Since April 2004, the Asahi University Medical and Dental Center (hereinafter referred to as our center) has been providing oral appliances (hereinafter referred to as OA) to treat patients diagnosed with obstructive ...Since April 2004, the Asahi University Medical and Dental Center (hereinafter referred to as our center) has been providing oral appliances (hereinafter referred to as OA) to treat patients diagnosed with obstructive sleep apnea. The effects of using the OA and progress of 71 patients who received treatment at our center by wearing OA from March 2005 to the end of March 2016 were examined through questionnaires sent by physical mail. In 21 of 24 patients who underwent polysomnography after wearing OA, the apnea-hypopnea index (hereinafter referred to as AHI) significantly decreased after wearing OA (9.44 ± 10.37) compared to that before wearing OA (24.02 ± 13.57) (p = 8.7 × 10<sup>-8</sup>). The results showed that for patients who continuously use OA, it is necessary to have sound sleep/sleep soundly;further, the patients experienced a decrease in snoring when wearing OA, with only a few side effects on the temporomandibular joints and teeth. In addition, the closer the distance from the plane of the lower margin of the mandible to the hyoid bone after wearing OA, the more likely it was for the AHI to decrease, which suggests that wearing OA contributes to the prediction of therapeutic effects.展开更多
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 i...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.展开更多
Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are prov...Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are proven to be efficient in treating mild to moderate sleep apnea and snoring. We examined patients who had been treated in Community Dental Care with a titrable Herbst-type MAD. The aim of the study was to evaluate the quality of sleep based on self report. Methods: A questionnaire was mailed to patients (n = 184) who had received treatment for OSA or snoring between 2007 and2010 inthe Helsinki Health Centre Oral Care Unit. The patients were referred to the clinic for primary treatment, or because another treatment modality had failed. Results: Of the respondents (n = 142, 78.4%), OSA had been diagnosed in 74%, while the MAD was applied for snoring to the remaining. Among all respondents, 78.4% had worn the MAD at least three nights per week. With the MAD in situ, sleep was felt significantly less disrupted (p < 0.001) and more restorative (p < 0.001), and snoring was markedly reduced (p < 0.001). Daytime tiredness was also markedly less frequent (p < 0.001). Conclusions: Treatment with a MAD improved perceived sleep quality and awoke alertness in mild and moderate OSA patients and in snorers. This study supports such treatment to be initiated and monitored in community dental care.展开更多
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 p...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.展开更多
文摘Since April 2004, the Asahi University Medical and Dental Center (hereinafter referred to as our center) has been providing oral appliances (hereinafter referred to as OA) to treat patients diagnosed with obstructive sleep apnea. The effects of using the OA and progress of 71 patients who received treatment at our center by wearing OA from March 2005 to the end of March 2016 were examined through questionnaires sent by physical mail. In 21 of 24 patients who underwent polysomnography after wearing OA, the apnea-hypopnea index (hereinafter referred to as AHI) significantly decreased after wearing OA (9.44 ± 10.37) compared to that before wearing OA (24.02 ± 13.57) (p = 8.7 × 10<sup>-8</sup>). The results showed that for patients who continuously use OA, it is necessary to have sound sleep/sleep soundly;further, the patients experienced a decrease in snoring when wearing OA, with only a few side effects on the temporomandibular joints and teeth. In addition, the closer the distance from the plane of the lower margin of the mandible to the hyoid bone after wearing OA, the more likely it was for the AHI to decrease, which suggests that wearing OA contributes to the prediction of therapeutic effects.
文摘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.
文摘Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are proven to be efficient in treating mild to moderate sleep apnea and snoring. We examined patients who had been treated in Community Dental Care with a titrable Herbst-type MAD. The aim of the study was to evaluate the quality of sleep based on self report. Methods: A questionnaire was mailed to patients (n = 184) who had received treatment for OSA or snoring between 2007 and2010 inthe Helsinki Health Centre Oral Care Unit. The patients were referred to the clinic for primary treatment, or because another treatment modality had failed. Results: Of the respondents (n = 142, 78.4%), OSA had been diagnosed in 74%, while the MAD was applied for snoring to the remaining. Among all respondents, 78.4% had worn the MAD at least three nights per week. With the MAD in situ, sleep was felt significantly less disrupted (p < 0.001) and more restorative (p < 0.001), and snoring was markedly reduced (p < 0.001). Daytime tiredness was also markedly less frequent (p < 0.001). Conclusions: Treatment with a MAD improved perceived sleep quality and awoke alertness in mild and moderate OSA patients and in snorers. This study supports such treatment to be initiated and monitored in community dental care.
文摘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.
