Customised mandibular advancement splint for apnoeic patients undergoing maxillomandibular advancement

Abstract

Fig. 1. Upper and lower fixed appliance in situ. andibular advancement splints are an effective treatment or patients with obstructive sleep apnoea,1 and prospecive studies have reported their use to be comparable to he gold standard of continuous positive airway pressure.2 owever, both these treatments address only the symptoms, nd patients often request a solution that avoids long-term ependence on either method. Recent evidence suggests that urgical advancement of the maxillary and mandibular bases s effective, and is associated with few complications.3 A postive response to the use of splints has been reported to predict ases that would be amenable to future maxillomandibular dvancement.4 The treatment involves use of orthodontic ppliances to prepare the patient before operation, but placeent of a fixed appliance can compromise use of a splint uring the pre-surgical orthodontic phase, and can result in ymptoms returning and worsening. To overcome this problem we construct a one-piece emovable vacuum-formed customised mandibular advanceent splint (Figs. 1 and 2). After initial placement of the rthodontic appliances, upper and lower alginate impressions re taken. A wax occlusal registration is taken with no jaw eviation at maximum mandibular protrusion with minimal aw opening. The splint is made from polyethylene blanks ® .5 mm thick (ERKOFLEX-95, ERKODENT Erich Kopp mbH, Germany). The fitting surface of the splint around the xed appliances is intentionally eased to enable the teeth to