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 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.

scholarly journals Treatment with Oral Appliances in Obstructive Sleep Apnea

2021 ◽  
Vol 1 (2) ◽  
pp. 1-6
Author(s):  
Palak Srivastava
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Oral Appliances ◽  
Invasive Treatment ◽  
Obstructive Sleep ◽  
Osa Treatment

Obstructive sleep apnea (OSA) is a disorder caused by a number of factors like an obstruction of the upper airway during sleep because of insufficient motor tone of the tongue and/or airway dilator muscles or inadequate growth of the maxillary jaw bone etc. Oral appliances (OAs) are commonly used as a non-invasive treatment for obstructive sleep apnea syndrome. The primary oral appliance (OA) used in obstructive sleep apnea (OSA) treatment is the mandibular advancement device (MAD). Tongue-retaining devices or tongue-stabilizing devices (TSDs) are a second type of OA, which displace the tongue anteriorly and may be customized or come in different stock sizes. This review article aims to examine the best in class on this particular subject of treatment of OSA with oral appliances, explaining acceptability of an appliance in patients on the basis of its construction and results, while providing enough cognizance regarding the diagnosis, management and causes of discontinuation.

scholarly journals Oral Appliances in Obstructive Sleep Apnea

Healthcare ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 141 ◽  
Author(s):  
Dieltjens ◽  
Vanderveken
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Oral Appliances ◽  
Invasive Treatment ◽  
Oral Appliance Therapy ◽  
Obstructive Sleep ◽  
Custom Made ◽  
Mandibular Advancement Devices

Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

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.

scholarly journals P149 The role of OSA pathophysiological traits on mandibular advancement treatment response and efficacy of a novel mandibular advancement device

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A70-A70
Author(s):  
B Tong ◽  
A Osman ◽  
C Bull ◽  
A Chiang ◽  
M Donegan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Gold Standard ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
The Novel ◽  
Oral Airway ◽  
Respiratory Events ◽  
Mandibular Advancement Devices ◽  
Pressure Catheter

Abstract Mandibular advancement devices (MAD) are an effective therapy for OSA. However, treatment response is difficult to predict. Recent studies have investigated the influence of OSA endotypes on MAD outcomes albeit using simplified endotyping methods. We aimed to prospectively quantify and compare OSA pathophysiological traits between responders and non-responders to a novel MAD using gold-standard endotyping methodology. Data from 30 OSA patients (AHI>10events/h) are analysed to date. OSA was confirmed via in-laboratory polysomnography. Next, a detailed physiology night was conducted before MAD therapy. Participants were instrumented with EEG, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular genioglossus electrodes to quantify baseline OSA pathophysiological traits. Pcrit was quantified via CPAP drops and non-anatomical traits from naturally occurring respiratory events. Participants were fitted with a novel MAD with a built-in oral airway (Oventus O2Vent Optima™) and titrated to ≥75% of maximum mandibular advancement. A treatment efficacy PSG followed therapy acclimatisation. OSA severity decreased by 41±30% (25.1[16.3,39.2] vs. 12.1[7.3,20.0] events/h P<0.001) with MAD therapy. Similar reductions occurred in participants with high nasal resistance. OSA pathophysiological traits measured by gold-standard methodology were similar between responders and non-responders to MAD (residual AHI>10events/h). MAD responders had less collapsible airways at baseline when measured using simple estimates (Vpassive: 92.5[86.3,97.0] vs. 72.5[43.0,91.3] %Veupnea, P=0.022). The novel MAD reduced OSA severity by ~40% including in those with nasal obstruction. The upper airway was less collapsible in responders to MAD when estimated but not when directly measured. Simple estimates of OSA pathophysiological traits may be used to predict responses to MAD.

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

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).

