Comparison of efficacy and usability of custom mandibular advancement devices fabricated with the conventional method and digital workflow: A pilot clinical study.

PURPOSE: To compare the effects of fabricating methods of custom monoblock mandibular advancement devices (MADs) on usability and efficacy in patients with mild and moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS: Digitally fabricated custom MADs (dMADs) were produced for 11 OSA participants who had previously used conventionally fabricated custom MADs (cMADs). The participants answered a modified usability questionnaire for both MADs, and the average scores that were given to the questionnaire were evaluated by age, sex, and body mass index (BMI), and the scores of cMADs and dMADs were compared. After 6 months of usage of each MAD, the apnea-hypopnea index (AHI), mean and lowest oxygen saturations, and total sleep time were measured for efficacy assessment. Data were analyzed with Cronbach's alpha, Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, one-way repeated measures analyses of variance, and Bonferroni tests (α = 0.05). RESULTS: Cronbach's alpha was found at 0.834 and 0.722 for the conventional and digital questionnaires, respectively. The usability scores of the dMADs were significantly higher than those of cMADs (p = 0.013). There was no difference in usability scores in terms of sex or BMI (p > 0.05). No statistically significant difference was found for cMAD (p = 0.113) among age groups; however, there was a significant difference for dMAD (p = 0.046). The AHI, mean, and lowest oxygen saturation values were significantly affected by MAD usage (p < 0.001). However, total sleep time values did not differ after the MAD treatments (p > 0.05). Significantly lower AHI and significantly higher lowest oxygen saturation values were observed with dMAD, while both appliances led to similar results for mean oxygen saturation and total sleep time values (p > 0.05). CONCLUSIONS: Participant usability scores were higher for digitally manufactured MADs than conventionally manufactured MADs. However, both conventional and digital MADs were found effective in decreasing the AHI levels and increasing the mean and lowest oxygen saturation values of the participants.

Fabricating a custom monoblock mandibular advancement device by using an open-source nondental CAD software program and additive manufacturing: A dental technique.

Custom mandibular advancement devices (MADs) can be fabricated by using either conventional processes or computer-aided design and computer-aided manufacturing (CAD-CAM). The CAD-CAM technique involves digitizing the dental arches of the patients, designing by using a dental CAD software program, and additive manufacturing with a suitable material. This article describes the steps of the design of a custom MAD by using an open-source nondental CAD software program and of the fabrication with additive manufacturing.

Design and fabrication of an interim fixed restoration with an open-source nondental CAD software program and additive manufacturing: A technical report.

This technique aimed to identify the potential of an open-source software program and to present the design and fabrication procedures of a single interim crown with a nondental CAD software program. The steps included defining the margins, establishing the cement interval value, completing the virtual modeling of the crown, and checking the proximal and occlusal contacts by using color mapping.

Effects of nocturnal complete denture usage on cardiorespiratory parameters: A pilot study.

STATEMENT OF PROBLEM: Sleeping without conventional complete dentures (CCDs) has been stated by some to induce negative effects on the cardiorespiratory functions of edentulous patients with obstructive sleep apnea (OSA), although others have reported the exact opposite. Therefore, a consensus on nocturnal CCD usage is lacking. PURPOSE: The purpose of this clinical study was to assess the effects of nocturnal denture usage on cardiorespiratory stability by using pulse oximetry (PO). MATERIALS AND METHODS: Thirty CCD wearers were enrolled in the study. The first nocturnal pulse oximetry (FNPO) recordings were made on 3 different nights while the participants were sleeping without dentures (WOD). Oxygen desaturation index (ODI) and other PO parameters of the participants, including total respiratory event (TRE), basal SpO2 (BSpO2), time≤88 (T88), average low SpO2 (ALSpO2), total pulse event (TPE), average pulse rate (APR), and heart rate variability index (HRVI), were processed and the obtained data were recorded as WOD condition values. According to the ODI scores, the OSA status of the participants was grouped as normal (ODI<5), mild (530). Complete dentures were fabricated by an experienced prosthodontist and a dental laboratory technician by following conventional procedures. At the end of the first month of the follow-up period, the second nocturnal PO recordings (SNPO) were made on 3 different nights while the participants slept wearing dentures (WID), and the data obtained were recorded as WID condition values. The comparison of mean PO values obtained from WOD and WID were analyzed with the Wilcoxon signed- rank test (α=.05). RESULTS: Significant differences were found between WOD and WID values in terms of TRE (P=.01), ODI (P=.001), ALSpO2 (P=.006), TPE (P=.001), and HRVI (P=.001) parameters. The significance of the improvements in the WID condition increased with the severity of OSA. CONCLUSIONS: Improvements were observed in substantial cardiorespiratory parameters such as the ODI and HRVI of the participants wearing dentures nocturnally.

