A method comprising: receiving, by a server, one or more data sets associated with a patient; determining, by the server one or more positions for placement of button protrusions (1810, 1820,...) based on the received data sets from a scanner, the received data sets including at least a dentition pattern, a palate measurement of a soft palate shape of the patient and a uvula placement measurement with respect to the soft palate shape of the patient, and a gum line of the patient; communicating, by the server the one or more positions for placement of button protrusions and a vertical displacement, the communicating comprising: assigning a value associated with each of the one or more positions for placement of button protrusions (1810, 1820...), each value representative of a distance between an upper tray button protrusion and a lower tray button protrusion for mandibular advancement; transmitting the value data to one or more of a three-D printer, a milling apparatus and an injection molding apparatus; forming a dental appliance via direct manufacture using the value associated with each of the one or more positions for placement of button protrusions (1810, 1820...), the dental appliance including a lower dental tray and an upper dental tray, each of the lower dental tray and the upper dental tray being homogeneous, the lower dental tray inclusive of the vertical displacement and a first pair of the button protrusions (1830, 1849), the upper dental tray inclusive of a second pair of the button protrusions (1810, 1820), the first pair of button protrusions (1830, 1849) and the second pair of button protrusions (1810, 1820) providing the forward mandibular position when two elastic bands (1870, 1880) are attached to connect the upper dental tray and the lower dental tray. receiving, by a server, one or more data sets associated with a patient; determining, by the server one or more positions for placement of button protrusions (1810, 1820,...) based on the received data sets from a scanner, the received data sets including at least a dentition pattern, a palate measurement of a soft palate shape of the patient and a uvula placement measurement with respect to the soft palate shape of the patient, and a gum line of the patient; communicating, by the server the one or more positions for placement of button protrusions and a vertical displacement, the communicating comprising: assigning a value associated with each of the one or more positions for placement of button protrusions (1810, 1820...), each value representative of a distance between an upper tray button protrusion and a lower tray button protrusion for mandibular advancement; transmitting the value data to one or more of a three-D printer, a milling apparatus and an injection molding apparatus; forming a dental appliance via direct manufacture using the value associated with each of the one or more positions for placement of button protrusions (1810, 1820...), the dental appliance including a lower dental tray and an upper dental tray, each of the lower dental tray and the upper dental tray being homogeneous, the lower dental tray inclusive of the vertical displacement and a first pair of the button protrusions (1830, 1849), the upper dental tray inclusive of a second pair of the button protrusions (1810, 1820), the first pair of button protrusions (1830, 1849) and the second pair of button protrusions (1810, 1820) providing the forward mandibular position when two elastic bands (1870, 1880) are attached to connect the upper dental tray and the lower dental tray. assigning a value associated with each of the one or more positions for placement of button protrusions (1810, 1820...), each value representative of a distance between an upper tray button protrusion and a lower tray button protrusion for mandibular advancement; transmitting the value data to one or more of a three-D printer, a milling apparatus and an injection molding apparatus; forming a dental appliance via direct manufacture using the value associated with each of the one or more positions for placement of button protrusions (1810, 1820...), the dental appliance including a lower dental tray and an upper dental tray, each of the lower dental tray and the upper dental tray being homogeneous, the lower dental tray inclusive of the vertical displacement and a first pair of the button protrusions (1830, 1849), the upper dental tray inclusive of a second pair of the button protrusions (1810, 1820), the first pair of button protrusions (1830, 1849) and the second pair of button protrusions (1810, 1820) providing the forward mandibular position when two elastic bands (1870, 1880) are attached to connect the upper dental tray and the lower dental tray.