MSG – Sound Sleep – Aparelho intraoral auxiliar na terapia do ronco e síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) / MSG – Sound Sleep – Intraoral appliance therapy helps snoring and obstructive sleep apnea and hypopnea syndrome (OSAHS)

A inter-relação entre as especialidades da área de saúde inclui a Odontologia, em especial a Ortodontia associada à Ortopedia Funcional dos maxilares e a Cirurgia Ortognática, a corresponsabilidade no diagnóstico e terapia dos distúrbios do sono. O sono é primordial para a homeostase do organismo, porém, distúrbios de origem central ou fatores obstrutivos nas vias aéreas podem afetar seu equilíbrio. Um sinal clínico dos distúrbios do sono é o ronco, que se evidencia pelos problemas sociais, mas é um alerta para a síndrome da apneia e hipopneia obstrutiva do sono (SAHOS). Os aparelhos intraorais (AIOs), de acordo com a literatura, por se tratar de terapias não invasivas, vêm se tornando eletivos para os casos leves e moderados das SAHOS, bem como no tratamento do ronco. O aparelho MSG - Sound Sleep é um ativador postural construído a partir de acessórios utilizados na Ortopedia Funcional e mecânica, agindo na mudança da postura terapêutica da mandíbula (MPT), aumentando a ventilação nas vias aéreas superiores. Possui como vantagem ativação gradativa e a liberdade de movimentação lateral que traz conforto e maior adesão pela terapia. Outra vantagem é atingir um maior número de pacientes por possuir baixo custo técnico e laboratorial. O propósito deste artigo é apresentar o aparelho MSG - Sound Sleep descrevendo seu registro de oclusão, fase laboratorial, tipos de aparelhos, instalação e protocolo clínico.

The relationship between healthcare specialties includes Dentistry, particularly Orthodontics associated with Functional Jaw Orthopedics and orthognathic surgery, and the corresponsibility regarding diagnosis and treatment of sleep disorders. Sleep is essential for homeostasis, but sleep disorders of central origin as well as airway obstruction factors may affect sleep balance. Snoring is a clinical sign of sleep disorders , which is evidenced by social problems, and may act as an alert for the obstructive sleep apnea hypopnea syndrome (OSAHS). According to the literature, since intraoral devices (AIOs) are a non-invasive therapy they became an alternative to treat snoring and the mild to moderate cases of OSAHS. The MSG-Sound Sleep appliance is a postural activator constructed from accessories used in functional and mechanical orthopedics, that changes jaw therapeutic posture increasing the ventilation in the upper airway. It has the advantage of gradual activation and freedom for lateral movement that provides comfort resulting on greater compliance. Another advantage is due to low technical and laboratory costs reaching more patients. The purpose of this paper is to present the MSG-Sound Sleep appliance describing its occlusal record, laboratorial phase, types of equipment, installation, and clinical protocol.

Comfort evaluation of non occlusal intraoral appliance use during sleep in patients with muscular temporomandibular dysfunction / Evaluación del confort del uso durante el sueño de un aparato intraoral no oclusal en pacientes con disfunción temporomandibular muscular

The aim of this study was the evaluation of the discomfort level during the utilization of non oclusal intraoral appliance during sleep in patients with muscular temporomandibular dysfunction; time of acceptance; and the effectiveness of non oclusal intraoral appliance related to the relief of pain symptoms. We evaluated 30 patients from Orofacial Pain and Temporomandibular Dysfunction Clinic (UNIFESP/EPM/HSP) with muscular temporamandibular dysfunction, 25 females and 5 males, between 19 to 60 years. We used a non-oclusal intraoral appliance, based on the model developed by Minagi et al. (2001). Patients was conducted to use the appliance during all sleeping period e to persist in use, even when there was any kind of discomfort, which would be natural during the adaptation period, for 30 consecutive days. After this period, the researcher interviewed all patients, answering specific questions designed for this study. The mean time for adaptation was 4 days. Of all patients, 23.33 percent had no difficulty in adapting the appliance, with immediate acceptance. The gradual reduction in the intensity of myofascial pain and discomfort, as well as improving the quality of life in 78.3 percent of the sample confirmed the effectiveness of non-oclusal palatal intraoral appliance without occlusal contact in relieving the painful symptoms of muscular TMD.

