Patent Publication Number: US-2023148953-A1

Title: Mandibular advancement device for preventing sleep apnea

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the priority of Korean Patent Application No. 10-2021-0156568 filed on Nov. 15, 2021, in the Korean Intellectual Property Office, the disclosure of which is incorporated herein by reference. 
     BACKGROUND OF THE INVENTION 
     Field of the Invention 
     The present disclosure relates to a mandibular advancement device for preventing sleep apnea and, in detail, a device for advancing the mandible to prevent sleep apnea symptoms such as obstructive sleep apnea. 
     Description of the Related Art 
     Sleep apnea, which is a sleep breathing disorder accompanied with frequent waking due to stop or reduction of breathing by repetitive obstruction of the upper respiratory tract during sleep, is a disease that may cause not only excessive daytime sleepiness or a recognition disorder, but hypertension, cardiovascular diseases, abnormal glycometabolism, etc. if it is not treated. 
     Sleep apnea can be classified into obstructive sleep apnea that occurs due to obstruction the respiratory tract in the oral cavity even though there is an attempt to breathe and central sleep apnea that shows temporal stop of an attempt itself to breathe. Hypoventilation means a situation in which breathing is not completely stopped, but the amount of breath reduces under a half, whereby concentration of oxygen in blood decreases. 
     When two or more of five symptoms of excessive daytime sleepiness, choking during sleep, repetitive waking during sleep, not feeling well even after sleep, and daytime fatigue and concentration reduction are shown and a sleep breathing disorder is shown in a polysomnograph test, obstructive sleep apnea is diagnosed. The sleep breathing disorder means the case in which apnea or hypoventilation occurs 5 or more times per hour. 
     It has been known that over 90% of such sleep apnea is obstructed sleep apnea. A reason of obstructive sleep apnea is narrowing of the upper respiratory tract during sleep. When the pharyngeal airway is narrowed by hypertrophy of the velum and the uvula and dilatation of the tonsils and the tongue, etc., which can be frequently observed from patients with sleep apnea, air is difficult to move over the pharyngeal airway in breathing, so more effects are required to breathe in. 
     It does not matter when the respiratory tract dilates due to these efforts, but if the respiratory tract does not dilate due to fatigue of the pharyngeal dilator muscles, etc., sleep apnea occurs. That is, sleep apnea occurs when the pharyngeal airway narrows and the respiratory tract does not dilate. 
     Sleep apnea described above may cause metal/physical complications. 
     In detail, sleep apnea may cause various psycho neurological complications by causing awakening during sleep and segmenting sleep, and it has been known that, for example, other than fatigue, a personality change, a recognition ability disorder, deterioration of driving ability, etc. may occur with high frequency. 
     Further, it was reported that arrhythmia occurs 2 to 4 times in patients with serious sleep apnea in comparison to normal people and the relationship between sleep apnea and hypertension has been well known. Furthermore, it has been known that sleep apnea is highly connected with arteriosclerosis and cardiac insufficiency too and increases frequency of crebrovascular diseases. 
     As described above, sleep apnea is accompanied with severe snoring during sleep, a sleep disorder such as lethargy, etc. and frequently causes apnea during sleep, so it is a disease that may various cardiovascular and pulmonary vascular diseases due to hypoxemia. 
       FIG.  1    is a view showing a “DENTAL APPLIANCE FOR TREATMENT OF SNORING AND OBSTRUCTIVE SLEEP APNEA” disclosed in U.S. Pat. No. 5,868,138. 
       FIG.  1    is an intraoral device for maintaining a respiratory tract at the upper pharyngeal airway of a patient. The intraoral device includes an upper member  11 , a lower member  12 , a connector  13 , and slots  14 . When the connector  13  is selectively inserted in any one of the slots  14 , the lower member  12  may be maintained at a position protruding forward further than the upper member  11 . 
     In the device shown in  FIG.  1   , since the lower member  12  protrudes forward further than the upper member  11 , a respiratory tract is secured of a user and snoring is prevented in sleep. Further, the upper member  11  and the lower member  12  are manufactured to fit the sets of teeth of a patient, but the device is large, complicated, and inconvenient to use. 
     As another example of treatment device for snoring and sleep apnea, a device including an upper splint in which upper teeth are inserted, a lower splint in which lower teeth are inserted, and a rod connecting the upper splint and the lower splint, in which an end and another end of the rod are hinged to the upper splint and the lower splint, respectively, and the lower splint is moved forward by operating the rod is also used. 