Fabrication of a Mandibular Advancement Device Using a Fully Digital Workflow: A Clinical Report.

Obstructive sleep apnea (OSA) is a common disorder among adults with a potential to be life-threatening. Continuous positive airway pressure is the gold-standard for the treatment of OSA, but patient compliance may be reduced due to various reasons. Mild to moderate cases of OSA can be treated reliably and successfully using oral appliances, and the mandibular advancement device (MAD) is the most frequently used appliance. The aim of this clinical report is to present a fully digital workflow for fabrication of a custom non-adjustable MAD using computer aided design/computer aided manufacturing and additive manufacturing for the treatment of a patient with moderate OSA.

Can nocturnal use of implant-retained overdenture improve cardiorespiratory stability of a patient with obstructive sleep apnea? A clinical report.

Few studies have evaluated the interaction between conventional complete dentures (CCD) and the respiratory system and the authors are unaware of any that evaluated the interaction between implant-retained overdentures (IROs) and the respiratory system. This clinical report documented the effects of wearing an IRO on the cardiorespiratory stability of an edentulous patient with obstructive sleep apnea (OSA). A 64-year-old woman was referred to the department of otolaryngology because of daytime sleepiness and morning headaches. The patient refused polysomnographic evaluation because of claustrophobia. Overnight pulse oximetry (PO) was performed to detect cardiorespiratory stability during sleep, and the oxygen desaturation index (ODI) of the patient was found to be 20.9. A mandibular advancement device (MAD) was fabricated; however, the patient did not comply with the treatment and stopped using the MAD because of intraoral discomfort. Therefore, the patient started to wear the conventional complete dentures (CCDs) nocturnally to prevent upper airway collapses. Despite the significant drop in ODI score to 12.6, because of displacement, the mandibular denture was converted to an IRO. The PO tests performed after another 6 months revealed an ODI score of 7.8. Wearing CCDs might improve respiratory stability of patients with edentulism during sleep; however, more favorable results could be obtained with IROs.

Can Impression Procedures Affect Certain Vital Functions of Edentulous Patients? A Clinical Study.

PURPOSE: The most suitable treatment conditions and timing for medically unstable patients with severe systemic diseases about to undergo invasive dental treatment are well documented in the literature; however, no medical guides or recommendations identify these conditions for noninvasive dental treatments in such patients. The aim of this clinical study was to determine the effect of impression procedures on arterial oxygen saturation (AOS) and pulse rates (PRs) of edentulous subjects. MATERIALS AND METHODS: A total of 28 Caucasian edentulous participants (15 females, 13 males) were included in the study. Pulse oximetry recordings (150 seconds) were performed for each participant at three stages; recording at rest (CON), during mandibular impressions (MANIs), and maxillary impressions (MAXIs). The mean values of PR, AOS, and event scores (ESs) indicating desaturation were obtained from the records. The comparisons of mean PR and AOS values were performed with the Bonferroni-corrected Wilcoxon-signed ranks test. The ESs were analyzed with the McNemar Test. RESULTS: The mean AOS values of MANI and MAXI did not display significant changes when compared with CON; however, the ESs obtained in both MANI and MAXI were significantly higher than those of CON (p = 0.008, p = 0.004). In addition, mean PR values obtained in MAXI were significantly higher than CON (p = 0.009). CONCLUSIONS: According to the results of this clinical study, the impression procedures may affect the PR values and lead to desaturation events in edentulous patients; however, further studies evaluating blood gas levels, which indicate precise AOS values, are necessary to support the results of this study.