Modified biblock versus monoblock mandibular advancement appliances for treatment of obstructive sleep apnea: A randomized controlled trial

Treatment of obstructive sleep apnea syndrome (OSAS) with mandibular advancement devices-A statement of the Portuguese Society of Pulmonology, the Portuguese Society of Stomatology and Dental Medicine, the Portuguese Dental Association, and the Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep

With the purpose of establishing a consensus around clinical orientations for professionals involved in managing patients with sleep breathing disorders (SBD), an interdisciplinary group of scientific societies involved in this field discussed and reviewed all the published international guidelines from the American Dental Association, American Academy of Sleep Medicine, American Academy of Dental Sleep Medicine and the European counterparts. Treatment of SBD is multidisciplinary and should be made in concert with the patient, the sleep physician, and the qualified dentist to solve the individual, social, and economic burden of the disease. This consensus document represents the current thinking of a team of Portuguese experts on managing patients with SBD based on the available evidence.

Elastic Bands Improve Oral Appliance Treatment Effect on Obstructive Sleep Apnoea: A Randomised Crossover Trial

BACKGROUND

Oral appliances (OAs) that limit mouth opening during sleep, such as monobloc appliances, have shown superior treatment effects in subgroups of patients with obstructive sleep apnoea. The application of elastic bands on bibloc appliances may resemble these benefits.

OBJECTIVES

The primary objective was to investigate if application of elastic bands to bibloc appliances improves treatment success (> 50% reduction of respiratory event index (REI)), in addition to other subjective variables. Furthermore, we aimed to identify variables predicting the need for elastic bands in OA treatment.

METHODS

Included patients (n = 69) were randomly assigned to OA treatment with or without elastic bands. After 3 weeks, treatment effect was investigated with home respiratory polygraphy and questionnaires. Thereafter, patients changed treatment modality, with identical follow-up regime. Statistical analyses were performed using Student's t-test and Pearson's chi-squared test to investigate differences between the two treatment modalities, and logistic regression analysis was conducted to investigate variables tentatively associated with treatment success.

RESULTS

Based on REI, the success rate with OA treatment was in favour of elastic bands (53.9% vs. 34.6%, p = 0.002). Male sex and larger maximum mouth opening were identified as predictors for increased treatment success with elastic bands. The main benefit with elastic bands seemed to be greater reduction of REI when supine. However, patients seem to prefer OA without elastic bands.

CONCLUSIONS

Elastic bands improved OA treatment effect by reducing the REI in supine position. Patient groups that seemed to benefit from elastic bands in OA treatment were men with large maximum mouth openings.

Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions

BACKGROUND

Mandibular advancement devices (MADs) are considered a primary alternative treatment for adults with moderate to severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, supported by substantial scientific evidence. While a range of designs and materials for MADs are commercially available, there is a lack of clear diagnostic guidelines to assist clinicians in selecting the most appropriate device based on a multidisciplinary evaluation of OSA patients. This narrative review seeks to outline the key characteristics of MADs that clinicians should evaluate during both the diagnostic and treatment phases for patients with OSA.

METHODS

An extensive search of academic databases was conducted to gather relevant studies that address therapeutic and diagnostic recommendations for the design and titration of MADs. The search was carried out across EMBASE, Scopus, PubMed, and Web of Science up to May 2024. From a total of 1445 identified citations, 1103 remained after duplicate removal. Based on the inclusion criteria, the full text of 202 articles was retrieved, and 70 studies were ultimately included in this review. The extracted data were organized to generate clinical insights, aimed at guiding orthodontists in optimizing diagnostic and decision-making processes for treating OSA patients with MADs.

RESULTS

The analysis led to the identification of key clinical questions that can assist orthodontists in enhancing their approach and choosing the appropriate appliance basing on the diagnosis and clinical dento-orofacial characteristics.

CONCLUSIONS

Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient's clinical condition and orofacial symptoms. Provisional devices could be used as screening tools to verify the patient's adherence to the therapy. Regardless of the MAD design, type and programmed advancement, it must be under-lined that the rule of the orthodontist/dental specialist is secondary to the other sleep-medicine specialists (ORL, pulmonologist) and must be related to (1) a preliminary assessment of MAD usage (dental anatomical conditions), (2) testing a diagnostic MAD usable during a sleep examination (PSG or DISE), (3) final treatment with a definitive MAD.

Comparison of efficacy and usability of custom mandibular advancement devices fabricated with the conventional method and digital workflow: A pilot clinical study

PURPOSE

To compare the effects of fabricating methods of custom monoblock mandibular advancement devices (MADs) on usability and efficacy in patients with mild and moderate obstructive sleep apnea (OSA).

