Abstract
Oral appliance (OA) therapy with a mandibular advancement device (OAm) is a non-invasive, alternative approach to maintaining upper airway patency. The main requirement for an OAm to be effective is the adequate retention on the teeth while the patient is asleep. We evaluated the retentive forces of a new low-cost, customizable, titratable, thermoplastic OAm (BluePro (®); BlueSom, France). Dental impressions and casts were made for one patient with complete upper and lower dental arches including the third molars and class II bite proportions. A setup based on Frasaco ANA-4 models was also used. Two protrusive positions of the mandible were investigated: 3 mm and 8 mm, representing respectively 25% and 65% of the maximal protrusion. The forces required to remove the BluePro (®) device from the carriers were recorded continuously over 730 cycles (=365 days, twice a day) to simulate 1 year of clinical use. At 8 mm protrusion the BluePro (®) device showed retentive forces of ~27N. There was a slight but non-significant decrease in retentive forces in the tests on the epoxified carriers which was not found on the ANA-4 carriers. There were no significant differences between the carriers as a function of protrusion. The BluePro (®) device tested in the present study possesses sufficient retention forces to resist initial jaw opening forces and full mouth opening forces estimated to be ~20N. It could therefore broaden the indications for use of thermoplastic OAms. It could provide a temporary OAm while a custom-made OAm is being manufactured or repaired. Patients could be provided with a low-cost try-out device capable of reliable titration, providing an indication of effectiveness and of patient acceptance of an OAm, although the effect of device shape and size on therapeutic outcome is not yet known. Finally it could provide an affordable OAm solution in resource-restricted healthcare settings.
Highlights
Oral appliance (OA) therapy with mandibular advancement devices (OAm) is becoming the main non-invasive and alternative approach to continuous positive airway pressure
The removal forces (N) expressed as a mean (± SD) for both protrusion positions (3 mm and 8 mm) at the beginning and end of the tests revealing the effect of test duration are shown in Table 1: there was a slight but not significant decrease in retentive forces for the tests on the epoxified carriers, not to be found for the ANA-4 carriers
The results indicate that the measurements did not differ significantly between the two types of carriers, namely epoxified casts versus ANA-4 Frasaco models
Summary
Oral appliance (OA) therapy with mandibular advancement devices (OAm) is becoming the main non-invasive and alternative approach to continuous positive airway pressure. By advancing the mandible and tongue, upper airway patency is favoured during sleep thereby preventing upper airway collapse[1]. Many types of OAm are available[2,3,4,5], each requires retention on the teeth to maintain protrusion of the mandible during sleep. Lack of retention causes loosening of the OAm and may result in reduced efficacy of treatment, patient complaints about poor fit and an increased risk of side effects[4,6,7]. A setup based on Frasaco ANA-4 models (Frasaco, Germany) was made
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