Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
4.1. Query 1: Should Clinicians Use Monobloc or Bibloc MAD during Diagnostic Assessment or Treatment?
4.2. Query 2: Provisional MAD and Definitive MAD. What Are the Design Characteristics, Clinical Indications and Instrumental Examinations for Their Usage?
4.3. Query 3: Which Extension of Mandibular Advancement Should Be Registered and Sent to the Laboratory Technician for Producing MAD?
4.4. Examples of Digital Work Flow Used during Dental Diagnostic and Therapeutic Processes for Treating Adult Patients Affected by OSA with MAD
- Case 1: A forty-nine y.o. man received a diagnosis of severe OSA (AHI = 54) and refused to use a CPAP (Figure 6). The patient was referred to the ORL specialist and underwent drug-induced sleep endoscopy (DISE) to better address the pattern of obstruction. The DISE revealed that the pattern of obstruction featured a complete antero-posterior collapse of the oropharynx; there was also a significant improvement of the respiratory performance (complete reduction of the apnea episodes) with the pull-up/chin lift maneuver.
- Case 2: A fifty-four y.o. man received a diagnosis of severe OSA (AHI = 35) and refused to use a CPAP. The patient was referred to the ORL specialist and underwent drug-induced sleep endoscopy (DISE) to better address the pattern of obstruction (Figure 10).
5. Conclusions
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- Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient’s clinical condition and orofacial symptoms. However, bibloc systems necessitate a firm control of the anterior mandibular opening via elastics or an anterior screw design.
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- Non-customized devices could be used as screening tools to verify the patient’s adherence to the therapy. However, to achieve greater efficacy and better patient compliance, which is crucial, it is essential to use a custom-made adjustable device that allows for advancement adjustments either in the clinic or at home by the patient.
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- Clinicians should take a bite registration with the mandibular advancement set to at least 50% followed by a graduated titration protocol to reach the most tolerated therapeutic (advanced) position of the mandible.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Lo Giudice, A.; La Rosa, S.; Palazzo, G.; Federico, C. Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions. Diagnostics 2024, 14, 1915. https://doi.org/10.3390/diagnostics14171915
Lo Giudice A, La Rosa S, Palazzo G, Federico C. Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions. Diagnostics. 2024; 14(17):1915. https://doi.org/10.3390/diagnostics14171915
Chicago/Turabian StyleLo Giudice, Antonino, Salvatore La Rosa, Giuseppe Palazzo, and Carmelo Federico. 2024. "Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions" Diagnostics 14, no. 17: 1915. https://doi.org/10.3390/diagnostics14171915