Which Three-Dimensional Printing Technology Can Replace Conventional Manual Method of Manufacturing Oral Appliance? A Preliminary Comparative Study of Physical and Mechanical Properties

Three-dimensional printing technology is widely being adopted in the manufacturing of oral appliances. The purpose of this study was to determine the most suitable method of manufacturing oral appliances by comparing the physical and mechanical properties of various 3D printing methods with the conventional method. Experimental groups consisted of six 3D-printed specimens via FDM, two polyjets, SLS, SLA, and DLP, and the milling methods. The control group consisted of an acrylic resin specimen made by the conventional manual method. The water absorption and solubility, color stability, flexural strength, and surface hardness were tested and statistically analyzed. The FDM, SLS, and DLP methods exhibited comparable water absorption and solubility with the control group, and only the SLA method exhibited significantly higher water solubility than the control group. In terms of the color stability, only the milling method met the requirements of the allowable clinical range. The FDM, SLA, and DLP methods exhibited comparable flexural strength with the control group. The surface hardness of the PJ-2, DLP, and milling methods was acceptable for replacing conventional manual method. Therefore, the most suitable method of manufacturing oral appliances among the experimental groups was the DLP method in terms of its water absorption and solubility, flexural strength, and surface hardness.

Treatment with Oral Appliances in Obstructive Sleep Apnea

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.

Oral appliances: An odds-on in obstructive sleep apnoea management

Breathing affiliated with sleep disorders usually lies between simple snoring without sleepiness, upper airway resistance syndrome, obstructive sleep apnoea (OSA) syndrome, and hypercapnic respiratory failure. Of all these, OSA is very often accompanied with morning symptoms and extension of comorbidities and mortalities with a high prevalence rate. General health implications and an altered quality of living are the major setbacks. Mostly patients with neurologic disorders are affected. There are many surgical and non-surgical approaches concerned with its management. This review article provides a description of oral appliances along with recent treatment modalities, clinical efficacy of alternative treatment modalities of OSA patients.

Efficacy of Somnodent® Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients Somnodent® OAs for Moderate to Severe OSAHS

Objective: Oral appliances are one of the treatments of obstructive sleep apnea hypopnea syndrome. The main objective of the study was to determine the efficacy of the Somnodent® oral appliance on Apnea-Hypopnea Index. The secondary objective was to measure the efficacy on other oxymetric parameters and to determine its tolerance and dropout rate. Methods: Efficacy results of the oral appliances based on the apnea hypopnea index, the oxygen desaturation index and the lower oxygen saturation reduction, appliance complications and dropout rates were retrospectively collected from 25 patients with a moderate to severe obstructive sleep apnea hypopnea syndrome treated by a Somnodent® oral appliance. The procedure was entirely performed by otolaryngologists. Results: The AHI with OA was more significantly reduced in patients with a higher initial apnea hypopnea index and a higher initial body mass index but reduction was not related to age and not proportional to degree of mandibular advancement. The 50%-AHI reduction rate after OA was 55.6%, the AHI ≤5/h rate after OA was 22.2%. The OA significantly reduced the mean apnea-hypopnea index (-14.3/h, p<10-5). No patient had his AHI increased with oral appliance. One patient stopped using OA mainly because of nausea. Conclusions: Somnodent® is an effective and well-tolerated treatment for moderate to severe obstructive sleep apnea hypopnea syndrome.

An Anti-Snoring Oral Appliance to Reduce Simple Snoring as a Non-Invasive Method for Management of Snoring: A Case Report and Literature Review

Background and Objective: Simple snoring affects millions of people and their partners in the world and it indicates increased upper airways resistance and pharyngeal collapsibility. Snoring, particularly loud and habitual, may indicate obstructive sleep apnea (OSA). Case Report: The presenting patient was a middle-aged man with chief compliant of snoring, who was diagnosed with simple snoring after undergoing an overnight polysomnography (PSG). By using a simple oral appliance that retracted the tongue and improved airway patency, snoring improved completely. Conclusion: Simple snoring is a common condition and after excluding OSA, particularly in suspected patients, it can be managed by some instructions and interventions such as using available oral appliances.

Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review

Background. Recent clinical guidelines have extended indications for oral appliances to subjects affected by moderate-to-severe obstructive sleep apnoea (OSA). The aim of this systematic review covering this important issue for public health is twofold: updating and summarizing the best available scientific evidence by selecting RCTs of quality only, and identifying the therapeutic pathways that can be transferred to the current clinical practice. Methods. All the abstracts which were published before February 18, 2019, have been identified in three electronic databases (PubMed, Web of Science, and Cochrane). The Cochrane Collaboration’s tool for assessing risk of bias was used as an assessment tool in order to evaluate the quality of the selected studies. Results. The search strategy yielded 2,260 studies. After removing duplicates and studies that did not comply with the inclusion criteria, 32 full-text articles were assessed for eligibility, and 17 RCTs were finally included in the qualitative synthesis. The 17 selected studies were very heterogeneous in the type of included RCTs in terms of patient inclusion criteria, sample size, distribution of the two genders in the various groups, duration of treatment, and definition of primary and secondary outcomes, without any restriction on the definition of the control group. A common finding was the positive responsiveness of oral appliance treatment in subjects affected by mild-to-moderate OSA with some evidence for cases of severe OSA. Conclusion. Higher-quality studies are needed in order to provide additional useful guidelines for dental clinicians for OSA management.

Role of Paediatric Dentist in Non-Invasive Management of Obstructive Sleep Apnoea in Children

BACKGROUND Obstructive sleep apnoea (OSA) is a chronic disorder in which repetitive episodes of cessation of breathing occurs during sleep due to collapse of upper airway leading to recurrent awakening, sleep fragmentation, and perturbation in ventilatory function. The disorder is much more common than realised and the manifestations in children are different from those in adults. OSAS may present in different ways like cognitive dysfunction, excessive day time somnolence, decreased attention span, drooling of saliva, mood disorders like depression or irritability as well as adverse cardiovascular sequelae like hypertension, heart failure. Polysomnography or overnight sleep studies remain the gold standard for the diagnosis of paediatric obstructive sleep apnoea (POSA) disorder. Therapeutic approaches for POSA include surgical and nonsurgical means. The choice of therapy depends on various factors like aetiology, severity of the POSA and patient’s choice. Although continuous positive airway pressure (CPAP) remains the first line therapy in adults, the introduction of oral appliances provided an attractive alternative and made the role of dentists more prominent in management of this disorder. OSA is often under-diagnosed due to lack of awareness. So, it is essential for dentists to be aware of the various aspects of this disorder as well as its management. KEY WORDS OSA, Paediatric Dentist, Oral Appliances, Non-Invasive Management

Custom-Made Oral Appliances for the Treatment of Obstructive Sleep Apnea: Outcomes in Thai Patients

Objective: To evaluate the outcomes of custom-made oral appliances (OAs) for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: A retrospective review of polysomnography (PSG) results and relevant information, including patient characteristics, visual analog scale (VAS) of sleep-associated symptoms, and Epworth Sleepiness Scale (ESS) of patients treated with an OA between January 2010 and January 2018 was done at Siriraj Hospital, Thailand. Inclusion criteria were OSA patients aged 18 years or older who underwent diagnostic and therapeutic PSG with a custom-made OA. Exclusion criteria were patients who were lost to follow-up or had incomplete PSG data. Results: Sixty-seven OSA patients were recruited. The median apnea-hypopnea index (AHI) was significantly decreased from 16.5 (11.5, 27.8) to 5.1 (2.8, 11.3) events per hour (p<0.001) and the median minimal oxygen saturation increased from 82.0 (77.0, 86.0) to 87.0 (80.0, 90.0) with OA treatment (p<0.001). ESS scores decreased from 9 (6, 13) to 7 (4, 9) (p<0.001) and the VAS of snoring loudness and frequency as rated by family members or bed partners decreased from 6 (4, 7.5) to 3.3 (2, 5) and from 5.5 (3.2, 7.6) to 3.4 (2, 5.3), respectively (p<0.001). Forty-one patients (61%) had a 50% reduction of AHI, and an AHI of less than 15 events per hour after treatment, which were considered good responses. Common adverse effects of the treatment included temporomandibular joint discomfort, dry mouth, excessive salivation, gingival pain, and toothache, but these occurred to only a mild-to-moderate degree and were tolerable. Conclusion: Custom-made OA is an effective alternative treatment for OSA in selected Thai patients, particularly for those with a mild-to-moderate degree. Keywords: Custom-made oral appliance, Obstructive sleep apnea, OA, OSA, Thai