scholarly journals In vitro retention of a new thermoplastic titratable mandibular advancement device

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 56 ◽  
Author(s):  
Marc Braem
Keyword(s):  
Low Cost ◽  
Mouth Opening ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Patient Acceptance ◽  
Airway Patency ◽  
Custom Made

Oral appliance (OA) therapy with a mandibular advancement device (OAm) is a non-invasive, alternative approach to maintaining upper airway patency. The main requirement for an OAm to be effective is the adequate retention on the teeth while the patient is asleep. We evaluated the retentive forces of a new low-cost, customizable, titratable, thermoplastic OAm (BluePro®; BlueSom, France). Dental impressions and casts were made for one patient with complete upper and lower dental arches including the third molars and class II bite proportions. A setup based on Frasaco ANA-4 models was also used. Two protrusive positions of the mandible were investigated: 3 mm and 8 mm, representing respectively 25% and 65% of the maximal protrusion. The forces required to remove the BluePro® device from the carriers were recorded continuously over 730 cycles (=365 days, twice a day) to simulate 1 year of clinical use. At 8 mm protrusion the BluePro® device showed retentive forces of ~27N. There was a slight but non-significant decrease in retentive forces in the tests on the epoxified carriers which was not found on the ANA-4 carriers. There were no significant differences between the carriers as a function of protrusion. The BluePro® device tested in the present study possesses sufficient retention forces to resist initial jaw opening forces and full mouth opening forces estimated to be ~20N. It could therefore broaden the indications for use of thermoplastic OAms. It could provide a temporary OAm while a custom-made OAm is being manufactured or repaired. Patients could be provided with a low-cost try-out device capable of reliable titration, providing an indication of effectiveness and of patient acceptance of an OAm, although the effect of device shape and size on therapeutic outcome is not yet known. Finally it could provide an affordable OAm solution in resource-restricted healthcare settings.

Effect of head and jaw position on respiratory-related motion of the genioglossus

2016 ◽  
Vol 120 (7) ◽  
pp. 758-765 ◽  
Author(s):  
Mingshu Cai ◽  
Elizabeth C. Brown ◽  
Alice Hatt ◽  
Shaokoon Cheng ◽  
Lynne E. Bilston
Keyword(s):  
Mouth Opening ◽  
Upper Airway ◽  
Head Position ◽  
Spatial Modulation ◽  
Mandibular Advancement ◽  
Emg Activity ◽  
Quiet Breathing ◽  
Airway Patency ◽  
Head Flexion ◽  
Jaw Position

Head and jaw position influence upper airway patency and electromyographic (EMG) activity of the main upper airway dilator muscle, the genioglossus. However, it is not known whether changes in genioglossus EMG activity translate into altered muscle movement during respiration. The aim of this study was to determine the influence of head and jaw position on dilatory motion of the genioglossus in healthy adult men during quiet breathing by measuring the displacement of the posterior tongue in six positions—neutral, head extension, head rotation, head flexion, mouth opening, and mandibular advancement. Respiratory-related motion of the genioglossus was imaged with spatial modulation of magnetization (SPAMM) in 12 awake male participants. Tissue displacement was quantified with harmonic phase (HARP) analysis. The genioglossus moved anteriorly beginning immediately before or during inspiration, and there was greater movement in the oropharynx than in the velopharynx in all positions. Anterior displacements of the oropharyngeal tongue varied between neutral head position (0.81 ± 0.41 mm), head flexion (0.62 ± 0.45 mm), extension (0.39 ± 0.19 mm), axial rotation (0.39 ± 0.2 mm), mouth open (1.24 ± 0.72 mm), and mandibular advancement (1.08 ± 0.65 mm). Anteroposterior displacement increased in the mouth-open position and decreased in the rotated position relative to cross-sectional area (CSA) ( P = 0.002 and 0.02, respectively), but CSA did not independently predict anteroposterior movement overall ( P = 0.057). The findings of this study suggest that head position influences airway dilation during inspiration and may contribute to variation in airway patency in different head positions.

scholarly journals A Procedure for Analyzing Mandible Roto-Translation Induced by Mandibular Advancement Devices

Materials ◽  
2020 ◽  
Vol 13 (8) ◽  
pp. 1826 ◽  
Author(s):  
Giovanni Bruno ◽  
Alberto De Stefani ◽  
Edoardo Conte ◽  
Manila Caragiuli ◽  
Marco Mandolini ◽  
...  
Keyword(s):  
Mouth Opening ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Dental Arch ◽  
Invasive Treatment ◽  
Sleep Related Breathing Disorders ◽  
Local Reference System ◽  
Local Reference ◽  
Mandibular Advancement Devices

