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Conservative therapy of obstructive sleep apnea using an in-office 3D-printed, titratable mandibular advancement
Eva Řezáčová1, Jiří Hálek2, Eva Kubásková1
1Department of Stomatology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Stomatology, University Hospital Pilsen, Pilsen, Czech Republic.
Background:
The aim of this study was to evaluate the effectiveness and side effects of in-office 3D-printed mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA).
Methods:
The study included 23 patients. A novel type of 3D-printed MAD was developed specifically for the treatment of OSA. At the beginning of therapy, orthodontic documentation was obtained. During follow-up visits, a cone-beam computed tomography scan was performed with the MAD in situ to verify changes in the airways, and patients were referred to a sleep laboratory to assess the effectiveness of the therapy. After 1 year of treatment, orthodontic documentation was repeated, and the side effects of MAD therapy were noted. Patients also completed questionnaire to evaluate the subjective effectiveness of the treatment.
Results:
Side effects were observed during MAD therapy for OSA. These side effects were primarily related to dentoalveolar compensation, most notably changes in the position of the upper (2.22° P < 0.001) and lower (1.91°, P = 0.003) incisors and alterations in occlusion. A statistically significant increase was observed in the maximum cross-sectional area (72.62 mm2, P < 0.001). The therapy was objectively successful in 74% of patients. Subjectively, all patients reported an improvement in their condition. The study did not reveal any direct association between the use of the MAD and temporomandibular joint damage in the study cohort.
Conclusions:
In-office 3D-printed, titratable MADs represent easily fabricated therapeutic option for OSA treatment, with favorable clinical outcomes. They may offer a solution for a broad spectrum of patients.
