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Is there a gold standard mandibular advancement splint for the treatment of snoring and sleep apnoea?

1 May 2017

There is a large array of oral appliances on the market today with
over 85 different designs coming from various companies. There are
also two oral appliance companies publicly listed on the Australian
stock exchange, both with large resources. These companies make
unsubstantiated claims in their extensive marketing that they have
the best appliance. This can be confusing for dentists, physicians and
the public.

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 this years 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 study1showed 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 study2
demonstrated 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.


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


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 apnea appliances
N Norrhem & H Nemeczek & M Marklund
SleepBreath Jan 2017


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