     SUMMARY OF THE INVENTION 
     An objective of the present disclosure is to provide a mandibular advancement device for preventing sleep apnea, in detail, obstructive sleep apnea (OSA), the device bang able to appropriately adjust and advancement amount of the mandible. 
     An aspect of the present disclosure relates to a mandibular advancement device for preventing sleep apnea that moves a mandible forward to prevent sleep apnea. The mandibular advancement device includes: a first hook to which a first end of an elastic member providing a mandible traction force for advancing the mandible can be connected and that supports the elastic member; an upper frame that can be mounted on upper teeth to distribute a traction support force, which is applied to the first hook by the elastic member, to a maxilla; a second hook to which a second end of the elastic member can be connected and that transmits the mandible traction force applied by the elastic member to the mandible at a distal location in comparison to the first hook; and a lower frame that can be mounted on lower teeth under the upper frame to distribute the mandible traction force, which is applied to the second hook, to the mandible. 
     The mandibular advancement device has the following effects. 
     First, according to the present disclosure, since it is possible to easily and appropriately adjust an advancement amount of a mandible, it is effective in preventing sleep apnea, in detail, obstructive sleep apnea (OSA) of not only adults, but children. 
     Second, according to a fixed-type mandibular advancement device, for example, an archwire-type mandibular advancement device that is fixed to upper teeth and lower teeth, an occlusal clearance is not required, so patients can more comfortably use the device. 
     Third, when a mandibular advancement device, that is, a hybrid-type mandibular advancement device having an archwire type frame (fixable frame) that is mounted on one of upper teeth and lower teeth and a removable splint-based frame (removable frame) is mounted on another one is applied to the inside of an oral cavity, the occlusal clearance can be greatly reduced in comparison to existing devices and the splint type frame can be used in a removable type, so it is possible to more comfortably use the device. 
     Fourth, the fixable frame that is applied to the present disclosure can be applied to young child patents with primary dentition or transitional dentition from whom it is very difficult to an optimal maintaining force using an acrylic removable frame due to anatomical limitation of primary teeth (lack of undercut that is important to maintain an acrylic device). Further, the fixable frame is effective to young child patents because its cooperation level in use of device is low in comparison to a detachable (removable frame). 
     Fifth, the hybrid-type mandibular advancement device is helpful to not only patients with obstructive sleep apnea (OSA) requiring vertical occlusion, but patients with temporomandibular disorder (TMD). 
     Sixth, according to the present disclosure, a user has only to carry an elastic member such as an elastic rubber band or an elastic rod, the device can be very conveniently carried in comparison to acrylic removable devices having large volume in the related art. Further, it is possible to easily titrate an advance amount of a mandible by applying different elastic members. 
     Seventh, the present disclosure has an excellent effect to young child patient with transitional dentition, can maintain a clearance in eruption of permanent teeth. In particular, the fixable frame does not require a remake or correction process in eruption of permanent teeth and can sufficiently maintain teeth while dentition changes. Further, the fixable frame prevents deterioration of maintaining force in comparison to removable frames and it can be omitted to make a space for a permanent tooth that is slowly erupted. 
