Types Of Oral Appliances

Oral appliances used for OSA generally fall into one of two classes, viz. mandibular advancement splints (MAS) and tongue retaining devices (TRD). MAS induce protrusion of the mandible by anchoring a removable device to part of or the entire upper and lower dental arches, while TRD use a suction cavity to protrude the tongue out of the mouth. MAS are far more widely used in clinical practice and there is an extensive literature on their use, compared to TRD. There are many designs available, but they generally fall into either one-piece (monobloc) or two-piece (duobloc) configurations (Figs. 1 and 2). Beyond this, they can differ substantially in size, type of material, degree of customization to the patient's dentition,

FIGURE 1 (See color Insert.) An example of a monobloc (one-piece) mandibular advancement splint.

coupling mechanism, amount of occlusal coverage, titratability of mandibular advancement, degree of mandibular mobility permitted (vertical and lateral), and allowance for oral respiration. The impact of these design differences on clinical outcomes is largely unknown at this stage, and this suggests the need for caution in extrapolating the results of studies using one type of appliance to all types of appliances.

Two-piece splints consist of an upper and a lower removable plate with some type of intermaxillary coupling (Fig. 2). There are several modes of coupling between the upper and the lower plates, such as elastic or plastic connectors, metal pin and tube connectors, hook connectors, acrylic extensions or magnets. There has been a steady shift toward the predominant use of two-piece appliances in clinical practice because of the advantages they often confer, including titratability over time and permission of movement (vertical and/or lateral). Although prefabricated appliances are commercially available, it is considered that the best retention, comfort, and side-effect profile is achieved with custom-made oral appliances.

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