The use of oral appliances in obstructive sleep apnea: a retrospective cohort study spanning 14 years of private practice experience

Abstract

In patients with evaluable data, there was an 80% success rate for treatment of OSA using a custom-fabricated adjustable MAD including substantial numbers of patients with moderate and severe disease.

Reasons for failure of mandibular advancement splint therapy in the treatment of obstructive sleep apnea

“…Thus, there does not appear to be a clear reason for treatment failure. The current results are similar to the previous results of Mintz et al [7], who also found no clear reason for treatment failure. Instead, they also found several different reasons for the failure of MAS treatment, e.g., TMJ or masticatory muscle pain, difficulties in tolerating MAS, bite changes, tooth loss, tooth pain, gagging, and lack of retention.…”

“…In addition, a shortened dental arch or missing teeth can also cause problems in MAS treatment. Tooth loss is a highly prevalent oral health problem with a high impact on general health and quality of life [7]. A shortened dental arch causes reduced masticatory performance, and distal-extension removable partial dentures are commonly used to compensate for edentulism, although the effects of the dentures are not fully conclusive [8].…”

Evaluation of factors that influence the success rate of OSA treatment with a customised adjustable MAD device - a retrospective study

“…Fernandez-Julian et al reported successful (AHI< 10 and Epworth Sleepiness Score < 10) treatment in 50% of adult patients with moderate to severe OSA 3 . Mints et al showed a higher success (defined as post-treatment AHI < 10) rate of 80% using a customised adjustable appliance in a sample of 510 patients comprising mild, moderate and severe OSA 10 , and concluded that treatment success is not dependent on the baseline degree of severity of OSA. This finding is in contrast with our results: a significant (P = 0.001) effect of baseline 3% ODI value on treatment success was found ( Tab.…”

“…A MAD acts by forcing the mandible to a forward position, thus increasing the upper airway’s volume by widening the velopharynx, stabilising the soft palate and hyoid bone, stretching the tongue muscles and preventing the posterior rotation of the mandible 9 . Although CPAP is more effective in reducing the AHI, this difference is overcome by greater compliance and acceptance of MAD therapy 10 , 11 .…”

“…The results of a systematic review demonstrated that different types of MADs have different efficacy in terms of mandibular protrusion and reduction of OSA events 12 , with fully customisable devices showing superior performance 10 . While there is consensus on a comparable efficacy in AHI reduction between CPAP and MAD in mild to moderate OSA patients, there is still some uncertainty regarding severe OSA patients: while some authors reported promising results for severe OSA patients 10 , a systematic review of the relevant literature was unable to perform a subgroup analysis to evaluate the efficacy of MAD therapy related to OSA severity 11 . In addition, the current literature provides only a limited number of studies that describe the amount of mandibular advancement, considered as an important factor for both treatment outcomes and side effects 13 .…”