     Eighth, existing mandibular advancement devices are for only adults and there is not mandibular advancement device for children, but the present disclosure can achieve various functional priorities for not only adult patients with OSA who prefer the convenience and comfortableness of a fixable frame, but child patients with OSA. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The features and advantages of the present disclosure will be more clearly understood from the following detailed description of embodiments of the present disclosure with the accompanying drawings to be described below, in which: 
         FIG.  1    is a view showing a device for preventing sleep apnea of the related art; 
         FIGS.  2 A and  2 B  are views showing a first embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure; 
         FIGS.  3 A and  3 B  are views showing a second embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure; 
         FIGS.  4 A and  4 B  are exemplary views showing the state in which an elastic member is connected to a splint-type removable mandibular advancement device shown in  FIGS.  3 A and  3 B ; 
         FIGS.  5 A and  5 B  are views showing the state in which the mandibular advancement device for preventing sleep apnea shown in  FIGS.  2 A and  2 B  has been installed on teeth; 
         FIGS.  6 A and  6 B  are views showing the state in which a third embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  7 A and  7 B  are views showing the state in which a fourth embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  8 A and  8 B  are views showing the state in which a fifth embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  9 A and  9 B  are views showing the state in which a sixth embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  10 A and  10 B  are views showing the state in which a seventh embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  11 A and  11 B  are views showing the state in which an eighth embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  12 A and  12 B  are views showing the state in which a ninth embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  13 A and  13 B  are views showing the state in which a tenth embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; 
         FIGS.  14 A and  14 B  are views showing the state in which the mandibular advancement device for preventing sleep apnea shown in  FIGS.  3 A and  3 B  has been installed on teeth; 
         FIG.  15    is a view showing the state in which an eleventh embodiment of a mandibular advancement device for preventing sleep apnea according to the present disclosure has been installed on teeth; and 
         FIGS.  16 A and  16 B  are another embodiments of an upper archwire and a lower archwire of the mandibular advancement device for preventing sleep apnea according to the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Hereafter, an exemplary embodiment that can achieve the objectives of the present disclosure in detail is described with reference to the accompanying drawings. In the description of the embodiment, the same components are given the same names and reference numerals and are not repeatedly described. 
     Terms used herein are used to describe embodiments of the present disclosure and it is to be understood that when one element is referred to as being “connected to” or “coupled to” another element, it may be connected directly to or coupled directly to another element or be connected to or coupled to another element with another element therebetween, including indirect connection. 
     It will be further understood that the terms “comprises” or “have” used in this specification, specify the presence of stated features, steps, operations, components, parts, or a combination thereof, but do not preclude the presence or addition of one or more other features, numerals, steps, operations, components, parts, or a combination thereof. 
     An appropriate amount of advancement (titration) is a very important factor in a mandibular advancement device (MAD) for sleep apnea, for example obstructive sleep apnea. The mandibular advancement amount may be adjusted through a titration mechanism, depending on how a patient reacts to a predetermined mandibular advancement amount. When the advance amount is large, a patient feels uncomfortable, and when the advance amount is too small, there will be not improvement of OSA, so appropriate adjustment is required and this advancement amount adjustment process is called ‘titration’. 
     When the MAD for an OSA patient is an entirely removable device, for example, when a removable acrylic device is applied to both of upper and lower teeth, this removable device is loosened over time, so periodic remake or relining is required, it is difficult to apply larger maintaining force, it is difficult to carry the device in traveling, and inconvenience may be increased by an occlusal clearance. Further, at present, there is no MAD for children approved by FDA. 
     The present disclosure relates to a mandibular advancement device for sleep apnea that is convenient to use, can be applied to children with a low treatment cooperation level, and is more comfortable in use. 
     First, referring to  FIGS.  2 A to  5 B , the present disclosure, which is a device for preventing sleep apnea symptoms, that is, a device for improving, attenuating, or treating sleep apnea, is a mandibular advancement device for sleep apnea that advances a mandible to prevent sleep apnea. 
     The mandibular advancement device for sleep apnea (hereafter, referred to as an ‘MAD’) according to the present disclosure includes a first hook  10  supporting an elastic member  30 , an upper frame  100  that can be mounted on upper teeth UT, a second hook  20  connected to the elastic member  30 , and a lower frame  200  being able to be mounted on lower teeth LT. That is, the MAD may be implemented in an intraoral device type. 
     The elastic member  30  is an element for providing a force for advancing a mandible  2 , that is, a mandible traction force (mandible advancement force) to the mandible  2 . A first end of the elastic member  30  may be connected to the first hook  10  and a traction support force (force supporting the mandible traction force) applied to the first hook  10  is transmitted to a maxilla  1 . 
     The upper frame  100  is mounted on the upper teeth UT to distribute the force (traction support force) applied to the first hook  10  by the elastic member  30  to the maxilla  1 . In more detail, the traction support force applied to the first hook  10  is distributed to the upper teeth by the upper frame  100  and distributed to the maxilla  1 . Accordingly, concentration of traction support force can be reduced or prevented at the portion where the first hook  10  is positioned. 
     A second end of the elastic member  30  is connected to the second hook  20 . The second hook  20  transmits the mandible traction force by the elastic member  30  to the mandible  2  at a distal location further than the first hook  10 . 
