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(1) Tongue
retainer.
There are not many available, however they have been well
researched and shown to be effective in selective patients. Patient
compliance and acceptance is a problem for long term use. Useful
for patients with limited or no teeth.
(2) MonoBlocks or Fixed
Devices.
These are by far the most common available. Can be
useful as a trial splint or where economics dictate what a patient
should have.
However TMJ problem's are universally reported with
them because they lock the jaw and mouth into a fixed position.
Total disaster for bruxers.
They offer no adjustment, therefore they have to be
remade if further protrusion is needed (which is common after a
patient has worn a splint for a few months). The common complaint
is "it worked ok at the start but I have started to snore
again".
While they are cheap, the complications from side
effects and costs associated with having to remake, make it
expensive therapy.
Tend now only to be sold by mail order or advertised
over the air or in papers. Not used often by Dental Sleep
Dentists.
(3) Flimsy Trial Splints.
There are not
many of these available. Traditionally made from all plastic with
plastic side hinges. Can be useful as a trial
splint.
Most supply
with a repair kit to replace hinges when they break. The real
question is if they break when wearing them which is while you are
asleep where do the broken bits go?
(4) Adjustable Mandibular Repositioning
Appliances.
These are by far the largest group and the
first of the adjustable, based on traditional orthodontic
principals, devices or components.
They have a variety of different
configurations but all have the one major problem, lack of lateral
movement.
Those that have metal hinges on the side
have been reported to caused teeth movement and
eruptions.
Often to make further adjustments during
treatment can be very difficult and complicated leading to extended
periods to acclimatize patients with this type of
device.
This was reported in a study using this
style of appliance published in the Am.J, respir.crit.care med
Volume 163, number 6, May 2001.(page 6 - results-study
population)
A Randomized, Controlled Study of a
Mandibular Advancement Splint for Obstructive Sleep Apnea. by MEHTA
et al AJRCCM Vol 163 2001.....The mean acclimatization period (wash
in period) was 19.7± 8.8 weeks ( range, 5 to 40 wks
)...
Oral
appliance Therapy Improves Symptoms in OSA by Helen
Gotsopoulos etal AJRCCM Vol 166 2002 ...The acclimatization to the
MAS was 8±4 wks ( range, 2-22wks )
They are also very
expensive to make and tend to be made only by large commercial
orthodontic labs.
 
 
 
(5)
Titratable Mandibular Repositioning Appliances.
(A)The first of these
was the TAP which allowed full lateral movement and titration while
in situ.
The downside of the appliance
is
(a) Only made by commercial
labs
(b) uses a combined acrylic plate with
boil and bite filler for retention. Filler breaks down and not very
durable.
Very rigid and hard on teeth causing tooth
soreness and ache
(c) Large lingual bar in the bottom plate
impedes the tongue coming forward.
(d) an external winder has to be used till
the right advancement is obtained (can be for some weeks) once the
winder is cut off no post adjustment can be
obtained.
 
(B) The MDSA® Component concept
Appliance.
The most versatile and clinically proven
to be an effective alternative to CPAP for the treatment of Snoring
and Mild to Moderate Sleep Apnea.
Efficacy of Positive Airways Pressure and
Oral Appliance in Mild to Moderate Obstructive Sleep Apnea. M
Barnes et al. Am Jnl Resp Cr C M June
2004.
...In the wash-in period it was advanced
weekly by the study dentist as tolerated by subjects, until the
maximum comfortable protrusion was reached, taking up to 3
weeks.
Clinically
tested to overcome the problems, limitations and side effects
associated with all other oral appliances.
For full details on the MDSA® refer to
opening page of website.
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