A Fully Digital Workflow and Device Manufacturing for Mandibular Repositioning Devices for the Treatment of Obstructive Sleep Apnea: A Feasibility Study

Abstract

Dentists are being inundated with outrageous email and print claims regarding dental sleep medicine education. Examples of claims that have hit my inbox include: " …join the members…producing over $70, 000 a month in oral appliances…" "…reduce overhead…" " …the only course that establishes the dentist as primary treatment providers…" " …get started immediately after one weekend…" And if you believe these claims, I have a bridge to sell you.Dental sleep medicine (DSM) is a growing field and there are full time fellowship programs of one to two years emerging at a few dental schools. However the majority of dentists will get their training in DSM through post-dental school continuing education. There is good quality evidence-based education available for those interested in DSM. The courses offered by the American Academy of Dental Sleep Medicine are a leading example of quality, evidence based DSM education. This journal is also a source of evidence-based, peer-reviewed scientific information in DSM. There is no need to partake in educational offerings from questionable sources.The practice of DSM has features that are uncommon in general dentistry. Although there are technical aspects, it is primarily intellectual work that cannot be done by a dentist working alone. Diagnosis, treatment and follow up of patients with sleep-disordered breathing is a collaborative, interdisciplinary activity. Collaboration with physicians is critical at diagnosis, treatment, follow-up, and-in some cases-years later if oral appliance therapy (OAT) is no longer effective and alternative or additional therapies need to be considered. Courses that aim to educate dentists and physicians together such as the 2018 Sleep Medicine Trends course will be an important component to future interdisciplinary team building.DSM practitioners treat a chronic disease; this is not a field with "quick fix" treatments. Once you begin OAT the patient is your responsibility for years. Managing inevitable side effects, particularly occlusal changes, continues to be an important challenge in DSM. Despite these challenges, many dentists have found DSM to be a satisfying and rewarding addition to their practices. Many more are beginning to explore the field. Don't be fooled by outrageous claims of pots of gold. Practicing quality DSM requires a considerable body of knowledge and training. There are good quality offerings out there. Don't cheat yourself-go for quality. Don't buy the bridge. CITATIONDort LC. And if you believe that, I have a bridge to sell you.

Evaluation of a New Oral Appliance With Objective Compliance Recording Capability: A Feasibility Study

“…This is in agreement with prior studies that focused exclusively on the feasibility of a digitally fabricated oral appliance workflow. 15 The OAT-CRs were manufactured in advance of the intercept appointments, enabling the patient to switch into the new device without a lapse in therapy.…”

Evaluating the Clinical Performance of a Novel, Precision Oral Appliance Therapy Medical Device Made Wholly From a Medical Grade Class VI Material for the Treatment of Obstructive Sleep Apnea

“…What is precision OAT? Precision OAT consists of patient-specific treatment plans, patient-specific oral appliance therapy medical devices, and patient-specific titration options that are designed based on the unique upper airway and dental anatomy of each patient [13,14]. Digital manufacturing technologies are utilized to ensure that each precision, patient-specific oral appliance therapy device is capable of repositioning, stabilizing, and titrating the mandible within < 1 mm of the therapeutic position associated with reducing upper airway collapse [15].…”

<p>A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion</p>

“…First, the use of intraoral scanners permits the production of digital models of the dental arches, thus reducing the need for fabrication of physical models. 8 Furthermore, the utilization of the cone beam computer tomography (CBCT) technology allows a more detailed diagnosis compared to the conventional one made with 2D radiographs and cephalometric analysis. Intra-oral digital models, CBCT imaging, and 3D facial scan enable the analysis of the dentition, skeletal structures, and facial soft tissues in the three dimensions of space, increasing the details and the accuracy of the orthodontic setup.…”

“…Intra-oral digital models, CBCT imaging, and 3D facial scan enable the analysis of the dentition, skeletal structures, and facial soft tissues in the three dimensions of space, increasing the details and the accuracy of the orthodontic setup. 7,9 Also, the digital manufacturing technology related to 3D printing and metal laser melting allows a completely unrestricted design and personalization of the orthodontic devices and appliances, 6,8,10 which traditionally have been a custom-made laboratory work. The large and continuously growing range of materials for 3D printers permits to expand the choice for the needed application, moving away from the usual orthodontic materials such as stainless steel, titanium alloys, or acrylic resin.…”