     Next, the lower frame  200  is mounted on the lower teeth LT under the upper frame  10  to distribute the mandible traction force applied to the second hook  20  to the mandible  2 . In more detail, the mandible traction force applied to the second hook  20  is distributed to the lower teeth LT by the lower frame  200  and distributed to the mandible  2 . Accordingly, concentration of traction force can be reduced or prevented at the portion where the second hook  20  is positioned. 
     In embodiments of the present disclosure, the upper frame  100  fastens the upper teeth UT and the lower frame  200  fastens the lower teeth LT. To this end, the upper frame  100  may be mounted on the upper teeth UT in a fixed type or a removable type and the lower frame  200  may be mounted on the lower teeth in a fixed type or a removable type. 
     For reference, the upper teeth UT are a plurality of teeth at the maxilla  1  and the lower teeth LT are a plurality of teeth at the mandible  2 . 
     The first hook  10  may be disposed at the upper frame  100  and the second hook  20  may be disposed at the lower frame  200 . Of course, the first hook  10  may be directly fixed to a tooth itself of the upper teeth  1 , that is, front tooth parts such as both canines UC. The second hook  200  may be directly fixed to a tooth itself of the lower teeth LT, that is, the posterior teeth of the lower teeth such as molars at both sides. The elastic member  30  may be removably connected to the first hook  10  and the second hook  20 . 
     The elastic member  30 , for example, may be a rubber band  30   a , a spring-shaped elastic rod  30   b , or an elastic strap. For example, the elastic rod  30   b  may include a spring body  31  and hook holes  32   a  and  31   b  at both ends of the spring rod. Accordingly, the mandible advancement force and advancement amount can be adjusted in accordance with the length of the elastic member, and an elastic member having an appropriate length can be selected, depending on the condition of patients. 
     The upper frame  100  may include an upper archwire  100 A mounted on the upper teeth  1  in a fixed type and/or an upper splint  100   b  in which the dental arch of the upper teeth  1  is fitted. 
     For example, the upper frame  100 , as in the example shown in  FIG.  2 A , may include an upper archwire  100 A mounted (attached) in a fixed type to the maxillary arch (superior dental arch). The first hook  10  may be may be disposed in both front teeth area of the upper archwire  100 A, for example, a canine area adjacent to canines UC. 
     As a more detailed example, the upper archwire  100 A may include a lingual archwire fixed to the lingual side of the upper teeth UT and the lingual archwire  110  may be fixed to the lingual side of the maxillary arch by wire fixing member  120  such as wire fixing pads or wire fixing bases that are fixed to tooth surfaces. 
     Of course, the upper archwire may be manufactured in a type that is installed on the labial side of upper teeth, but the lingual archwire is better in terms of aesthetic/mental aversion. The upper archwire  100 A may be manufactured integrally with the wire fixing members  120  in a patient-customized type through 3D printing, etc., and then fixed to the upper teeth UT of the patient through resin. The second hook  10  may be formed integrally with the upper archwire  100 A through 3D printing or metal bonding such as soldering. 
     The first hook  10  may be formed on the lingual side or the palatal side of the upper archwire  110 . The palatal side includes the gums direction. The first hook  10  may be formed on a buccal side on the upper archwire  100 A across the embrasure between a canine and a first premolar UP 1  (see  FIGS.  8 A and  8 B ). 
     The upper frame  100 , as in the example of  FIG.  3 A , may include an upper splint  100 B in which the upper teeth  1  are fitted. A mouthpiece-type removable frame may be applied as the upper frame of the mandibular advancement device according to the present disclosure. In this case, the first hook  10  may be disposed in both front teeth areas (both side areas of a front teeth seat section) of the upper splint  100 B, but is not limited thereto and may be disposed at other positions. 
     The upper splint  100 B, as in the example  100 D shown in  FIG.  15   , may be modified in a shape in which the occlusion sides (bottom sides) of molar seat sections in which the posterior teeth of the upper teeth, particularly, molars UM 1  and UM 2  are fitted are bored such that occlusal surfaces of the upper molars are exposed. 
     The lower frame  200  may include at least one of a lower archwire  200 A on which the arch of the lower teeth  1  is mounted in a fixed type and a lower splint  200 B in which the mandibular arch is fitted. 
