Mandibular Advancement Device for Obstructive Sleep Apnea

Abstract

Sleep disorder is a public health problem touching 1 billion of people worldwide and mandibular advancement devices therapy, as a modality to continuous positive airway pressure, is now a good alternative for obstructive sleep apnea treatment. Efficacious technic that requires a good follow up and customization. The purpose of this work was to understand the efficiency of the different appliances and their side effects compared to the CPAP, carrying out a scientific review. Mandibular advancement devices are represented by many possibilities of designs. Custom-made appliance is, by its capacity of reduction of the apnea hypopnea index of the patient, better with 6± 8 events per hours compared to the preformed with 11±9 events per hours. Monobloc and bi-bloc appear different, monobloc allows a better reduction of the AHI but bi-bloc is preferred by the patient. The amount of protrusion is very important for the success of the treatment as the more protrusion the better it is. Adjustable appliance has greater efficacity compared to the fixed appliance. Compared to CPAP, MAD is a good alternative at all degree of severity but mainly in non-severe cases. CPAP, if tolerated, is the golden standard. MAD is also related to side effects at short and long terms meaning that a good follow-up is necessary to assess the good protrusion finding the best effectiveness / side effects ratio to avoid the withdraw of the treatment and the best outcomes of that long-life treatment.