Changes in sleep parameters following biomimetic oral appliance therapy: A case report

BACKGROUND Mandibular advancement devices(MADs)are used to treat mild to moderate obstructive sleep apnea(OSA),but there is a risk that the underlying condition can worsen in the long-term.Therefore,this case report is based on biomimetic oral appliance therapy as an alternative to MADs,which was found to be beneficial in the treatment of a case with severe OSA.CASE SUMMARY An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index(AHI)was found to be 32.8/h.Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention,treatment with a MAD was initiated.Approximately 10 years later,another sleep study was performed with no MAD in the mouth,which revealed an AHI of 67.9/h.In view of the deterioration in sleep quality,the patient sought alternative treatment and elected on biomimetic oral appliance therapy,using a mandibular repositioning nighttime appliance(mRNA appliance®,Vivos Therapeutics,Inc.,United States).After 10 mo,another sleep study was performed with no device in the patient’s mouth,which revealed an AHI of 11.8/h,a mean oxygen saturation of 94%and a mean oxygen desaturation index of 5.3%while sleeping.Finiteelement analysis of the pre-and post-treatment study models of the upper jaw showed localized size increases of 15%-17%in the premolar regions and 15%-23%in the molar regions.CONCLUSION In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment,biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex.Long-term follow up studies are required to verify these novel findings.

Changes in pneumatization of the maxillary air sinuses in Korean adults following biomimetic oral appliance therapy

Objective:For the treatment of obstructive sleep apnea in adults,mandibular advancement devices(MADs)are often used.Since adults with a prognathic mandibular phenotype are at risk of developing an unfavorable facial profile,midfacial development using biomimetic oral appliance therapy might provide a suitable alternative.However,the effect of this procedure on the maxillary air sinuses is unknown;therefore,changes in sinus pneumati-zation were investigated in this study.Methods:After obtaining informed consent,16 consecutive Korean adults with midfacial hypoplasia had 3D cone-beam(CB)CT scans taken,and biomimetic upper appliances(DNA appliance■,Vivos Therapeutics,Inc.,USA)were constructed.All subjects were instructed to wear the device 12-16 h/day.Each month,examination for the progress of midfacial development was recorded.Post-treatment,a follow-up 3D CBCT scan was undertaken with no device in the patienfs mouth.Pre-and post-treatment linear and volumetric measurements were obtained using appropriate software,and compared statistically using t-tests.Results:The mean age of the sample was 25.0 yrs±8.7.The mean treatment time was 15.5 mths±5.2.Post-treatment,the transpalatal bone width increased from 35.3 mm±3.0 to 38.5 mm±2.0(P<0.001);the maxillary air sinus volume on the left side increased from 18.8 cm^(3)±6.5 to 20.0 cm^(3)±6.0(P<0.05),and from 18.5 cm^(3)±5.7 to 19.7 cm^(3)±5.8(P<0.05)on the right side.Conclusions:Biomimetic oral appliance therapy may be able to increase the maxillary air sinus volume in adults.In view of these preliminary findings,further studies on the effect of enhanced pneumatization on paranasal sinus function and sleep parameters are warranted.