Dental Update – January/February 2003
tomography and magnetic resonanceimaging scans demonstrate significantincreases in airway dimensions with theappliances.
Successful treatment has,and continues to be, demonstrated – fromquestionnaires of patients and their partners and scientifically from sleepstudy polysomnography.
The effectiveness of appliance therapy,however, depends on the severity of thesleeping disorder, the airway anatomy
and whether the patient can tolerate theappliance. It is generally advocated for mild OSA and simple snoring (i.e. snoringin the absence of OSA) and moderate tosevere OSA as an alternative to nasalcontinuous positive airway pressure(nCPAP) or craniofacial surgery.
Theuse of intra-oral appliances is simple,non-invasive, reversible and cost-effective and may be the basis of definitive lifelong treatment.The technical aspects of constructionhave been evolving since the early1980s,
although prostheses were firstconsidered in the early 1900s.
Originallythere were three concepts for a dentalappliance to modify the airway, whichcould be used alone or in combinationdepending on where the airwayobstruction occurred:
Soft palate lifting – the prosthesislifts and/or stabilizes the soft palate, preventing vibration during sleep.
Tongue retention – tongue-retainingdevices (TRDs) incorporate ananterior hollow bulb, which generatesa negative pressure vacuum when thetongue is inserted. The tongue is held forward, away from the posterior pharyngeal wall, opening up theairway. Owing to muscle anatomy,this appliance simultaneouslymodifies the position of themandible.
Mandibular repositioning – theseappliances (MRAs) hold the mandiblein an anteroinferior position, which,as a consequence of muscleattachment, indirectly brings thetongue forward, opening up the posterior airway (Figure 1). Therepositioning may also stretch and reduce the collapsibility of the soft palate via its connection to the baseof the tongue and increase thesuperior airway space.
A recent review of 129 paperssuggested that more than 35 appliancesare currently available,
although Loweestimates the number to be in excess of 55.
Appliance nameDescriptionTypeOcclusal coverage
Adjustable Soft Palate Lifter
Lifts the soft palate and prevents vibration during sleepOne-pieceFullEqualiser
Repositions the mandible anteriorly, equalizes intra- and extra-oral airOne-pieceFullpressure (via tubes) and elevates soft palateHerbst
Repositions the mandible anteriorly, in open and closed position, withTwo-pieceFulladjustable struts. Jasper Jumper
Repositions the mandible anteriorlyTwo-pieceFullMandibular Repositioner
Repositions the mandible anteriorly (3–7 mm)One-pieceFullNocturnal Airway PatencyRepositions the mandible anteriorly and inferiorlyOne-pieceFullAppliance
Sleep and Nocturnal ObstructiveRepositions the mandible anteriorly (6–9 mm) and inferiorly (17 mm)One-pieceExcludes anterior maxillaApnoea Reducer (SNOAR)
Repositions the mandible anteriorly (3 mm behind maximal protrusion)One-pieceExcludes molarsand inferiorly (7 mm)Snoring Treatment Appliance
Repositions the mandible anteriorlyOne-pieceExcludes molarsTepper Oral ProprioceptiveModifies tongue positionOne-pieceNot applicableStimulator
Tongue Locking Device
Preformed elastic appliance with a cavity that holds the tongue forwardOne-pieceFullby self-created vacuumTongue Positioner andHelps train the tongue to be in a more favourable positionOne-pieceFullExerciser
Tongue Retaining Device
Holds the tongue anteriorly during sleep by negative pressure in a bulbOne-pieceFullKlearway
Keeps teeth together, holding mandible and tongue forwardTwo-pieceFullPM Positioner
Advances mandible, vertical opening of 5 mmTwo-pieceFullTherasnore
Lower fin prevents tongue and mandible dropping backTwo-pieceFull
A summary of dental appliances described for the treatment of snoring and obstructive sleep apnoea (adapted from Lowe