ORAL APPLIANCE

THERAPYCASE PRESENTATION

THOMAS M. GOTSIS DDS FAGD

MIDWEST DENTAL SLEEP MEDICINE INSTITUTE @ SSM DEPAUL HEALTH CENTER

BOARD OF DIRECTORS MISSOURI SLEEP SOCIETY

"I have no relevant financial relationships to disclose”.

Successful therapies of sleep

disordered breathing

decrease the collapsibility of the pharyngeal

airway.American Academy of Sleep Medicine

PERFORMANCE CRITERIA FOR OSA TREATMENT

TREATMENT• The most common

type of treatment is CPAP (continuous positive air pressure)

• Although highly effective, patients are frequently non-compliant with CPAP

• Other treatments include oral appliances, surgery and weight loss

7

SOMNOMED MAS™

The TAP I & II & III Developed by Dr. Keith Thornton FDA approved for OSA

Pro’s Fine protrusive adjustability

(.25mm) Variety of acrylics, comfortable Some lateral mobility (TAP II)

Con’s Advancement mechanism may

slightly intrude on tongue space

THE TAP SERIES

The TAP I

The TAP III

AIRWAY ASSESSMENT

Acoustic Reflection (Pharyngometry)

ACOUSTIC REFLECTIONADVANTAGES DISADVANTAGES

LAVIGNE, GJ, CISTULLI, PA, SMITH MT, "Sleep Medicine for Dentists", Quintessence Publishing Co., 2009, p. 62.

• Non-Invasive• Free of radiation• Reproducible• Dynamic imaging

modality• No weight

limitation

• Performed with patient in sitting position

• Performed through patient’s mouth (modification of the upper airway anatomy)

• Does not provide direct information on airway structures or geometry

ACOUSTIC PHARYNGOMETRY

Pick-ups

Microphone

PHARYNGOMETRY LANDMARKS

Oropharyngeal Junction, OPJ

Oropharynx

Epiglottis

Oral Cavity

Hypopharynx

2-D Pharyngometer readings

Mandible is Advanced - Dilation

Patient had hx of chest pains.

ESS=14

Snoring was keeping spouse from sleeping.

Did not feel refreshed upon wakening.

Excessive daytime sleepiness.

AHI=30 events/hr

Pt is CPAP-intolerant and is referred for OAT.

Follow-up PSG:

Occasional breakthrough snoring.

AHI=.2 events/hr

At 6 month recare the patient wearing MAD nightly. So compliance=100%