one embodiment of a bite block 10 in accordance with the present invention is illustrated in fig2 - 4 . it should be understood that the embodiment illustrated in , and described in relation to fig2 - 4 merely represents one representative example of the invention and that , in practice , a plurality of bite blocks 10 are to be provided and used in practice , each bite block 10 providing a different combination of dimensions for positioning a patient &# 39 ; s lower jaw relative to the upper jaw in both horizontal and vertical directions . thus , the invention contemplates a plurality of bite blocks of varying sizes and dimensions that are sized , shaped , and configured to function as more fully described below . as used herein : “ superior ” refers to the direction toward the top of the oral cavity , “ inferior ” refers to the direction toward the bottom of the oral cavity ; “ anterior ” refers to the direction toward the front of the oral cavity or tips ; “ posterior ” refers to the direction toward the back of the oral cavity and airway ; “ horizontal ” or “ longitudinal ” refers to the direction generally in the forward and / or backward direction in the oral cavity ; and “ vertical ” refers to the direction generally in the up and / or down direction in the oral cavity . in one embodiment , the bite blocks may be configured generally as illustrated fig2 . bite block 10 may have an upper notch 12 , a lower notch 14 , an anterior portion 16 located anterior of notches 12 and 14 , a posterior portion 18 located posterior of notches 12 and 14 , and a stem 19 located anterior of anterior portion 16 . as discussed in additional detail below , bite block 10 is configured to receive a portion of a patient &# 39 ; s upper central incisors in notch 12 and to receive a portion of the patient &# 39 ; s lower central incisors in notch 14 , so that anterior portion 16 is positioned anterior to , or in front of , the patient &# 39 ; s central incisors and posterior portion 18 is positioned posterior to , or behind , the patient &# 39 ; s central incisors . stem 19 may be provided to facilitate manipulation and placement of bite block 10 by a dental professional or the patient . referring to fig3 , bite block 10 preferably has a small form factor , to facilitate its use to position a patient &# 39 ; s mandible relative to the upper jaw without significantly interfering with diagnostic airflow testing and / or the making of dental impressions . for adult patients , the overall height ( h ) of bite block 10 may be in the range of from approximately 15 mm to approximately 25 mm , and may preferably be approximately 20 mm . for adult patients , the overall length ( l ) of bite block 10 may be in the range of from approximately 20 mm to approximately 30 mm , and may preferably be approximately 25 mm . and , for adult patients , the transverse thickness ( t ) of bite block 10 may be in the range of from approximately 2 mm to approximately 4 mm , and may preferably be approximately 3 mm . it will be appreciated that bite blocks 10 may also be appropriately reduced in size , as necessary , or appropriate , for use with smaller and / or younger patients . notwithstanding its small form factor , bite block 10 is configured to stably support and maintain a patient &# 39 ; s jaw in the desired position . upper notch 12 is sized and configured to receive and engage a portion of the upper central incisors of a patient . similarly , lower notch 14 is sized and configured to receive and engage a portion of the lower central incisors of a patient as graphically represented in fig5 . referring to fig4 , upper notch 12 may have a first surface 20 and a second . surface 22 , forming an apex 24 at the intersection first surface 20 and second surface 22 . first surface 20 and second surface 22 form angle α . as shown in fig4 , the shape and depth of upper notch 12 is preferably selected to receive a substantial portion of , and to relatively closely engage the anterior and posterior surfaces of , a portion of the upper central incisors of the patient . referring again to fig4 , lower notch 14 may have a first surface 30 and a second surface 32 , forming a lower apex 34 at the intersection of first surface 30 and second surface 32 . first surface 30 and second surface 32 form angle the shape and depth of lower notch 14 is also preferably selected to receive a substantial portion of , and to relatively closely engage the anterior and posterior surfaces of a portion of the lower central incisors of the patient . in addition , as further illustrated in fig5 , upper and lower notches 12 and 14 are preferably sized and shaped so that , when a patient bites down on the bite block 10 , the upper central incisors of the patient are gently wedged between the first and second surfaces 20 and 22 of upper notch 12 and the lower central incisors of the patient are gently wedged between first and second surfaces 30 and 32 of lower notch 14 in such a way that the relative positions of the upper jaw and the mandible are securely fixed . in addition , the bite block 10 is securely , and stably , supported by the patient &# 39 ; s teeth in such a way that it is not free to rock back and forth or pivot in an anterior or posterior direction relative to the patient &# 39 ; s teeth . in one embodiment intended for adult patients : the depth of upper notch 12 may be in the range of from approximately 5 mm to approximately 10 mm , and may preferably be approximately 6 mm ; the angle a may be in the range of from approximately 50 degrees to approximately 55 degrees , and may preferably be approximately 52 degrees ; the depth of lower notch 14 may be in the range of from approximately 5 mm to approximately 10 mm , and may preferably be approximately 7 mm ; and the angle β may be in the range of from approximately 45 degrees to approximately 50 degrees , and may preferably be approximately 47 degrees . referring to fig3 - 4 , the relative positioning along the longitudinal axis of bite block 10 of first surface 20 of upper notch 12 and first surface 30 of lower notch 14 , shown as x in fig3 , generally