     For example, the lower frame  200 , as shown in  FIG.  2 B , may include a lower archwire  200 A that is mounted (attached) on the mandibular arch. It is advantageous in terms of adjustment of a mandibular advancement amount that the second hook  20  is disposed posterior teeth area at both sides of the lower archwire  200 A, for example, as distal teeth area as possible of the lower teeth such as molars, in more detail, the area of a first molar LM 1  or a second molar LM 2 . 
     As a more detailed example, the lower archwire  200 A may include a lingual archwire the lingual side of the lower teeth  1  and the lingual archwire  210  may be fixed to the lingual surface of the lower teeth by wire fixing members  220 . 
     Of course, the lower archwire  200 A may be applied in a type that is attached to the labial side of the lower teeth, but the lingual archwire is better in terms of aesthetic/mental aversion. The lower archwire  100 A may also be manufactured integrally with the wire fixing members  220  through various methods such as 3D printing and then fixed to the upper teeth of a patient through resin. The second hook  20  may be formed integrally with the lower archwire through 3D printing or metal bonding such as soldering. 
     The second hook  200  may include a lingual hook formed on the lingual side of the lower archwire  200 A or a buccal hook (see  FIGS.  5 A and  5 B ) across the embrasure of posterior teeth of the lower archwire  200 A, for example, the area between a first molar LM 1  and a second molar LM 2 . 
     The lower frame  200 , as in the example of  FIG.  3 B , may include a lower splint  200 B in which the lower teeth LT are fitted. That is, a mouthpiece-type removable frame may be applied as the lower frame of the mandibular advancement device according to the present disclosure. In this case, the second hook  20  is better to be disposed in the posterior teeth areas at both sides, in detail, molar areas of the lower splint  200 B. That is, the second hook  20  is better to be disposed in the posterior teeth seat sections at both sides, preferably, molar seat sections of the lower splint  200 B. 
     The lower splint  200 B, as in the example  200 D shown in  FIG.  15   , may be modified with the occlusion sides (top sides) of molar seat sections in which the lower molars are fitted are bored such that occlusal surfaces of the lower molars LM 1  and LM 2  are exposed. 
       FIGS.  2 A and  2 B  are an embodiment (first embodiment) having fixable frames, that is, archwire-type upper frame and lower frame that are attached to teeth and  FIGS.  3 A and  3 B  are embodiments (second embodiment) having removable frames, that is, splint-type upper frame and lower frame in which teeth are fitted, but any one of the upper frame and the lower frame may be an archwire-type fixable frame and the other one may be a splint-type removable frame. 
       FIGS.  4 A and  4 B  show examples in which the upper splint  100 B and the lower splint  200 B are connected by the elastic member  300 , for example, the rubber band  30   a , and mandibular advancement is implemented by connecting a first hook and a second hook through the elastic member  30  also in other embodiments of the present disclosure. 
       FIGS.  5 A and  5 B  are views showing the state in which the fixable (attachable) upper frame (upper archwire  100 A) and the fixable lower frame (lower archwire  200 A) shown in  FIGS.  2 A and  2 B  are mounted on the upper teeth UT and the lower teeth LT. In other words, the upper archwire  100 A is fixed to the lingual side of the upper teeth UT, the lower archwire  200 A is fixed to the lingual side of the lower teeth LT, the first hook  10  is integrally formed on the lingual side of the upper archwire  100 A, and the second hook  20  is integrally formed on the lingual side of the lower archwire  200 A. 
     In more detail, it is advantageous in terms of titration of an advancement amount that the first hook  10  is positioned in the area of a canine (UC) and the second hook  20  is positioned in the most distal tooth area, for example, the area of a second molar (LM 2 ), but they are not limited thereto. For example, the first hook  10  may be positioned at the lingual side of the area of a lateral incisor or a first premolar UP 1  and the second hook  20  may be positioned at the lingual side of the area of a first molar LM 1 . 
       FIGS.  6 A and  6 B  show another embodiment (third embodiment) of the MAD and the embodiment of  FIGS.  6 A and  6 B  includes the upper frame  100  ( 100 A), the lower frame  200  ( 200 A), and the first hook  10  that have the same structures as those of the example shown in  FIGS.  5 A and  5 B , but a second hook  20   a  connected to the lower frame, that is, the lower archwire is positioned on the buccal side of the lower teeth. 
