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CPAP was previously considered the “gold standard” due to its high efficacy in eliminating obstructive events. Despite improvements in technology, the “effectiveness” of CPAP has been compromised by poor real-world compliance. Technological improvements have improved the “effectiveness” of Oral Appliances. This study reports the efficacy of a novel, precision engineered Oral Appliance for the primary treatment of all severities of OSA. Methods Digital scans and digital bite registrations were recorded with a George Gauge utilizing a a 3mm bite fork. Initial protrusion was set at 40–60% and varied according to the degree of overbite and overjet, the severity of OSA, and the presence or absence of TMJ symptoms. All patients were fitted with a ProSomnus (IA) MAD and titrated according to their subjective symptoms. An efficacy study was obtained with a HST after titration and compared to the initial PSG or HST. Results Outcome data on 85 patients (37 female, 48 males, aged 56.7 +/1 10.2 years) was retrospectively reviewed. The patients were consecutively ordered for follow up data, many patients did not return for follow ups. The pre-treatment AHI was 24.5 +/- 19.1 with 36 patients Mild, 26 Moderate and 23 Severe patients. O2 Nadir was 84.1% +/- 5.5%. Post treatment AHI was 5.5 +/- 4.9 with an AHI reduction of 71.6% +/- 20.3%. 59% of the patients scored &amp;lt;5, 31% 10 on the outcome AHI data. O2 Nadir improved to 88.2% overall. 31 patients had RERA’s (RDI-AHI) &amp;gt;10 with an average of 16.7 +/- 7.5, of these patients 27 saw a reduction of RERA’s of 54.4% from 16.9 to 7.1. Conclusion The data shows that a precision oral appliance is capable of successfully treating patients with all levels of severity, with the majority of patients treated to an AHI&amp;lt;5. 23 severe patients with an average AHI of 49.7 were treated to a final average of 8.6, 4 of the patients scored above 10. Additionally, patients successfully saw a reduction in upper airway resistance airflow as evidenced by a reduction of RERA’s of 54.5%, showing that a precision oral appliance can have a significant impact on the upper airway. Support (if any) None

434 Precision Oral Appliance Therapy: The Prime-Time Treatment for OSA