Immediate Intraoral Adaptation of Mandibular Advancing Appliances of Thermoplastic Material for the Treatment of Obstructive Sleep Apnea

Abstract

Background: In the treatment of obstructive sleep apnea (OSA), mandibular advancing devices (MAD) are usually individually fabricated on plaster casts of both jaws from polymethyl-methacrylate. The potential disadvantages of these devices are (1) the costs and (2) the time required to construct the device. Objective: In this study, the efficacy and feasibility of a cheap MAD consisting of thermoplastic material (SnorBan^®), which can be directly moulded intraorally, were evaluated. Methods: In a prospective study, the effect of an MAD consisting of thermoplastic material was investigated in 22 consecutive patients with OSA [respiratory disturbance index (RDI) 32.6 ± 18.4/h]. Polysomnographic sleep was recorded prior to treatment and after 3 months of treatment with the MAD. Results: Three of the 22 patients who did not tolerate the MAD were excluded from the analysis, whereas 11 patients were classified as responders. In the responder group, the mean RDI decreased from 27.6 ±7.3 to 7.3 ± 2.9 (p < 0.01), correspondingly the sleep quality and the Epworth Sleepiness Scale improved (p < 0.05). Eight patients proved to be non-responders without relevant changes for the measured parameters. Conclusions: In 50% (11 of 22) of the patients, the MAD improved the OSA to a clinically relevant degree. In contrast to the majority of established MAD, the MAD investigated is cheap and immediately adaptable and thus a feasible strategy to ‘screen’ the efficacy of this therapeutic principle. Thus the construction of unnecessary MAD is avoided.

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

“…81 Initially it was proposed as a feasible, low cost, screening device for the treatment of snoring and OSA. 82,83 A later randomized controlled cross-over study found that AHI was only reduced with the customized device which was preferred by 82% of subjects. 84 In this study, 33% of patients cited poor overnight retention as the main reason for compliance failure whereas a later study by Tsuda et al recorded 77.8% of non-users of thermoplastic OAs were non-compliant in the first three months complaining of poor comfort and fit of the device.…”

Snoring and Obstructive Sleep Apnea: Objective Efficacy and Impact of a Chairside Fabricated Mandibular Advancement Device

“…8 However, few studies have been conducted on immediately fitted devices; most of the results available focusedd on mono-block MADs, which had lower success rates than custom-built devices. [9][10][11][12][13][14] Some authors have suggested that the lower efficacy of monoblock MADs could be related to two parameters: first, the stability in the mouth, and second, the degree of control of mandibular advancement, which were both better with custommade MADs, due to the tailored production and use of different length connectors. 9,12,14 Several studies have shown that there is a relationship between OSAS treatment efficacy and degree of control over mandibular advancement.…”

Comparison of a Custom-made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea

“…Potential disadvantages of this custom-made method are the costs and time required to construct the device. Therefore, prefabricated MADs made out of thermoplastic material, which can be adapted immediately at the outpatient clinic, have been studied as a treatment option (16,22). It has been hypothesized that these thermoplastic devices could provide a reasonable alternative to custom-made devices to reduce the costs as well as to predict the success with the custom-made devices (22,23).…”