Retention of mandibular advancement devices in the treatment of obstructive sleep apnea: an in vitro pilot study

Abstract

PurposeIn order for a mandibular advancement device (MAD) to be efficacious, it must remain seated on the teeth during sleep. Quantitative data on the retentive characteristics of MADs are currently unavailable. The present pilot study is the first to describe an in vitro setup testing the retentive characteristics of different monobloc MADs.MethodsA hydraulic cyclic test machine was used with MADs seated on dental casts to measure retention forces upon removal of the MADs. A custom-made monobloc (CM-mono), a thermoplastic monobloc (TP-mono), and a thermoplastic duobloc (TP-duo) configured as a monobloc were tested. Two protrusions were investigated, representing 25 and 65 % of the maximal protrusion. The effects of the type of MAD, duration of the test, and amount of protrusion on removal forces were measured.ResultsThe measured removal forces of all three MADs tested differed significantly, with the TP-duo showing the highest values (P < 0.0001). The effects of wear due to the repetitive cyclic loading became obvious by the production of wear particles in all MADs tested. However, only the TP-duo showed a significant reduction in time in removal forces for both protrusion positions (P < 0.0001; P = 0.0011). The effect of the amount of protrusion on the removal forces differed significantly between all three MADs tested (P = 0.0074).ConclusionsThis in vitro pilot study reveals significant differences in retention forces for the MADs tested. The findings are consistent with clinical effects of nightly loss of MADs as reported in the literature and are within the range of reported physiological mouth-opening forces. Future research is needed to determine the key design features of MADs that explain these differences.

In vitro retention of a new thermoplastic titratable mandibular advancement device

“…The setup used in this study extends the experimental setup used previously 8 by introducing a more standardized set of carriers with respect to tooth anatomy and shape of the tooth arcs. The results indicate that the measurements did not differ significantly between the two types of carriers, namely epoxified casts versus ANA-4 Frasaco models.…”

“…The casts and ANA-4 models were mounted in average value inclination of the occlusal plane and centred in a hydraulic cyclic test machine (Dartec HC10, Testbench Dartec 9600 Controller; Dartec, UK) as described previously 8 .…”

“…The primary requirement for an OAm to be effective is the adequate retention on the teeth while the patient is asleep. Recently, in vitro testing of such retentive characteristics of different types of OAm, including thermoplastic ones, was reported in the literature 8 , demonstrating that generalization of the retentive characteristics with respect to the design and type of an OAm is not pertinent.…”

Orthodontic occlusion and temporary removable retainers

“…It is essential to assess the state of dental support, rendered sensitive by the phenomena of apposition and resorption inevitably induced by displacing teeth 32 , and to ensure absence of mobility.…”

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

“…A previous randomized cross-over trial found that a monobloc nonadjustable thermoplastic MAD with insufficient overnight retention was less effective that a custom-made MAD [13]. The main requirement for a MAD to be effective is the adequate retention on the teeth while the patient is asleep [14,15]. The aim of this study was to evaluate the efficacy of a titrable, thermoplastic MAD compared to a custommade MAD for mild to severe OSA therapy.…”