Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients

• Published in: Journal of stomatology, oral and maxillofacial surgery oral and maxillofacial surgery, 2021-09, Vol.122 (4), p.361-366
• Main Authors: Kerbrat, A., Vinuesa, O., Lavergne, F., Aversenq, E., Graml, A., Kerbrat, J.B., Trost, O., Goudot, P.
• Format: Article
• Language: English
• Subjects: CBCT; Human health and pathology; Life Sciences; Mandibular repositioning device; Obstructive sleep apnoea; Oral device; Upper airway volume; Vertical dimension
• ISSN: 2468-7855; 2468-7855
• DOI: 10.1016/j.jormas.2021.06.002

•Two different custom made MRDs have different impact on upper airway volume.•A higher vertical dimension can have adverse effects on pharyngeal collapse.•Vertical dimension impacts upper airway volume on patient with MRDs.•With a smaller vertical dimension, MRDs are less responsible of TMJ discomfort. This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.