determines the position of the mandible relative of the upper jaw in the horizontal direction , or bite offset . for example , in one embodiment , individual bite blocks 10 may be configured to position the mandible dative to the upper jaw to selectively provide spacing in the horizontal direction , or bite offset , equal to approximately − 2 mm , approximately − 1 mm , approximately 0 , approximately + 1 mm , approximately + 7 mm , approximately + 3 mm , or approximately + mm . as used herein , a “ negative ” or “−” designation indicates that the patient &# 39 ; s lower central incisors are located behind or posterior to the upper central incisors ( i . e ., in an “ overbite ” position ), and a “ positive ” or “+” designation indicates that the patient &# 39 ; s central incisors are positioned forward of or anterior to the upper central incisors ( i . e ., in an “ underbite ” or “ advanced ” position ). on the other hand , the distance separating the apex 24 of upper notch 12 and the apex 34 of lower notch 14 , shown as y in fig3 , generally determines the separation between the upper teeth and the lower teeth in the vertical direction , or “ bite opening .” for example , in one embodiment , individual bite blocks 10 may be configured to selectively position the mandible relative to the upper jaw to provide spacing in the vertical direction , or bite opening , equal to approximately 4 mm or approximately 6 mm . thus , the bite block 10 illustrated in fig2 - 4 would position the mandible of a patient relative to the upper jaw in an advanced , or forward , position by a distance equal to x in the horizontal plan , and a bite opening in the vertical plane equal to y . in other words , in the illustrated embodiment , the patient &# 39 ; s lower central incisors may be located forward of the upper central incisors by a distance of approximately x . referring generally to fig6 , the invention also contemplates a kit or system , having a plurality of bite blocks 10 , with each bite block 10 having a desired configuration for providing a desired combination of ( i ) a desired mandible advance in the anterior plane and ( ii ) a desired bite opening in the vertical plane . more specifically , the position of upper notch 12 relative to the position of the lower notch 14 controls the position of the mandible relative to the upper jaw in the horizontal or anterior plane , and can be varied in predetermined increments ( e . g ., − 2 mm , − 1 mm , + 1 mm , + 2 mm , + 3 mm , + 4 mm , etc . ), similarly , the distance between the apex 24 of upper notch 12 and the apex 34 of lower notch 14 determines the size of the bite opening in the vertical plane , and can be varied in predetermined increments ( e . g ., 4 mm , 6 mm , etc ). consequently , a separate bite block 10 is provided for each desired combination of ( i ) mandible position relative to the upper jaw ( e . g ., − 2 mm , − 1 min , 0 , + 1 mm , + 2 mm , + 3 mm , + 4 mm , etc .) and ( ii ) bite opening ( e . g ., 4 mm , 6 mm , etc .). for example , a first bite block 10 included in the kit or system may be configured to position a patient &# 39 ; s mandible in an advanced , or forward , position of approximately + 2 mm relative to the upper jaw and a bite opening equal to approximately 4 mm , a second bite block 10 included in the same kit or system may be configured to position a patient &# 39 ; s mandible in an advanced , or forward , position of approximately + 4 mm relative to the upper jaw and a bite opening equal to approximately 6 mm , and so on and so forth until all such desired combinations are provided . in practice , the bite blocks 10 are used to iteratively arrive at the best position and bite opening to optimize airflow and reduce obstructive sleep apnea and / or snoring . this is commonly done using a pharyngometer . the small size of bite block 10 allows a portion of bite block 10 to be positioned or received inside the primary lumen of a pharyngometer during airflow diagnostic testing , and the relatively small thickness of bite block 10 minimizes potential interference with , or restriction of , airflow through the pharyngometer during such testing . in practice , several different jaw positions can be tested , using several different bite blocks 10 to position the jaw in various different positions based on the different configurations of the various bite blocks 10 used , until the best airflow volume is achieved . once the best mandible position and bite opening are identified , the corresponding bite block 10 can then be selectively attached to a bite fork so that dental impressions can be made with the patient &# 39 ; s jaw positioned by the selected bite block 10 in the position previously determined to provide optimal airflow for the patient . here , again , the bite block 10 is small enough that it does not significantly interfere with the process of making a dental impression , yet the bite block 10 accurately positions , stably supports , and maintains , the jaw in the desired position ( in both the horizontal and vertical directions ) while dental impressions are formed . the dental impressions can then be used to fabricate a dental appliance to be worn by the patient for treatment of obstructive sleep apnea and / or snoring . the present invention may be embodied in other specific forms without departing from its spirit or essential characteristics . the described embodiments are to be considered in all respects only as illustrative and not restrictive . the scope of the invention is , therefore , indicated by the appended claims rather than by the foregoing description . all changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope .
the invention is directed to improved jigs or mandibular positioning bite blocks for positioning the mandible relative to upper jaw for treatment of obstructive sleep apnea and / or snoring , as well as a system for mandibular advancement positioning . the invention provides for controlled variations for both forward and back positions in the anterior plane of the mandible relative to the jaw and bite opening positions in the vertical plane .