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Impact of mandibular advancement device design and material in the efficacy of OSA treatment: Case report

Pedro Pileggi VINHA, Antonio FAGNANI–FILHO, Sheila Marques Inamassu LEMES, Gerson Paulino dos SANTOS, Eric THULER

Objective: To demonstrate that the intraoral appliance design can influence the snoring and obstructive sleep apnea (OSA) treatment efficacy. Method: Case report of OSA patient, also presenting snoring and daytime sleepiness. Initial polysomnography (PSG) with an apnea and hypopnea index (AHI) of 29.8 and oxygen nadir (SpO2 ) <90% = 5.9% of total sleep time. Non-adherent to CPAP, the patient was referred to an intraoral device with mandibular advancement (MAD), fully crafted with acrylic resin, covering the maxillary and mandibular incisors, approximately 4.5-mm thick. A control PSG was performed wearing this MAD, which resulted in an IAH of 15.4 and a SpO2 <90% = 4.4%. The complaint of persistent snoring and fatigue led her to search for an otolaryngolo- gist, who performed a drug-induced sedated endoscopy (DISE), identifying an upper airway (UA) obstruction due to the lack of tongue support, compromising the velopharyngeal and hypopharyngeal areas, not suitable for surgical treatment. She was finally referred to another sleep dentist, who changed the model of the device to a PPV2 in acetate, 1.5-mm thick. The same initial advance of 6mm was maintained and a PSG with the new MAD was performed, resulting in an AHI of 3.4 and SpO2 <90% = 0.5%. Conclusion: The design of the mandibular advancement device for OSA and snoring treatment can be determinant in the treatment efficacy. Apparently, appliances using thinner materials (such as acetate) have a better performance in the treatment of snoring and OSA.

Keywords: Sleep apnea, obstructive. Snoring. Mandibu- lar advancement.

How to cite: Vinha PP, Fagnani-Filho A, Lemes SMI, Santos GP, Thuler E. Impact of mandibular advancement device design and material in the efficacy of OSA treatment: Case report. Clin Orthod. 2020 Aug-Sept;19(4):109-21.

Tuesday, October 27, 2020 21:16