pubmed.ncbi.nlm.nih.gov

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

  • ️Fri Jan 01 2021

Case Reports

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

G Dave Singh et al. World J Clin Cases. 2021.

Abstract

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. Finite-element 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.

Keywords: Biomimetic oral appliance therapy; Case report; Continuous positive airway pressure; Mandibular advancement device; Obstructive sleep apnea.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest except that Professor G. Dave Singh DMD PhD DDSc is Founder and Chief Medical Officer of Vivos Therapeutics, Inc.

Figures

Figure 1
Figure 1

Pre-treatment upper and lower study models: Note that the upper and lower arches appear to be reduced in size with mild crowding and wear facets of the upper and lower anterior teeth.

Figure 2
Figure 2

Pre-treatment cone-beam computed tomography scan: Note that the minimum transpalatal bone width measured at the cervical margin of the mesio-palatal cusps of the first molars is approximate 32 mm.

Figure 3
Figure 3

The biomimetic appliance used in this study: Note 6 anterior 3D axial springs; midline anterior/posterior screws; occlusal pads; retentive clasps, a labial bow and a screw-fin mechanism.

Figure 4
Figure 4

Post-treatment upper and lower study models: Note the upper study model shows an increased in size with partial recapture of the premolar spaces.

Figure 5
Figure 5

Post-treatment cone-beam computed tomography scan. Note that the minimum transpalatal bone width measured at the cervical margin of the mesio-palatal cusps of the first molars has increased from 32 mm pre-treatment to approx. 34.2 mm post-treatment over 10 mo.

Figure 6
Figure 6

Finite-element analysis of the pre- and post-treatment upper arch. Note the pseudocolor scale indicates a localized size increases of 15%-20% in the incisal region, 15%-17% in the premolar regions and 15%-23% in the molar regions (orange-yellow coloration). Node A: Contact point of central incisors in midline at incisive papilla; Node B: Medial-most point on cingulum of right cuspid at cervical margin; Node C: Medial-most point on cingulum of left cuspid at cervical margin; Node D: Medial-most point on palatal cusp of right second premolar at cervical margin; Node E: Medial-most point on palatal cusp of left second premolar at cervical margin; Node F: Medial-most point of mesio-palatal cusps of right first molar at cervical margin; and Node G: Medial-most point of mesio-palatal cusps of right first molar at cervical margin.

Similar articles

Cited by

References

    1. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2019;15:335–343. - PMC - PubMed
    1. Li HY, Lee LA, Tsai MS, Chen NH, Chuang LP, Fang TJ, Shen SC, Cheng WN. How to manage continuous positive airway pressure (CPAP) failure -hybrid surgery and integrated treatment. Auris Nasus Larynx. 2020;47:335–342. - PubMed
    1. Medical Advisory Secretariat. Oral appliances for obstructive sleep apnea: an evidence-based analysis. Ont Health Technol Assess Ser. 2009;9:1–51. - PMC - PubMed
    1. Marklund M. Long-term efficacy of an oral appliance in early treated patients with obstructive sleep apnea. Sleep Breath. 2016;20:689–694. - PubMed
    1. Cooper BC, Cooper DL, Lucente FE. Electromyography of masticatory muscles in craniomandibular disorders. Laryngoscope. 1991;101:150–157. - PubMed

Publication types

LinkOut - more resources