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

Abstract

This study demonstrates the efficacy of a titrable thermoplastic MAD in reducing SDB and related symptoms in patients with mild to severe OSA. Reported compliance at 6 months was high despite more dental discomfort than with custom-made MAD.

Ready‐made versus custom‐made mandibular advancement appliances in obstructive sleep apnea: A systematic review and meta‐analysis

“…Furthermore, given that the main requirement for a MAA to be effective is the adequate retention on the teeth while the patient is asleep, in relation to the ready‐made MAAs, the lack of device retention was the most frequently cited reason for discomfort and non‐adherence (Tsuda, Almeida, Masumi, & Lowe, ; Vanderveken et al., ). More recently, a recent prospective non‐randomised comparative study (Gagnadoux et al., ) demonstrated the efficacy of a new titrable thermoplastic MAA with adequate retention in reducing sleep‐disordered breathing and related symptoms in patients with mild to severe OSA. Thus, there is merit in a further RCT to compare the effectiveness of a custom‐made MAA and a titrable ready‐made MAA, with the improved retention and the viability of offering patients a short‐duration ready‐made MAA trial prior to the fabrication of a custom‐made device.…”

“…Mandibular advancement appliances are intra‐oral devices, worn overnight to posture the mandible in a forward and downward direction, and are regarded as relatively non‐invasive with a high acceptance (Vanderveken et al., ). These devices can be either custom‐made or bought in a ready‐made state over the counter, with some offering the advantage of being titrable (Gagnadoux et al., ). Ready‐made MAA offer the considerable clinical advantages of being easily available, with the potential to be adapted immediately to provide therapeutic benefit at relatively low cost.…”

Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial

“…They found no efficacy differences either during PSG or in clinical outcomes. However, the Gagnadoux study9 was flawed by the usual limitations of observational studies while the robustness of our data is supported by a head-to-head comparison in a randomised controlled trial design. We clearly established that in patients with OSA refusing or not tolerating CPAP, the thermoplastic heat-moulded titratable MAD was non-inferior to the custom-made acrylic MAD in terms of the rate of response, reduction in indices of OSA severity, patient-centred outcomes and blood pressure improvement.…”

“…It is cheaper and allows treatment delays to be reduced compared with classic custom-made devices. In a bicentric cohort, Gagnadoux et al evaluated the efficacy of another titratable, thermoplastic MAD compared with a custom-made MAD 9. They found no efficacy differences either during PSG or in clinical outcomes.…”

“…Also, the MAD titration (adjustment of the degree of protrusion to optimise therapy) procedures are poorly standardised and the process can last several months with difficulties in predicting long-term effectiveness. Thermoplastic two-piece MADs constructed of a material that becomes mouldable when warmed by immersion in hot water,7 recently became titratable and might offer relatively cheap devices for testing efficacy in a given patient and to provide a fast-track treatment pathway before prescription of a more expensive two-piece custom-made MAD for long-term use 9. Such a paradigm merits being tested in a randomised controlled head-to-head trial.…”