Background: Sleep-Related Breathing Disorders are characterized by repeated episodes of complete or partial obstruction of the upper airway during sleep. Mandibular advancement devices represent a non-invasive treatment in reducing the number of respiratory events and in decreasing symptoms. The advancement extent of these devices is responsible for the mandibular roto-translation and its effects on the temporomandibular joint. Methods: This study defined a systematic method to assess the mandible roto translation that is caused by MADs according to a scan-to-CAD approach. Starting from a closed mouth position and simulating the oral appliance at different settings it was possible to define a local reference system that is useful for the evaluation of the mandibular roto-translation. This latter was then applied to evaluate the movements of the condyle and the mandibular dental arch. Results: MAD1 resulted in a reduced mouth opening and protrusion, while MAD2 enabled a higher degree of motion of the mandible useful for patients who need an important protrusion. Conclusions: The two devices present different dynamics. Results that are achievable employing this method can be directly used by practitioners in comparing MADs, as well as by researchers in evaluating MADs effects.

scholarly journals A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients

2020 ◽  
Vol 25 (5) ◽  
pp. 44-50
Author(s):  
Denise Fernandes Barbosa ◽  
Lilian Chrystiane Giannasi ◽  
Liege Maria Di Bisceglie Ferreira ◽  
Miguel Meira e Cruz ◽  
Marcelo Corrêa Alves ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Occlusal Plane ◽  
Apnea Hypopnea Index ◽  
Study Objective ◽  
Airway Patency ◽  
Obstructive Sleep

ABSTRACT Introduction: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper’s plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. Objective: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. Methods: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. Results: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. Conclusion: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.

scholarly journals Management of Obstructive Sleep Apnea with Implant Retained Mandibular Advancement Device

2014 ◽  
Vol 5 (3) ◽  
pp. 184-189 ◽  
Author(s):  
Pokpong Amornvit ◽  
Sahana Bajracharya ◽  
Dinesh Rokaya ◽  
Konrawee Keawcharoen ◽  
Walop Supavanich
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Case Reports ◽  
Upper Airway ◽  
The Elderly ◽  
Oral Appliance ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Edentulous Patient ◽  
Obstructive Sleep

ABSTRACT Obstructive sleep apnea (OSA) is a condition which occurs from the narrowing of the upper airway. Obstructive sleep apnea in the edentulous patient can be caused by the anatomical obstruction of oropharyngeal space. In the elderly patients, the muscles of soft palate can easily be collapsed which can result in obstruction in respiratory passage. Oral appliance, namely, mandibular advancement device (MAD) is the recommended treatment appliance for the patient with mild to moderate OSA. In the elderly edentulous patients, OSA is worsening as these patients are difficult to treat with oral appliance due to with diminished vertical dimension and lack of retention for MAD. The use of osseointegrated dental implants and the locator attachments aid in the retention of the appliance provides support to the denture and the device, and also prevent trauma to the underlying mucosa. This case reports the technique of fabrication of MAD with elastic mandibular advancement (EMA) device to treat moderate OSA from implant retained complete dentures in maxilla and mandible in complete edentulous patient. How to cite this article Amornvit P, Rokaya D, Bajracharya S, Keawcharoen K, Supavanich W. Management of Obstructive Sleep Apnea with Implant Retained Mandibular Advancement Device. World J Dent 2014;5(3):184-189.

Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

2009 ◽  
Vol 106 (5) ◽  
pp. 1668-1673 ◽  
Author(s):  
Ron Oliven ◽  
Naveh Tov ◽  
Majed Odeh ◽  
Luis Gaitini ◽  
Uri Steinfeld ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Upper Airway ◽  
Combined Effect ◽  
Mandibular Advancement ◽  
Cross Sectional ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Critical Closing Pressure ◽  
Stimulation Of

Both mandibular advancement (MA) and stimulation of the genioglossus (GG) have been shown to improve upper airway patency, but neither one achieves the effect of continuous positive airway pressure (CPAP) treatment. In the present study we assessed the combined effect of MA and GG stimulation on the relaxed pharynx in patients with obstructive sleep apnea (OSA). We evaluated responses of upper airway pressure-flow relationships and endoscopically determined pharyngeal cross-sectional area to MA and electrical stimulation of the GG in 14 propofol-anesthetized OSA patients. Measurements were undertaken at multiple levels of CPAP, enabling calculation of the critical closing pressure (Pcrit), upstream resistance (Rus), and pharyngeal compliance. GG stimulation, MA, and the combination of both shifted the pressure:flow relationships toward higher flow levels, resulting in progressively lower Pcrit (from baseline of 2.9 ± 2.2 to 0.9 ± 2.5, −1.4 ± 2.9, and −4.2 ± 3.3 cmH2O, respectively), without significant change in Rus. ΔPcrit during GG stimulation was significantly larger during MA than under baseline conditions (−2.8 ± 1.4 vs. −2.0 ± 1.4 cmH2O, P = 0.011). Combining the effect of GG stimulation with MA lowered Pcrit below 0 in all patients and restored pharyngeal patency to a level that enabled flow above the hypopnea level in 10/14 of the patients. Velopharyngeal compliance was not affected by either manipulation. We conclude that the combined effect of MA and GG stimulation is additive and may act in synergy, preventing substantial flow limitation of the relaxed pharynx in most OSA patients.

