UBC Theses and Dissertations
Mini-implant supported oral appliance for treatment of obstructive sleep apnea : a feasibility study Navarrete Grimminck, Matias
Introduction: Obstructive sleep apnea (OSA) is a major sleep breathing disorder characterized by repetitive obstruction of the upper airway during sleep leading to sleep fragmentation and oxygen desaturation. Mandibular advancing oral appliances (OAm) are an effective treatment for OSA but cause long-term dental changes, resulting in some patients stopping treatment. We hypothesized that a novel OAm which interfaces with orthodontic mini-implants (OMIs), instead of teeth, can avoid dental changes. This study aims to evaluate the effectiveness of a novel device; to suggest future design improvements; and to advance the understanding of design and anatomical factors that may contribute to successful treatment. Methods: The pilot trial included 3 non-obese adult OSA patients that were successfully treated with OAm. For each patient 4 OMIs were placed in the maxilla and 2 in the mandible, and an appliance was digitally designed and 3D printed based on patient anatomy. The appliance was tested on patients to evaluate viability of the design, retention, and patience experience. To evaluate the influence of anatomical factors, the dental records of 5 OSA patients were measured to determine the appliance design configurations at different amounts of titration and various OMI positions. Mathematical modelling was used to quantitatively approximate forces that would be exerted on the lower OMIs for different amounts of mandibular protrusion. Results: The appliance retention was deficient under the initial design configuration. A total of 24 OMIs were inserted. The overall OMI failure rate was 50.0%; 38.5% in the maxilla, and 63.6% in mandible. Model analysis showed optimal sidebar angulation was only achieved in a sample Class II division 2 malocclusion/non-extraction case at maximum titration. Quantitative force analysis revealed forces of up to 32.5N could be generated on the lower OMIs with the existing design configurations. Conclusion: Appliance design is limited by anatomical factors, OMIs location, and sidebar angulation. The overall appliance retention was deficient with a high OMI failure rate compared to previous orthodontic-based studies. Multiple individual OMIs may not be a suitable option to anchor the appliance. Conclusions should be taken with caution due to small sample size and high risk of bias.
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