Effects of a mandibular advancement device on the upper airway morphology: a cephalometric analysis

AbstractOral devices that treat obstructive sleep apnea are an easy and influential option to protect the upper airways from sleep obstructions. One example is the mandibular advancement device (MAD), which is a non-invasive apparatus specified in adults with simple snoring and mild obstructive sleep apnea. Recently, due to the constraints of other therapies, like positive airway pressure treatment and surgical methods, there has been growing interest in the use of oral appliance for simple snoring patients. MAD is managed to improve the upper airway volume, minimize upper airway collapse and reduce snoring. On the other hand, it remains inferior to CPAP in the reduction of the apnea-hypopnea scores, with therapy success varying from 24% to 72%. The treatment modalities include skilled physicians and multidisciplinary strategies to treat patients with snoring and obstructive sleep apnea (OSA) effectively. Some researchers also suggest potential predictors of progress in care, but specific criteria for patient selection and predictive clinical principles for effectiveness in all treatment modalities are still needed. The aim of this brief clinical Study is to review MAD brief history, design, indications, contraindications, therapy efficiency, side effects, and current perspectives.

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Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices

Journal of Clinical Medicine ◽

10.3390/jcm10225255 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5255

Author(s):

Sara Camañes-Gonzalvo ◽

Rocío Marco-Pitarch ◽

Andrés Plaza-Espín ◽

Javier Puertas-Cuesta ◽

Rubén Agustín-Panadero ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Oxygen Saturation ◽

Upper Airway ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Apnea Hypopnea Index ◽

Percentage Increase ◽

Obstructive Sleep ◽

Mandibular Advancement Devices

Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).

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Impact Of Mandibular Advancement Device Associated With CPAP Interface On Upper Airway Mechanical Properties Assessed By Phrenic Nerve Stimulation In Patients With Obstructive Sleep Apnea

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3856 ◽

2012 ◽

Author(s):

Simon Gakwaya ◽

Jean-Christian Borel ◽

Jean-François Masse ◽

Cesar Melo-Silva ◽

Frederic Series

Keyword(s):

Mechanical Properties ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nerve Stimulation ◽

Phrenic Nerve ◽

Upper Airway ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Phrenic Nerve Stimulation ◽

Obstructive Sleep

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A Novel Mandibular Advancement Device for Treatment of Sleep-Disordered Breathing: Evaluation of Its Biomechanical Effects Using Finite Element Analysis

Applied Sciences ◽

10.3390/app10134430 ◽

2020 ◽

Vol 10 (13) ◽

pp. 4430

Author(s):

Jonghun Yoon ◽

Sang Hwa Lee ◽

Yuhyeong Jeong ◽

Dong-Hyun Kim ◽

Hyun-Il Shin ◽

...

Keyword(s):

Finite Element ◽

Side Effects ◽

Sleep Disordered Breathing ◽

Upper Airway ◽

Fe Analysis ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Three Dimensional Model ◽

Element Analysis ◽

Disordered Breathing

Stress or pressure induced by the use of a mandibular advancement device (MAD) to treat sleep-disordered breathing can cause side effects including occlusal changes, pain, and discomfort. In this paper, we describe and use finite element (FE) analysis to evaluate a novel MAD that can reduce the stress and side effects associated with these devices. The MAD includes a protruding part that enables rostral movement of the lower tray, providing a wider upper airway and a supporting shield that helps uniformly distribute the concentrated stress. After assembling the three-dimensional model for the MAD and the upper oral structures, a designated force was applied to evaluate the stress distributions of a conventional MAD and the proposed design. FE analysis showed that the stress applied to the upper front teeth and the gingival area near the upper incisors differed between the newly developed and conventional MAD. Concentrated stress was relieved by inserting such a shield, helping to distribute the stress from the front teeth to the gingival area. Our proposed MAD reduced the concentrated stress on the front teeth by distributing it over the gingival area.

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