Updates in Dental Sleep Medicine: Is there a gold standard oral appliance for snoring and sleep apnoea?

There is a large array of oral appliances on the market today with over 85 different designs coming from various companies.

There have been at least seven recent studies comparing different appliances for effectiveness. These studies have not shown evidence that any one appliance is superior to another. The consensus of experts in the field is that the degree of mandibular advancement is the factor that provides efficacy, not the design.

According to Professor Fernanda Almeida who is a world authority in dental sleep medicine, an extensively published researcher, and the key note speaker at the 2017 Australasian Sleep Association dental sleep medicine course:

“The appliances in the market today appear to have very similar efficacy. Patient preference and comfort may impact long term effectiveness.”

The key factors for achieving good compliance

1. Use of materials which allow for minimal thickness – with the new 3D printed materials this can average 1mm thickness.

2. Minimal extension over the soft tissues.

3. Minimal vertical dimension (separation between the upper and lower teeth). A recent study1 showed excessive vertical to be a key factor in patients giving up on an oral appliance – having a dry mouth from the appliance not allowing an adequate lip seal.

4. Rigid materials that maximise occlusal stability. A recent studydemonstrated that use of a flexible material allowed for significant tooth moment over a three year period when compared to a more rigid material.

There are a number of current appliances which should be regarded with caution, as they use soft,or flexible materials, such as Resmed’s Narvel and the Panthera.

Summary

When using a mandibular advancement splint, the focus needs to be on patient comfort and compliance, as well as achieving an optimal mandibular position.

References:

1 Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Disordered Breathing: A Prospective Clinical Trial
Dieltjens M, Verbruggen A, et al
Otolaryngol Head Neck Surg. 2015 Oct;141(10):894-900

2 Changes in lower incisor irregularity during treatment with oral sleep apnoea appliances
N Norrhem & H Nemeczek & M Marklund
SleepBreath Jan 2017