Oral Appliances are placed in the mouth and are
worn much like an orthodontic appliance or sports mouth protector.
They are worn during sleep to prevent the collapse of the
tongue and soft tissues in the back of the throat so that
the airway stays open during sleep. Oral appliances can be
used alone or in conjunction with other means of therapy
such as continuous positive air pressure (CPAP). Determination
of proper therapy can only be made by joint consultation
of your dentist and sleep physician. For a dentist near you
who has received training in oral appliance therapy please
visit our
links page.
Types of Oral Appliances
Currently, over 40 different types of oral appliance are
available to specially trained dentists to treat sleep disordered
breathing. At first glance, this number appears overwhelming
but on close examination each of the appliances falls basically
into one of two categories and the diverse variety is simply
a variation of a few major themes. Oral appliances can be
classified by mode of action or design variation.
Mandibular Repositioning Appliances
Mandibular repositioning appliances are by far the most
numerous type on the market. They all function to reposition
and maintain the lower jaw (mandible) in a protruded position
during sleep. It is felt that this serves to open the airway
by indirectly pulling the tongue forward since the tongue
is attached to the lower jaw, by stimulating activity of
the muscles in the tongue and making it more rigid, and by
holding the lower jaw and other structures in a stable position
to prevent opening of the mouth.
An example of a mandibular repositioning appliance is shown
at left (Image 1). Thin shells are placed over the upper
and lower teeth and a device
is incorporated that will pull the lower jaw forward as necessary
to open the airway.
Tongue Retaining Appliances
There are very few tongue retaining devices available, but
they have been well studied and shown to be effective in
many patients. Tongue retainers function by directly holding
the tongue in a forward position by means of a suction bulb
that holds the tongue. When the tongue is in a forward position,
the back of the tongue does not collapse during sleep and
obstruct the airway in the throat.
<
An example of a tongue retaining appliance. The tongue is
held in the suction bulb that protrudes from between the
teeth on this cast.
Non-Adjustable Mandibular Repositioning
Devices |
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Made of a very pliable soft, custom-injected
silicone and is tooth retained. There are no clasps
or wires to adjust. The flexibility of the material
lends itself to a high degree of patient comfort. The
Elastomeric appliance is not protrusively adjustable.
The vertical opening is 5 mm and the mandible is afforded
some limited movement due to the high flexibility of
the material.
FDA Approval: Approved for both snoring
and OSA. |
Elastomeric
Sleep Appliance
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Snore Guard®, an oral appliance
easily assembled at chair side, comprises a structure
shaped to conform
to the upper dental arch of the user and to create
a ramp behind the lower anteriors. This ramp prevents
the user's jaw from receding; in addition, the tongue
seeks an opening between the upper and lower portion
of the Snore Guard, thus keeping the air passage
of the throat open.It is made of two polycarbonate
thermoplastics
fused together under high pressure. This unique combination
of materials allows stability of the unit while providing
ease of wear and insertion.Snore Guard has been marketed
since 1989 with a 95% reported success rate for reducing
snoring. Snore Guard's design allows the user to
breathe orally while promoting nasal breathing. It
also permits
lateral movement of the mandible.
FDA Approval: Approved |
Snore
Guard
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One-part thermoplastic mandibular
advancement device to treat snoring and mild to moderate
obstructive sleep apnoea. Appliance consists of a
hypoallergenic thermoplastic body. After heating
the appliance in water that has been boiled the thermoplastic
co-polymer becomes soft and mouldable. While soft,
the appliance is fitted to the upper and lower jaws
and once cooled it is ready to be worn at night.
It differs from the preceding SomnoGuard by a 3.0
mm thicker molar biting zone. This thicker molar
area means that fitting is faster and easier for
those patients with a "deep bite". The
monobloc appliance exhibits the following features
and advantages: • Easy fitting within minutes,
preferably by physicians or their trained staff
• Clinical
efficacy well proven by several clinical trials performed
with the SomnoGuard® with success rates between
50 to 80% in reducing snoring and RDI (i.e. Respiratory
Disturbance Index). Literature references and detailed
actual clinical trial outcome data is published on
www.tomedcare.com
• Normally very well tolerated.
Minor and temporary side effects refer mainly to
hypersalivation and morning discomfort
• Average
life of about one year, and thus considered for short
to medium term use
• The most cost-effective
option to treat snoring and sleep apnoea.
FDA Approval
received for the complete line of SomnoGuard oral
appliances. |
Somno
Guard 2.0
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Adjustable Mandibular
Repositioning Appliances |
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The Adjustable PM Positioner™ utilizes
materials and a design that minimize office chair-time
and provide the patient control of adjusting the
jaw position under the dentist’s supervision.
Research studies have shown that this appliance is
successful in treating 77% of patients with moderate
obstructive sleep apnea. The appliance fits over
all maxillary and mandibular teeth and is made of
a special acrylic material (Bruxeze™) that
softens in hot water to provide a combination of
comfort, strength, and retention. This material has
proven to be very durable. Expansion screws are located
on the right and left buccal areas to allow maximum
space for the tongue and easy anterior-posterior
positioning of the mandible to achieve optimal effectiveness.
This design permits ample lateral and protrusive
movement to maintain jaw comfort. The device uses
a unique method of retention consisting of small
projections of acrylic within the device that comfortably
grip the undercut areas of two posterior teeth in
each quadrant. Therefore, no metal clasps are necessary.Clinical
Research Associates gave the Adjustable PM Positioner™ its
highest rating for appliances tested.
FDA Approval: Approved
for both snoring and OSA. |
Adjustable
PM
Positioner
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The appliance is constructed of maxillary and mandibular
full arch thermoplastic bases with Velcro-like attachments
on the occlusal surfaces of both. It is retained by
friction grip to the teeth. These provide simple and
easy adjustment antero-posterior and left and right
over a wide range. Adjustments are easily accomplished
by the doctor or patient.
FDA Approval: Approved
for both Snoring and OSA. |
Hilsen
Adjustable
Positioning Appliance
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