0551 A Combined Approach for Upper Airway Remodeling for Skeletal class III Malocclusion with Complex OSA

Abstract

Introduction: Obstructive Sleep Apnea (OSA), is a common sleep-disorder, which might emanate from decreased pharyngeal muscle tone, craniofacial obesity, and craniofacial deficiencies amongst others. Current treatments are continuous positive airway pressure therapy (CPAP) and/or mandibular advancement appliances. These treatments attempt to normalize the upper airway, with little regard to osseous and soft tissue features. Skeletal class III malocclusion with OSA is a complex orthodontic/orthopedic problem. Patients with skeletal class III malocclusion and OSA have underdeveloped maxillae from childhood, which can lead to sleep breathing disorders. This preliminary study tests the hypothesis that biomimetic oral appliance therapy (BOAT) can be used in conjunction with surgery to reduce AHI and ameliorate OSA. Methods: This study included two male patients aged 24yrs (case A) and 31 yrs (case B) with class III malocclusion who had been diagnosed with OSA. Prior to treatment, the craniofacial region was imaged using 3D cone-beam CT scans. They were then treated with FDA-cleared BOAT (mRNA appliance ® and DNA appliance®). After 9 to 24 months of treatment, AHI was reassessed, without any appliance in the mouth during sleep, by a home sleep test (HST). Posttreatment, the upper airway volume was reassessed with another 3D cone-beam CT scan. Results: For case A, the mean AHI decreased from 31hr-1 to 3hr-1. The upper airway volume (from the posterior nasal spine to the epiglottis) increased from 16.7cm3 to 20cm3, a 12% increase. For case B, the mean AHI decreased from 36.6hr-1 to 3.2hr-1, while the upper airway volume increased from 17cm3 to 23cm3, a 13% increase. Conclusion: The study suggests that decreases in AHI may be associated with non-surgical upper airway remodeling in adults with OSA and craniofacial deficiencies secondary to skeletal class III malocclusion.