     In more detail, the second hook  20   a  is formed on the buccal side of the lower archwire  100 A, that is, the lingual archwire  110  across the embrasure of posterior teeth, for example, the area between a first molar LM 1  and a second molar LM 2 . Accordingly, the elastic member  30  described above can be connected from the buccal side of the lower teeth to the lingual side of the upper teeth. 
       FIGS.  7 A and  7 B  show a fourth embodiment of the MAD and the embodiment of  FIGS.  7 A and  7 B  includes the upper frame  100  ( 100 A), the lower frame  200  ( 200 A), and the first hook  10  that have the same structures as those of the example shown in  FIGS.  5 A and  5 B , but the fourth embodiment has a second hook  20   b  that is fixed (attached) to a specific tooth of the lower teeth. 
     In more detail, the second hook  20   b  is fixed to the buccal side of the posterior teeth section, for example, a first molar LM 1  of the lower teeth, and is attached to the posterior teeth section by a hook fixing member  21  of the second hook. Of course, the second hook  20   b  may be fixed to the second molar LM 2 . Accordingly, in the fourth embodiment too, the elastic member described above can be connected from the buccal side of the lower teeth to the lingual side of the upper teeth. 
     Next,  FIGS.  8 A and  8 B  show a fifth embodiment of the MAD and the embodiment of  FIGS.  8 A and  8 B  includes the upper frame  100  ( 100 A), the lower frame  200  ( 200 A), and the second hook  20  that have the same structures as those of the example shown in  FIGS.  7 A and  7 B , but the fifth embodiment has a first hook  20   a  that is fixed (attached) to a specific tooth of the upper teeth. 
     In more detail, in the fifth embodiment, the first hook  20   a  is fixed to the buccal side of the front teeth section, for example, both canines of the upper teeth and is attached to the front teeth section, that is, the canines of the upper teeth by a hook fixing member  11  of the first hook. Of course, the teeth to which the first hook  20   a  is attached are not limited to the canines. Accordingly, in the fifth embodiment, the elastic member described above can be connected from the buccal side of the lower teeth to the labial side of the upper teeth. 
       FIGS.  9 A and  9 B  show a sixth embodiment of the MAD and the embodiment of  FIGS.  9 A and  9 B  includes the upper frame  100  ( 100 A), the lower frame  200  ( 200 A), and the second hook  20   a  that have the same structures as those of the example shown in  FIGS.  5 A and  5 B , but, in the sixth embodiment a first hook  10   b  that is connected to the upper frame, that is, the upper archwire  100 A is positioned at the buccal side. 
     In detail, the first hook  10   b  may be formed on a buccal side in an area from a premolar UP 1  and a canine UC across the embrasure between the canine UC and the first premolar UP 1  of the upper archwire  100 A. Accordingly, in the sixth embodiment too, the elastic member described above is connected from the buccal side of the lower teeth to the labial side of the upper teeth. 
     The MAD using an upper archwire and a lower archwire is not limited to the examples described above and mandibular advancement devices with various structures not shown in  FIGS.  5 A to  9 B  may be implemented by alternately applying any one of the first hooks  10  with various structures and any one of the second hooks  20  with various structures shown in  FIGS.  5 A to  9 B . For example, it is possible to implement an MAD including the first hook  10   b  of  FIGS.  9 A and  9 B  and the second hook  20  of  FIGS.  5 A and  5 B  or the first hook  10   b  of  FIGS.  9 A and  9 B  and the second hook  20   b  of  FIGS.  7 A and  7 B . 
     An MAD according to the present disclosure a mandibular advancement device, that, is a hybrid-type MAD including a removable frame that is mounted on any one of upper teeth and lower teeth, for example, a splint type frame and a fixable frame that is mounted on the other one, for example, a teeth-attachable frame such as the archwire time frame exemplified in  FIGS.  5 A to  9 B . 
     In more detail, another embodiment (seventh embodiment) of the MAD may include a removable frame, that is, an upper splint  100 B that is mounted on upper teeth, a first hook  10  supporting an elastic member, a fixable frame, that is, a lower archwire  200 A that is mounted on lower teeth, and a second hook  20  connecting the elastic member. 
     For example, as shown in  FIGS.  10 A and  10 B , the seventh embodiment of the MAD may include an upper splint  100 B that can be removably mounted on upper teeth UT, and a lower frame  200  ( 200 A) and a second hook  20   a  that are the same as those in the example shown in  FIGS.  6 A and  6 B , and a first hook  10   c  supporting an elastic member may be disposed at the upper splint  100 B. For example, one end portion of the first hook  10   c  may be embedded in a side of the upper splint. 
