Abstract
A mandibular advancement device (MAD) is a commonly used treatment modality for patients with mild-to-moderate obstructive sleep apnea. Although MADs have excellent therapeutic efficacy, dental side effects were observed with long-term use of MADs. The aim of this study was to analyze the force distribution on the entire dentition according to the materials and design of the MADs. Three types of MADs were applied: model 1 (single layer of polyethylene terephthalate glycol (PETG)), model 2 (double layer of PETG + thermoplastic polyurethane (TPU)), and model 3 (core-reinforced multilayer). In the maxilla, regardless of the model, the incisors showed the lowest force distribution. In most tooth positions, the force distribution was lower in models 2 and 3 than in model 1. In the mandible, the mandibular second molar showed a significantly lower force in all models. The mandibular incisors, canines, and molars showed the highest force values in model 1 and the lowest values in model 3. Depending on the material and design of the device, the biomechanical effect on the dentition varies, and the core-reinforced multilayered MAD can reduce the force delivered to the dentition more effectively than the conventional single- or double-layer devices.
Highlights
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated obstruction of the upper airway during sleep, and it is highly prevalent in the elderly population [1]
According to the clinical guidelines of the American Academy of Sleep Medicine (AASM) in 2015 [7], the improvement in quality of life by customized and titratable mandibular advancement device (MAD) is not inferior to that reported with Continuous positive airway pressure (CPAP) therapy
There is no definite consensus on which design is the most effective, and a wide variety of vertical dimension of MADs were reported ranging from 1–14 mm [27,28]
Summary
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated obstruction of the upper airway during sleep, and it is highly prevalent in the elderly population [1]. Continuous positive airway pressure (CPAP) is the first-line treatment for adult patients with moderate-to-severe OSA. A significant proportion of patients are unable to tolerate CPAP [2]. Mandibular advancement devices (MADs) are widely used to treat OSA patients with mild-to-moderate symptoms who are unable to tolerate CPAP therapy [3,4,5,6]. Long-term study showed that both CPAP and MAD therapy demonstrated good and stable treatment effects over a 10-year follow-up [8]. As the therapeutic value of MADs became important, the role of dentists in dealing with MADs is being increasingly emphasized. A qualified dentist should have the skill to choose the appropriate MAD and make necessary modifications to accommodate patients
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