A Novel Use of Complete Denture Prosthesis as Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea in Edentulous Subjects

Abstract

Study Objective: Mandibular advancement devices have been used to efficiently treat mild to moderate obstructive sleep apnea by effecting a forward positioning of the tongue-mandible complex and a resultant increase in oropharyngeal volume. These devices are essentially tooth anchored and hence, work well in dentate patients. However, it is difficult to anchor such devices in an edentate mouth. This clinical study presents a case series on use of complete dentures modified to function as mandibular advancement device. Methods: Ten edentulous OSA patients (8 male and 2 female, aged 61 ± 4 years; BMI 22 ± 5; AHI 15-30) who volunteered and provided written informed consent were included in the study. All of them were provided with complete dentures, and after 1 month of comfortable wear and attaining optimum function, the prosthesis was modified to serve alternatively as a mandibular advancement device. Use of complete dentures as MAD was recorded separately. Five variables were assessed preoperatively and after 6 months of wearing the modified mandibular advancement device. The variables were: sleep efficiency, apnea-hypopnea index, oxygen desaturation events/h, mean O 2 saturation, and snoring index. Overnight polysomnography was done to evaluate the sleep variables preoperatively and after 6 months of wearing the modified mandibular advancement device. Results: A significant decrease in apnea-hypopnea index (AHI) from 22.5 preoperatively to 4.8 postoperatively (p = 0.005) and snoring index from 7.9 preoperatively to 2.1 postoperatively (p = 0.005) was observed after 6 months of use of the modified oral appliance. Sleep efficiency increased from 62.55% preoperatively to 73.20% postoperatively (p = 0.005). Conclusions: The results indicate that within the limits of the present study, this specific MAD can be effective in reducing sleep apnea by lowering the AHI, reducing snoring and oxygen desaturation events/h and increasing sleep efficiency.