Changes in 3D Midfacial Parameters after Biomimetic Oral Appliance Therapy in Adults

Singh, G. Dave; Heit, Tammarie; Preble, Derek

doi:10.1177/0974909820140205

Cited by 6 publications

(3 citation statements)

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“…While MADs are thought to mechanically enlarge the airway while being worn during sleep[ 9 ], BOAT aims to mimic natural craniofacial growth and development to induce putative upper airway remodeling that persists even after the device has been removed. It has been shown that BOAT increases the midfacial bone volume in adults non-surgically[ 10 ], which ostensibly permits nasal breathing through an enhanced nasal airway volume[ 11 ]. In fact, several studies have shown the efficacy of BOAT in mild, moderate and even severe cases of OSA[ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

Singh¹,

Kherani²

2021

WJCC

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BACKGROUND Mandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA. CASE SUMMARY An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance ® , Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient’s mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions. CONCLUSION In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Long-term follow up studies are required to verify these novel findings.

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Section: Discussionmentioning

confidence: 99%

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

Singh¹,

Kherani²

2021

WJCC

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“…Biomimetic oral appliance therapy (BOAT) aims to mimic natural growth and development of the facial complex, and the system is designed to correct craniofacial and upper airway issues in both children and adults. 8 , 9 , 10 , 11 The design used in this study had: 6 (patented) anterior 3D axial springs™, midline anterior and/or posterior jackscrews, occlusal pads, retentive clasps and a labial bow ( Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

Changes in pneumatization of the maxillary air sinuses in Korean adults following biomimetic oral appliance therapy

Singh¹,

Kim²

2021

World j. otorhinolaryngol.-head neck surg.

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Objective For the treatment of obstructive sleep apnea in adults, mandibular advancement devices (MADs) are often used. Since adults with a prognathic mandibular phenotype are at risk of developing an unfavorable facial profile, midfacial development using biomimetic oral appliance therapy might provide a suitable alternative. However, the effect of this procedure on the maxillary air sinuses is unknown; therefore, changes in sinus pneumatization were investigated in this study. Methods After obtaining informed consent, 16 consecutive Korean adults with midfacial hypoplasia had 3D cone-beam (CB) CT scans taken, and biomimetic upper appliances (DNA appliance®, Vivos Therapeutics, Inc., USA) were constructed. All subjects were instructed to wear the device 12–16 h/day. Each month, examination for the progress of midfacial development was recorded. Post-treatment, a follow-up 3D CBCT scan was undertaken with no device in the patient's mouth. Pre- and post-treatment linear and volumetric measurements were obtained using appropriate software, and compared statistically using t -tests. Results The mean age of the sample was 25.0 yrs ± 8.7. The mean treatment time was 15.5 mths ± 5.2. Post-treatment, the transpalatal bone width increased from 35.3 mm ± 3.0 to 38.5 mm ± 2.0 ( P < 0.001); the maxillary air sinus volume on the left side increased from 18.8 cm 3 ± 6.5 to 20.0 cm 3 ± 6.0 ( P < 0.05), and from 18.5 cm 3 ± 5.7 to 19.7 cm 3 ± 5.8 ( P < 0.05) on the right side. Conclusions Biomimetic oral appliance therapy may be able to increase the maxillary air sinus volume in adults. In view of these preliminary findings, further studies on the effect of enhanced pneumatization on paranasal sinus function and sleep parameters are warranted.

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“…While MADs have long been successfully deployed for the management of OSA, either in isolation or in combination, there is some concern about temporo-mandibular joint (TMJ) symptoms, changes in the occlusion and unwanted tooth movements [8]. Biomimetic oral appliance therapy (BOAT) differs from conventional MADs as it aims to correct the nasal airway [9] through midfacial redevelopment [10] in combination with mandibular repositioning, which aims to improve the oropharyngeal airway in adults [11]. But, there are very few studies in the literature that have investigated a combination of midfacial development in conjunction with mandibular repositioning in the treatment of OSA.…”

Section: Introductionmentioning

confidence: 99%

Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea Using Combined Maxillo-Mandibular Correction

Singh¹

2017

J Sleep Disord Manag

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Introduction: Although mandibular advancement devices (MADs) are utilized for the management of mild to moderate OSA, there are concerns about temporo-mandibular joint (TMJ) issues. Biomimetic oral appliance therapy (BOAT) differs from MADs as it aims to achieve midfacial redevelopment in combination with mandibular repositioning. In this study, we tested the hypothesis that mild to moderate cases of OSA can be addressed with combined maxillo-mandibular correction using BOAT.Methods: Nineteen adults diagnosed with mild to moderate OSA, following an overnight home sleep test (HST) that had been interpreted by a physician, participated in this study. Each subject was treated by a dentist with advanced training in dental sleep medicine. At each monthly followup, the devices were adjusted to optimize their efficacy. The mean apnea-hypopnea index (AHI), respiratory disturbance index (RDI) and oxygen desaturation index (ODI) of the study sample was calculated prior to and after BOAT. The findings were subjected to statistical tests. Results:Prior to treatment the mean AHI of the study subjects was 12.8 hr -1 ± 5; the mean RDI was 18.6 hr -1 ± 8.2, and the ODI was 6.3% ± 3.5. Follow-up HSTs after approximately 9 mos. indicated the mean AHI decreased significantly to 6.2 hr -1 ± 2.9 after BOAT (p < 0.001), which represents a fall in the mean AHI by 51.5% for the study sample. The mean RDI fell to 12.3 hr -1 ± 6.9 (p < 0.001), and the ODI was improved to 2.6% ± 1.7 (p < 0.001). Conclusions:This study suggests that combined maxillomandibular correction may be a useful method of managing mild to moderate cases of OSA in adults, and represents an alternative to MADs and continuous positive airway pressure therapy. However, further studies are needed to determine the additional advantages of combined maxillomandibular correction.

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Changes in 3D Midfacial Parameters after Biomimetic Oral Appliance Therapy in Adults

Cited by 6 publications

References 0 publications

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

Changes in pneumatization of the maxillary air sinuses in Korean adults following biomimetic oral appliance therapy

Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea Using Combined Maxillo-Mandibular Correction

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