437 Efficacy of a novel oral appliance and the influence of OSA pathophysiological traits on treatment response

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A173-A173
Author(s):  
Benjamin Tong ◽  
Christopher Bull ◽  
Alan Chiang ◽  
Michelle Donegan ◽  
Elizabeth Brown ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Phenotypic Traits ◽  
Oral Appliance Therapy ◽  
Successful Treatment Outcome ◽  
Oral Airway ◽  
Intramuscular Electrodes ◽  
Upper Airway Collapsibility

Abstract Introduction Oral appliance therapy is a recommended alternative to CPAP for OSA. Approximately 50% of patients have a major reduction in OSA severity but successful treatment outcome remains challenging to predict. Previous prediction methods have focused on clinical variables which have poor predictive value. OSA is recognised as a heterogenous disorder caused by 4 pathophysiological traits. The influence of OSA pathophysiological traits on oral appliance treatment outcome has been explored in recent physiological studies using simplified phenotyping methods. In this preliminary report, we prospectively compared differences in the 4 OSA phenotypes between responders and incomplete responders to a novel oral appliance with built in oral airway using gold standard phenotyping methodology. Methods Data from 22 people with OSA (AHI&gt;10events/h) have been analysed to date. A diagnostic in-laboratory PSG was initially conducted to confirm OSA. A detailed physiology PSG was carried out prior to commencement of oral appliance therapy. For this study night participants were instrumented with standard PSG equipment, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular electrodes inserted perorally into the genioglossus to quantify baseline OSA phenotypic traits. Pcrit was quantified via CPAP dial downs and the non-anatomical traits were quantified from naturally occurring apneas and hypopneas. Participants were then fitted with a next generation novel oral appliance with a built-in oral airway (Oventus O2Vent Optima™) and titrated to at least 75% of maximum mandibular advancement. After acclimatization to therapy, participants were invited to undergo a treatment efficacy PSG. Results Oral appliance therapy reduced the AHI by 52% (21[15,31] vs. 11[7,16] events/h, p&lt;0.001). 46% of participants responded to oral appliance therapy based on the definition of AHI &lt; 10events/h. Preliminary analyses indicated that estimates of baseline upper airway collapsibility tended to be different in responders versus non-responders (responders have less collapsible airways). Conclusion The novel oral appliance reduced OSA severity by 50% with resolution of OSA in half of participants. Baseline pharyngeal collapsibility may be an important physiological predictor of treatment outcome. Support (if any):

A Design of Oral Appliance for Obstructive Sleep Apnea (Preprint)

2020 ◽  
Author(s):  
Vikram Belkhode ◽  
Sharayu Nimonkar ◽  
Surekha Godbole ◽  
Pranali Nimonkar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Adult Population ◽  
Oral Appliance ◽  
Epidemiological Studies ◽  
Mandibular Advancement ◽  
Obstructive Sleep ◽  
Alternative Treatment Option ◽  
Mandibular Advancement Devices ◽  
Maxillary Arch

BACKGROUND As per the current epidemiological studies, the prevalence of obstructive sleep apnea (OSA) among the adult population is very high. Oral appliances (OA) has emerged as the most recommended alternative treatment option for mild to moderate OSA. OBJECTIVE The objective of this article is to develop a new design of OA named “customized maxillary oral appliance”, for managing moderate obstructive sleep apnea (OSA) syndrome. METHODS The design proposed in this clinical technique is first of its kind that is fabricated on the maxillary arch. Customized maxillary oral appliance is developed by combining the principles of the three most popular OA’s used in OSA, namely soft palate lifters, tongue retaining devices, and mandibular advancement devices. RESULTS A new design of OA for the maxillary arch is proposed for managing moderate OSA. CONCLUSIONS Given the potential impact of OSA on general and mental health and the side effects of existing appliances there is a need for a new remedy to be introduced in the field of sleep medicine. This novel design can provide a new therapeutic op¬tion for patients with moderate OSA. CLINICALTRIAL Trial Registration: CTRI/2020/07/026936 Registered 31 July 2020, http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=90265.33636

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