and the housing116can be the posterior-component connected with the maxillary dental tray102.

In alternative embodiments, some other technique(s) and/or structures can be used for positioning the telescoping member inside of the inner channel. For example, the narrowed end of the inner channel can be separately threaded onto the rest of the inner channel after a main length of a telescoping member is positioned through the narrowed end and a threaded anterior end of the telescoping member can be separately mated with the main length of telescoping member and advanced until the threaded anterior end is fully seated onto the main length of the telescoping member. Separating the telescoping member118into two threaded pieces and separating the inner channel into two pieces can simplify manufacturing and/or allow the attachment structure of the telescoping member to be integrally formed.

Embodiments described include but are not limited to, a dental device adapted to provide forward relative positioning of a mandible of a patient, the dental device including: a mandibular tray formed to the patient's mandibular dentition including a mandibular attachment wire encased within an outer circumference of the mandibular tray; a maxillary tray formed to the patient's maxillary dentition, the maxillary tray including a maxillary attachment wire encased within an outer circumference of the maxillary tray; and a pair of hinge devices coupled to the mandibular tray via the mandibular attachment wire and coupled to the maxillary tray via the maxillary attachment wire, each hinge device including a housing having an inner channel and a telescoping member movable within the inner channel to change a length of the hinge device to enable forward mandibular advancement, the telescoping member including precise circumferential grooves.

One or more embodiments include a dental device wherein each of the mandibular tray and the maxillary tray include a pair of metal posts at a forward location relative to the hinge device to enable a pair of elastic bands to releasably couple the mandibular tray to the maxillary tray.

One or more embodiments include a dental device wherein each hinge device further include a first attachment structure extending from the housing for pivotably connecting the housing to the mandibular attachment wire; and a second attachment structure extending from the telescoping member for pivotably connecting the telescoping member to the maxillary attachment wire.

One or more embodiments include a dental device wherein each hinge device includes an adjustable screw stop positionable within the inner channel, wherein the inner channel is threaded to block the telescoping member at a minimum length.

One or more embodiments include a dental device wherein the adjustable screw stop is at least three millimeters in length.

One or more embodiments include a dental device wherein at least a portion of a length of the inner channel is threaded and the adjustable screw stop is a nylon-coated set screw with threads mateable with the threads of the inner channel to identify a stop advanceable along the threads of the inner channel to select a minimum length.

One or more embodiments include a dental device wherein the housing has a curved edge where the telescoping member enters the housing to enable ease of movement of the telescoping member within the housing.

One or more embodiments include a dental device wherein a proximal end of the telescoping member extends from the housing and a distal end of the telescoping member is moveable within the inner channel; and a cross-section of the distal end of the telescoping member is larger than a cross-section of the proximal end of the telescoping member.

One or more embodiments include a dental device wherein the inner channel narrows at a proximal end for a last 1.5 mm of the inner channel to block movement of the telescoping member when a larger distal end of the telescoping member contacts the narrowed proximal end of the inner channel.

One or more embodiments include a dental device wherein the larger distal end of the telescoping member is 1.25 mm larger in diameter.

One or more embodiments include a dental device wherein the first attachment structure of each hinge device housing is a fin that extends downward toward the mandibular attachment wire relative to the housing when each hinge device is fixed in a mouth of a patient.

One or more embodiments include a dental device wherein the second attachment structure is a fin that extends upward toward the maxillary attachment wire relative to the telescoping member when the device is fixed in a mouth of a patient.

One or more embodiments include a dental device wherein the first attachment structure is produced independent of nickel by forming the housing with the via a metal injection mold process.

One or more embodiments include a dental device wherein the first attachment structure includes a structure in the center to enable an elastic band to couple the mandibular tray to the maxillary tray via a pair of metal posts at a forward location relative to the hinge device to enable a pair of elastic bands to releasably couple the mandibular tray to the maxillary tray via a triangular configuration.

One or more embodiments include a dental device wherein the telescoping member and the housing are fabricated from one or more of a surgical grade metal and a thermoplastic resin.

One or more embodiments include a dental device wherein the maxillary tray includes a pair of nasal dilators, each nasal dilator including a button adjustably connected to the maxillary tray by one or more wires.

One or more embodiments include a dental device wherein the mandibular tray includes a pair of tongue lifters, each tongue lifter adjustably connected to the mandibular tray via a wire.

One or more embodiments include a dental device wherein the pair of tongue lifters are produced with thermoplastic material.

One or more embodiments include a dental device wherein the pair of nasal dilators are produced with thermoplastic material.

One or more embodiments include a dental device wherein the first attachment structure extends no more than 5 millimeters from a proximate edge of the housing.

One or more embodiments include a dental device wherein the first attachment structure extends from the housing a shorter distance relative to the second attachment structure extension from the telescoping member.

One or more embodiments include a system adapted to advance a mandible of a patient, the system including a pair of hinge devices connectable between the mandible and the maxilla and positioned on opposite sides of a patient's mouth, each of the hinge devices including: a housing having an inner channel and a telescoping member movable within the inner channel to change a length of the respective hinge device; a first attachment structure extending from the housing for pivotably connecting the housing to a mandible, the first attachment structure extending no more than 5 millimeters from a proximate edge of the housing; a second attachment structure extending from the telescoping member for pivotably connecting the telescoping member toward a maxilla of a patient; and an adjustable set screw adjustably positionable within the housing to selectively limit movement of the telescoping member within the inner channel.

One or more embodiments include a system wherein the adjustable set screw is at least 3 millimeters in length;

One or more embodiments include a system wherein the housing has a curved edge where the telescoping member enters the housing.

One or more embodiments include a system wherein the telescoping member includes a plurality parallelly oriented circumferential grooves at millimeter spacing.