scholarly journals Comparison of titrable thermoplastic versus custom-made mandibular advancement device for the treatment of obstructive sleep apnoea

2017 ◽  
Vol 131 ◽  
pp. 35-42 ◽  
Author(s):  
Frédéric Gagnadoux ◽  
Xuan-Lan Nguyen ◽  
Marc Le Vaillant ◽  
Pascaline Priou ◽  
Nicole Meslier ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Obstructive Sleep ◽  
Custom Made

scholarly journals 1272 Control of Sleep-Associated Respiratory Distress with a Mandibular Advancement Oral Appliance in an Unusual Case of a Patient with a Mild Rather Persistent Nocturnal Baseline Hypoventilation/Hypoxia

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A483-A484
Author(s):  
I Manetta ◽  
A Almeida ◽  
D Schwartz ◽  
M Meira e Cruz
Keyword(s):  
Unusual Case ◽  
Upper Airway ◽  
Oral Appliance ◽  
Interesting Case ◽  
Normal Weight ◽  
Mandibular Advancement ◽  
Therapeutic Success ◽  
Sleep Related Breathing Disorders ◽  
Respiratory Parameters ◽  
Obstructive Sleep

Abstract Introduction Normal respiratory function is crucial for adequate sleep. Sleep Related Breathing Disorders, namely Obstructive Sleep Apnea (OSA) are frequent conditions among a large spectrum of obstructive events in the upper airway which are often linked to significant sleep related oxyhemoglobin dessaturation levels compared to those observed in baseline PSG-oximetry recorded. On the other hand, low baseline oxygen saturation (LBOS) is commonly linked to symptomatic cardiorespiratory disturbances which may adversely impact respiratory outcomes either awake or during sleep. Therefore it is relevant to be aware of the baseline ventilatory status in order to optimize the therapeutic care. Report of Case We present an unusual case of a patient with moderate OSA which was successfully controlled with a Mandibular Advancement Oral Appliance (OAm). Despite the control with the OAm, the patient still maintained a nocturnal pattern of hypoventilation/hypoxia. The 53 yo female patient with normal weight/height ratio (BMI=25,2) complaining of non restorative sleep, tiredness, impaired memory, excessive diurnal sleepiness (Epworth Sleepiness Scale - ESS=10 and bruxism with a PSG diagnosis of moderate OSA (BaselineO2Sat=94%; IAH=17,4 ev/h; ODI=32,9 ev/h; T90=34,7% of TST) was referred for treatment with a OAm. A PM Type 1 positioner was inserted and titrated until 12 mm of advancement (80% of maximal measured protrusion). Within 6 months follow up and after clinical titration, there was a clear symptomatic and objective improvement with resolution of all major complaints including sleepiness (ESS=5). Titration PSG showed a normalization in all parameters (IAH=1,4 ev/h;ODI=4 ev/h;T90=0,1% of TST). Baseline O2 Sat however remained low (93%) in the titration PSG even though no symptoms or signs of a disorder existed even after discounting for Ph related metabolic changes (normal levels of HCO3) Conclusion This is an interesting case of an unusual patient who presented with a LBOS level in the diagnostic PSG. Despite the therapeutic success of the OAm in controlling the sleep related respiratory condition, measured by all otherwise normalized PSG based sleep and respiratory parameters, maintained a LBOS in the titration PSG without any signs or symptoms of disease.

Changes in Upper Airway Volume in Edentulous Obstructive Sleep Apnea Patients Treated with Modified Mandibular Advancement Device

2015 ◽  
Vol 25 (6) ◽  
pp. 453-458 ◽  
Author(s):  
Arvind Tripathi ◽  
Ashutosh Gupta ◽  
Sabyasachi Sarkar ◽  
Suryakant Tripathi ◽  
Narendra Gupta
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Obstructive Sleep

Mandibular Advancement Device use for therapy of simple snoring: mini review

2021 ◽  
Vol 11 (41) ◽  
pp. 30-33
Author(s):  
Erdem Atalay Cetinkaya
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Treatment Modalities ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
Surgical Methods ◽  
Simple Snoring

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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