     In this embodiment, the first hook  10   c  may be disposed in both front teeth areas (both side areas of a front teeth seat section) of the upper splint  100 B, in more detail, the labial side of the upper splint  100 B, but is not limited thereto and may be disposed at other positions. The structure, for example the length, the direction, or the like of the first hook  10   c  may be changed in various ways. The seventh embodiment of the MAD may include the second hook  20 ,  20   b  of  FIGS.  5 A,  5 B,  7 A or  7 B  rather than the second hook  20   a  of  FIGS.  6 A and  6 B . 
     As another example (fourth embodiment), the MAD may include a fixable frame, that is, an upper archwire  100 A that is mounted on upper teeth UT, a first hook  10  supporting an elastic member, a movable frame, that is, a lower archwire  200 B that is mounted on lower teeth LT, and a second hook  20  connecting the elastic member. 
     For example, as shown in  FIGS.  11 A and  11    B, the eighth embodiment of the MAD may include an upper archwire  100 A and a first hook  10  that are fixed to upper teeth that are the same as those in the example shown in  FIGS.  5 A and  5 B , and a lower splint  200   b  that are removably mounted on lower teeth LT, and a second hook  20   c  connecting an elastic member may be disposed at the lower splint  200 B. For example, one end portion of the second hook  20   c  may be embedded in a side of the lower splint  200 B. 
     In this embodiment, the second hook  20   c  may be disposed in both posterior teeth areas (both side areas of a posterior teeth seat section) of the lower splint  200 B, in more detail, on the labial side of the lower splint  200 B in the molar area, but is not limited thereto and may be disposed at other positions. The structure, for example the length, the direction, or the like of the second hook  20   c  may be changed in various ways. The eighth embodiment of the MAD may include the first hook  10   a ,  10   b  of  FIG.  8 A,  8 B,  9 A or  9 B  rather than the first hook  10  of  FIGS.  5 A and  5 B . 
     As another example (ninth embodiment), the MAD may include an upper frame  100  including an upper archwire  100 A that is mounted on upper teeth UT in a fixed type and an upper splint  100 C in which the maxillary arch is fitted, a first hook  10  supporting an elastic member, a second archwire  200 A that is fixed to lower teeth LT, and a second hook  20  connecting the elastic member. 
     For example, as shown in  FIGS.  12 A and  12 B , the upper archwire  100 A is fixed to the lingual side of the upper teeth UT and the lingual side of the upper splint  100 C is open to prevent interference between the upper archwire  100 A and the upper splint  100 C. The first hook  10  may be disposed in both front teeth areas of at least one of the upper archwire  100 A and the upper splint  100 C. 
     The first hook  10 , as in the structure shown in  FIGS.  5 A and  5 B , may be formed on the lingual side of the upper archwire  100 A, but is not limited thereto, and for example, may be formed at a proximal area in comparison to the second hook  20  such as the labial side of the upper splint  100 C. The upper splint  100 C may have a structure that covers the labial side, the buccal side, the occlusion surface, and the incisal margin of the upper teeth and is open on the lingual side. The second hook  20  has the same structure as that exemplified in  FIGS.  5 A and  5 B , but is not limited thereto, and may be changed in other structures such as the structure  20   a ,  20   b  exemplified in  FIG.  6 A,  6 B,  7 A or  7 B . 
     As another example (tenth embodiment), the MAD may include an upper archwire  100 A that is mounted on upper teeth in a fixed type, a first hook  10  supporting an elastic member, a lower frame  200  including a lower archwire  200 A that is mounted on lower teeth in a fixed type and a lower splint  200 C in which the mandibular arch is fitted, and a second hook  20  connecting the elastic member. 
     For example, as shown in  FIGS.  12 A and  12 B , the lower archwire  200 A is fixed to the lingual side of the lower teeth and the lingual side of the lower splint  100 C is open to prevent interference between the lower archwire  200 A and the lower splint  200 C. 
