From Dumb and Dumber to Case Reports to Decision-Making in the DSM Practice

Study Objectives: To evaluate the efficacy of three mandibular advancement device (MAD) designs in terms of apnea-hypopnea index (AHI), minimum blood oxygen saturation (min SpO 2 ), and Epworth Sleepiness Scale (ESS) between pretreatment and posttreatment sleep studies for the management of obstructive sleep apnea (OSA). The protrusive range at the time of the second sleep study was correlated with the effectiveness of MAD designs. Methods: Retrospective data from 49 patients with OSA referred to the Orofacial Pain Clinic at University of Kentucky (March 2016- March 2021) treated with MAD, with a post-treatment sleep study, were included. Treatment success was defined as 50% improvement in AHI, or as 50% improvement with residual AHI < 10/h. Results: Posttreatment AHI improved with Herbst and SomnoDent-Classic ( P =.003 and P =.000, respectively). Posttreatment ESS score improved with Herbst, SomnoDent-Classic, and D-SAD designs ( P =.004, P = .000, and P =.018, respectively). No differences were found between the three MADs in terms of change in AHI, min SpO 2 , and ESS (all P >.050). Treatment success was achieved in 59.18% and 48.97%, according to the criteria, with no difference between the appliances and no correlation with the range of protrusion. Conclusion: The three MADs were efficacious in improving AHI and ESS, but not min SpO2, in patients with OSA, with no differences between MAD designs. Because some patients showed a worsening in AHI, a posttreatment sleep study is of great importance. Clinical Implications: MAD should be selected on an individual basis, according to patient preference and trained dentist recommendation, as the design did not affect the effectiveness in terms of AHI improvement. Comparison of three mandibular advancement device designs in the management of sleep A retrospective study. (range: 54.8-100%). Conclusions: The OAs used in the studies provided efficacious treatment for the majority of individuals with severe OSA, indicating that oral appliance therapy could be a suitable alternative to CPAP. The rate of therapeutic success was higher than that reported previously in the literature and might be a result of the precision of appliances generated from digital intraoral scans using a CAD/CAM approach. Study data were collected by and used the of Technologies. ProSomnus Sleep Technologies provided the OAs used in the studies. of mild, 96% of moderate and 59% of severe patients) Conclusions: This novel interactive device and material combination appear, after early analysis, appear to yield significantly better results that previous data has demonstrated. The literature suggests that legacy oral appliance efficacies range from 50%-62% and other AADSM poster/abstracts have reported similar precision milled, control cure PMMA appliances in the 74% - 76% range. These results suggest a need for further investigation of exceptional efficacy for this device design and material. Conclusions Severe SB is highly prevalent in adults with non-apneic snoring compared to the general population. The increase of sleep arousal increases the odds of having severe SB, while higher BMI and higher percentage of sleep stage 2 decreased the odds of having severe SB. Support Not applicable. prominence and nasolabial angle. The changes in soft tissue measurements were comparable between the two groups. The satisfaction degrees in breathing (7.0 vs 6.5, P = 0.713) and facial esthetics (6.5 vs 7.0; P = 0.983) did not differ significantly between both groups. Conclusions: Within the limitations of the retrospective study, it can be concluded that there is no significant difference in the effects of MMA on respiratory function and facial esthetics between OSA patients with and without maxillomandibular deficiency. Support: Not applicable. - 421(65%) & 230 the Epworth Sleepiness Scale Discussion: Patients with CompSAS have a poor initial experience with CPAP and may be non-adherent to continued therapy. MAD are indicated for mild to moderate OSA and in selected patients with severe OSA who are non-adherent to PAP therapy. This case report showed successful management of CompSAS with MAD. Assessment of patient characteristics, predictors of MAD success, and therapeutic mandibular position must be assessed by the sleep dentist to optimize patient selection and improve treatment outcomes. Support: Authors declared no conflict of interest and no financial support provided for this case report. values varied of 11% to 46% for atypical women and 2% to 75% for atypical men. The left masseter muscle was more affected, mainly in men. The severity of OSA, SB and SI was higher in men (38,5%, 54%, 27,65 events/h respectively). Conclusions: The mMH was confirmed in all subjects with DS, leading to a high amplitude of mouth opening due to ligament hyperlaxity of TMJ, mainly in atypical men. The pain, found in the masseter and temporal muscles and in the TMJ, may have interfered in the manifestation of the MMH, decreasing the muscle force mainly in some men. No correlation was found between the orofacial pain and sleep disorders. only daytime fatigue and sleepiness significantly worsened at 18 months in responders compared to non-responders, although daytime sleepiness was still within a normal range.