Patients' perceptions of the importance of improvements and side effects from mandibular advancement device therapy for obstructive sleep apnea and snoring.

OBJECTIVE: To assess which improvements and side effects are considered most important by patients with OSA treated with a MAD. METHODS: A specific questionnaire consisting of 20 questions, including 10 questions on improvements and 10 on side effects, was developed and mailed to all subjects (54). RESULTS: 42 patients, participated in the survey by answering the questionnaire. The results showed that patients placed greater importance on the positive outcomes of treatment, with the most significant being the reduction in snoring and improvement in sleep quality. On the other hand, the side effects of difficulty speaking with the device, tooth mobility, and foreign body sensation were considered important. CONCLUSIONS: The advantages perceived by the patients appear to outweigh the disadvantages, especially the reduction of snoring, increased productivity, and improved social and intellectual life. Most significant side effects are reversible and short-term, while occlusal changes, is not considered important by patients.

Personality traits and oral device: a new challenge to increase compliance with MAD therapy for OSAS and snoring.

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory syndrome and oral devices can be used for its treatment. This study aimed to evaluate the opinions of a generic subject about being treated by a dentist for a general health problem and the association between personality traits and the predisposition to use a MAD for the treatment of OSAS and snorting. One hundred and forty-eight participants were enrolled in the study and were asked to fill in the questionnaires. Personality traits were evaluated using NFC (Need for Closure), PER (openness to new experiences), STAI-Trait and STAI-Stat questionnaires (State-Trait Anxiety Inventory). The propensity to be treated with dental devices for a general health problem such as OSAS and snoring was evaluated with a specific questionnaire. Eight out of ten participants would accept to use dental device to be kept at night for the solution of a health problem or the treatment of a disease that does not affect the teeth. A positive opinion on device used to treat OSAS was associated with higher PER and lower Mad-related distress, while the opinion of usefulness of the device was positively associated with higher PER and STAI-Trait. A positive opinion about treatment of snorting and OSAS using dental devices was associated with higher PER, while lower STAI-Trait was associated with positive opinion on treatment of snorting using dental-devices. The results suggest that some personality traits are associated with the propensity to use MAD to treat a general pathology as OSAS.

Anisotropic computational modelling of bony structures from CT data: An almost automatic procedure.

BACKGROUND AND OBJECTIVE: The use of modelling techniques that combine CT data and bone tissue micromechanics is spreading in computational biomechanics. Finite Element models show great potential in surgical planning of intervention and in prediction of stress and strain fields through a non-invasive method. The main challenge pertains to the reliable characterization of bone mechanical behaviour. An almost automatic procedure is here defined, which provides computational models of bony structures considering the actual anisotropy of bone tissue response. The innovative aspect resides on the automatic detection of the directions of anisotropy as the eigenvectors of a three-dimensional distribution matrix of HU values. METHODS: The procedure combines CT data and micromechanics modelling techniques. Regarding a specific location, the procedure reports both the orthotropic elastic constants, by the analysis of the local HU value, and the anisotropic material directions, by the analysis of the HU values distribution around the specific location. RESULTS: The procedure returns the distribution of bone tissue orthotropic elasticity tensor. The procedure proves to correctly respect the differentiation between cortical and trabecular bone. Principal directions show to be consistent with experimental data from ultrasound measurements. Regarding the material mapping from voxel to FE model, the developed strategies show to be reliable, leading to marginal errors (lower than 10%) for most of CT voxels (more than 90%). The computational analyses of typical structural loading conditions lead to strain values that are comparable with results from strain gauges experimentations. The development and the exploitation of FE models of different bony structures allow assessing the reliability of the procedure for cortical bone. CONCLUSIONS: The results highlight the potentialities of the procedure in providing accurate patient-specific biomechanical models of bony structures starting from CT data. The accuracy and the automatism of the procedure are important factors for the development of real time clinical tools. The main limitations of this work remain the not fully automatism and the reliability assessment, which is based mainly on cortical bone regions only.