     The first hook  10 , as in the structure shown in  FIGS.  4 A and  4 B , may be formed on the lingual side of the upper archwire  100 A, but is not limited thereto, and for example, other structures such as the structure  10   a ,  10   b  shown in  FIGS.  7 A,  7 B,  8 A or  8 B  are possible. The lower splint  100 C may have a structure that covers the labial side, the buccal side, the occlusion surface, and the incisal margin of the lower teeth and is open on the lingual side. The second hook  20  may be disposed in both posterior teeth areas of at least one of the lower splint  200 C and the lower archwire  200 A. 
     For example, the second hook  20 , as in the structure shown in  FIGS.  5 A and  5 B , may be formed on the lingual side of the lower archwire  200 A, but is not limited thereto, and for example, may be formed at a distal area in comparison to the first hook  10  such as the buccal side of the lower splint  200 C. 
     As in the examples shown in  FIGS.  10 A to  13 B , when a splint type frame is applied to only any one of upper teeth and lower teeth, the mandible can smoothly slide forward, and an occlusal clearance can be reduced and it is possible to more comfortably use the device as compared with when a splint type frame is applied to both of upper teeth and lower teeth as in the examples of  FIGS.  14 A,  14 B and  15   . 
     Next, the MAD shown in  FIGS.  14 A and  14 B  include the removable upper frame (upper splint  100 B) and lower frame (lower splint  200 B) shown in  FIGS.  3 A and  3 B , a first hook  10   c  is disposed at the upper splint  100 B, and a second hook  20   c  is disposed at the lower splint  200 B. Accordingly, an elastic member is easily attached/detached and a teeth-attachable MAD can be used. 
     Referring to  FIG.  15   , the upper frame may include an upper splint  100 D having a shape in which the occlusion sides, that is, the bottom sides of the molar seat sections in which posterior teeth, that is, molars UM 1  and UM 2  of upper teeth are fitted are bored. 
     Although only the bottom sides of the molar seat sections are open in  FIG.  15   , the present disclosure is not limited thereto, and for example, the most distal tooth area of upper teeth, in detail, at least a portion from the second molar area and a premolar area may be open. 
     Referring to  FIG.  15   , the lower frame may include a lower splint  200 D having a shape in which the occlusion sides, that is, the top sides of the molar seat sections in which posterior teeth, that is, molars LM 1  and LM 2  of lower teeth are fitted are bored. 
     Although only the top sides of the molar seat sections are open in  FIG.  15   , the present disclosure is not limited thereto, and for example, the most distal tooth area of lower teeth, in detail, at least a portion from the second molar area and a premolar area may be open. 
     When any one of the upper splint  100 D and the lower splint  200 D is bored at the posterior occlusion sides, as in the example of  FIG.  15   , the occlusal clearance can be reduced and the device can be more comfortably used, considering movement of the temporomandibular joint. 
     The upper archwire that is fixed to the maxillary arch may be configured to pass the necks of upper teeth or the height of the gums. In more detail, the lingual archwire  110  of the upper archwire, as in the example shown in  FIGS.  2 A and  2 B , may be directly fixed to the wire fixing members  120  of upper teeth across the lingual side of the upper teeth, but is not limited thereto, and may be indirectly fixed to the wire fixing members  120  of upper teeth, as in the example shown in  FIG.  16 A . For example, the lingual archwire  110  of the upper archwire may be configured to pass the necks of upper teeth or the lingual side of the gums with a distance (height difference) from a virtual line connecting the wire fixing members  120  so that interdental cleaning is easy. 
     The lower archwire that is fixed to mandibular arch may also be configured to pass the necks of lower teeth or the height of the gums. In more detail, the lingual archwire  210  of the lower archwire, as in the example shown in  FIGS.  2 A and  2 B , may be directly fixed to the wire fixing members  120  of lower teeth across the lingual side of the upper teeth, but is not limited thereto, and may be indirectly fixed to the wire fixing members  220  of lower teeth, as in the example shown in  FIG.  16 B . For example, the lingual archwire  210  of the lower archwire may be configured to pass the necks of lower teeth or the lingual side of the gums with a distance (height difference) from a virtual line connecting the wire fixing members  120  of lower teeth so that interdental cleaning is easy. 
     Although preferred embodiments of the present disclose were described above, it would be apparent to those skilled in the art that the present disclosure may be achieved in other specific types without departing from the scope or spirit other than the embodiments described above. 
     Accordingly, the embodiments described above should be considered as being exemplifying rather than limiting, so the present disclosure may be changed within the range of the claims and the equivalent range without being limited to the above description.