MATERIALS AND METHODS

Digitally fabricated custom MADs (dMADs) were produced for 11 OSA participants who had previously used conventionally fabricated custom MADs (cMADs). The participants answered a modified usability questionnaire for both MADs, and the average scores that were given to the questionnaire were evaluated by age, sex, and body mass index (BMI), and the scores of cMADs and dMADs were compared. After 6 months of usage of each MAD, the apnea-hypopnea index (AHI), mean and lowest oxygen saturations, and total sleep time were measured for efficacy assessment. Data were analyzed with Cronbach's alpha, Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, one-way repeated measures analyses of variance, and Bonferroni tests (α = 0.05).

RESULTS

Cronbach's alpha was found at 0.834 and 0.722 for the conventional and digital questionnaires, respectively. The usability scores of the dMADs were significantly higher than those of cMADs (p = 0.013). There was no difference in usability scores in terms of sex or BMI (p > 0.05). No statistically significant difference was found for cMAD (p = 0.113) among age groups; however, there was a significant difference for dMAD (p = 0.046). The AHI, mean, and lowest oxygen saturation values were significantly affected by MAD usage (p < 0.001). However, total sleep time values did not differ after the MAD treatments (p > 0.05). Significantly lower AHI and significantly higher lowest oxygen saturation values were observed with dMAD, while both appliances led to similar results for mean oxygen saturation and total sleep time values (p > 0.05).

CONCLUSIONS

Participant usability scores were higher for digitally manufactured MADs than conventionally manufactured MADs. However, both conventional and digital MADs were found effective in decreasing the AHI levels and increasing the mean and lowest oxygen saturation values of the participants.

Upper Airway Characteristics and Morphological Changes by Different MADs in OSA Adult Subjects Assessed by CBCT 3D Imaging

This study aimed to analyse the effectiveness of four different designs of the Mandibular Advancement Device (MAD) and the morphological changes on upper airway characteristics of Obstructive Sleep Apnea (OSA) patients inducted by each of them, detected by Cone Beam Computer Tomography (CBCT) 3D imaging. Twenty-two patients were recruited after an OSA diagnosis with PSG. Four different customised and titratable MADs were used and an initial CBCT scan was obtained for each patient. Six months after the end of the MAD titration phase, all the subjects performed a second PSG with the MAD in situ; the second PSG showed an Apnoea-Hypopnoea Index (AHI) of <5 or a decrease of 50% in AHI when compared with the initial AHI. Moreover, a second CBCT scan with the MAD in situ was performed. DICOM files were imported into the airway analysis software programme and the pharyngeal area around the oropharynx was highlighted. The area and volume of the oropharynx with and without the device was evaluated. A considerable improvement of the airway was observed (+33.76%), and a significant difference in the enlargement ratio between the posterior soft palate (+32.41%) and the posterior tongue (+36.96%) region was also found. The greatest increase in airway volume was achieved in patients treated with the MAD Forward and TAP (+42.77% and +41.63%, respectively). MAD therapy is effective to treat moderate to severe OSA with an increased upper airway volume. The design of the MAD can influence the effectiveness of the treatment.

Cytotoxic assessment of 3D printed photoinitiated prosthodontic resins versus heat polymerized acrylic resin (In-Vitro Study).. [DOI: 10.21203/rs.3.rs-1948364/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Although 3D printed photoinitiated resins are among the many materials utilized in prosthetic appliances today, biocompatibility for photocuring 3D printing materials for direct and long-term contacting with living body remain scarce. The purpose of this in vitro study was to evaluate the cell viability of human gingival fibroblasts after the exposure to two different 3D printed photoinitiated resins and compare it to the traditionally used heat polymerized acrylic resin for up to 7 days.Methods: This comparative in vitro study of sample size (n= 96), where the 3D printed resin disc samples (n= 64), were divided into two test groups, test group 1 (TG1) for NextDent Base resin (n= 32) and test group 2 (TG2) for Dental LT clear resin (n= 32), to be compared to Heat polymerized acrylic resin samples (Reference group (RG)) (n= 32). Human gingival fibroblasts were extracted from attached keratinized gingival tissues collected from healthy patient undergoing clinical crown lengthening procedure, cellular viability using MTT assay in response to TG1, TG2 and RG samples was assessed throughout four-time intervals (24, 48, 72 and 168 hours). The One-Way ANOVA test followed by Tukey’s post hoc test and Repeated Measures ANOVA test were used for statistical analyses, statistically significant different at P value ≤ 0.05Results: Throughout time intervals, there was a decrease in cell viability of all groups but with favorable cell viability which was more that 90% denoting non cytotoxicity. It was found to be significant among RG (P< 0.0001). The highest cell viability was found after 24 hours among all groups; however, the least viability was found after 48 hours among TG1 and RG, and among TG2 after 72 hours. After 168 hours, there was a non-statistical significant change in cell viability between groups (P= 0.526). there was significant increase in optical density for all groups throughout time intervals (P< 0.0001).Conclusion: Photoinitiated resins are comparable to traditionally used heat polymerized acrylic resin with equivalent cytotoxic effect for long term use. 3D printed photoinitiated resins are biocompatible and suggested for long term intraoral use.