El objetivo fue evaluar la respuesta al uso de un aparato intraoral no oclusal durante el sueño en pacientes con disfunción temporomandibular (DTM) muscular. Se evaluaron 30 pacientes de la Clínica de Dolor Orofacial y Disfunción Temporomandibular (UNIFESP/EPM/HSP) con diagnóstico de DTM muscular, 25 mujeres y 5 hombres, entre 19 y 60 años. Se utilizó un aparato intraoral no oclusal, basado en el modelo desarrollado por Minagi et al. (2001) y se evaluó el tiempo de adaptación al aparato y la eficacia en términos de reducción del dolor. Los pacientes utilizaron el aparato al acostarse y mientras dormían por 30 días contínuos. Después de este período, todos los pacientes fueron entrevistados. El tiempo medio para la adaptación fue de 4 días. De todos los pacientes, el 23,33 por ciento no tuvo ninguna dificultad de adaptación al aparato, con aceptación inmediata. La reducción gradual en la intensidad del dolor miofascial y el malestar, así como la mejora de la calidad de vida en el 78,3 por ciento de la muestra confirmó la eficacia del aparato intraoral para aliviar los síntomas dolorosos de DTM muscular.

A cephalometric study in patients with obstructive sleep apnea after use of oral appliance / 대한치과교정학회지

It is well known that oral appliance could improve respiratory difficulty in patients with obstructive sleep apnea (OSA). To evaluate the effect of oral appliance, polysomnography and cephalometry were performed in OSA patients before and after oral appliance was used. Twenty four OSA patients were included in this study. Respiratory difficulty index (RDI) was obtained from polysomnography and the movement of soft palate, tongue, posterior pharygeal wall, hyoid bone, and mandible and the variables of the facial pattern were measured on the cephalogram. The changes of cephalometric parameters were compared to the RDI changes and the correlation was tested. After oral appliance was used, RDI decreased from 46.8 to 13.3. There was significant relationship between RDI improvement and the anterior movement of the mandible and superior movement of the hyoid bone. In 8 patients whose RDI was most improved, RDI improvement rate was correlated with the anterior movement of the on tongue and anterior-posterior (AP) diameter of the airway at the levels between the lower portion of the soft palate and epiglottis. These results could conclude that anterior movement of the tongue and superior movement of the hyoid bone would be favorable cephalometric parameters for the improvement of OSA.

Treatment effect of protraction head gear on skeletal Class III malocclusion / 대한치과교정학회지

Before 1970, mandibular overgrowth was known as main cause of skeletal Class III malocclusion in growing children ; however, recent study reports that many skeletal Class III malocclusion patients also show maxillary deficiency. Since 1972, when Delaire re-accommodated Protraction Head Gear (P.H.G.), many researchers have reported that skeletal Class III discrepancies could be corrected through use of P.H.G., which induces anterior movement of maxilla and change in mandibular growth pattern into infero-posterior direction ; nevertheless, it is very difficult to predict resultant changes of orofacial region. The purpose of this study was to find out what treatment effect P.H.G. has on different study samples. Author divided 51 skeletal Class III malocclusion patients with maxillary deficiency who were treated with P.H.G. into different study groups depending on sex, treatment beginning age, intraoral appliance, and facial growth pattern. By doing so, following results were obtained. 1. Treatment beginning age and Sex Four age groups (5.8 to 8 year-old, 8 to 10 year-old, 10 to 12 year-old, 12 to 14 year-old) were compared, and no significant difference was observed. (p<0.05) There was no significant difference between the sex groups, either. (p<0.05) 2. Intraoral appliance Treatment effects of study groups that used R.P.E.(mean age of 10.2) and Labio-Lingual appliance(mean age of 8.9) were compared. There was no significant difference depending on the type of intraoral appliance that was used. (p<0.05) 3. Facial growth pattern 1) Amounts of SNB and ANB corrections were smaller in clockwise growth pattern group than those in normal or counterclockwise growth pattern group. (p<0.05) 2) Amounts of increase in Wits appraisal and mandibular plane angle were greater in counterclockwise growth pattern group than those in normal or clockwise growth pattern group.(p<0.05) 3)Amounts of increase in articular angle were greater in counter lockwise growth pattern group than those in clockwise growth pattern group. (p<0.05)