Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study

Abstract

Objectives Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OAm) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OAm is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OAm use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures. Materials and Methods A retrospective longitudinal study of 33 OSA patient treated with a different OAm, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance. Results Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters. Conclusion In this pilot study, DIORS OAm as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.

A Ten-Year Follow-Up Case Report on the Treatment of Severe Obstructive Sleep Apnea Using a Mandibular Advancement Device

“…Although several studies that have compared CPAP with MAD have shown that CPAP is more effective in reducing AHI, 5 other studies have shown no clinically relevant difference between CPAP and MAD in patients with mild-to-moderate OSAS when both treatment modalities are titrated or advanced objectively. [7][8][9] Despite the greater efficacy of CPAP in reducing AHI, in comparative trials of equivalence of health outcomes with CPAP and MAD, even in severe OSAS, MAD has been shown to be effective in treating OSA, not only by improving AHI but also by improving a variety of physiological and behavioral-cognitive outcomes. 10 During the COVID-19 pandemic, PSG laboratories became more difficult to access; therefore, type IV PSG with Biologix NDM was proposed, as this was found to have diagnostic value in detecting OSA.…”

“…2), we demonstrated the mode of action of MAD therapy in pharyngeal airspace improvement and hyoid distance reduction to the mandibular plane. In an observational study of 33 patients with OSA treated with Diors ® MAD, 8 the authors have associated this mode of action with a considerable reduction in AHI.…”

Obstructive Sleep Apnea: A Case Report

“…Thiol-disulphide is an essential redox parameter and is assessed as a screening tool in obstructive sleep apnea to monitor affected patients, and such parameters are increased when compared to healthy unaffected individuals [ 14 ]. Obstructive sleep apnea was successfully controlled using DIORS OAm (an oral appliance with mandibular advancement), a novel technology that used the Camper plane as a reference for disocclusion [ 15 ]. Transoral epiglottopexy, also known as glossoepiglottopexy, is the least invasive surgical procedure available for treating patients with obstructive sleep apnea caused by epiglottis closure.…”

Combined Therapy for Associated Orofacial Disorders—A Challenging Case Report

“…According to NOR concepts, the Camper's plane as a disocclusion reference intends to achieve neuromuscular balance and functional stability, using the same principles of the oral appliance with mandibular advancement device for obstructive sleep apnea treatment. 7 9 Bausch carbon (BK 200 μ) and maxcut tungsten cutters for the handpiece were used for adjustment ( Fig. 1 ).…”

“…This study aimed to report a challenging case of TMJ dysfunction associated with tinnitus, 2 cervicalgia, 3 and bruxism 4 treated and controlled with an analogic occlusal splint 5 and selective occlusal adjustments. This treatment is based on the neuro-occlusal rehabilitation (NOR) proposed by Pedro Planas laws 6 approach for improving mandibular movements with the functional balance 7 of the stomatognathic system respecting the minimum vertical dimension. 8 …”