Dental treatment of snoring and apnea
The treatment of snoring and sleep apnea with temporomandibular protrusion splints has many years of experience and proven clinical efficacy.
The method of keeping the airways open by pushing the lower jaw and tongue forward has been known since the 19th century and was described by Professor Friedrich von Esmarch (1823-1908).
The first studies on the use of protruded mandibular splints for sleep apnea were made by Professor Karlheinz Meyer-Ewert, a German neurologist, psychiatrist, and sleep doctor who first presented this treatment method in 1984 at the European Congress of Sleep Medicine in Munich.
The American Academy of Sleep Medicine (AASM) published guidance back in 1995 for treating snoring and sleep apnea with intraoral devices.
This directive was updated 11 years later and the S3 recommendation was also published, according to which the treatment of patients with mild to moderate obstructive sleep apnea using protrusion splints was evaluated with a degree of effectiveness 1a, i.e. very high.
The German Society for Dental Sleep Medicine (DGZS) published a 2007 guideline on the use of protrusion splints in adult patients with sleep-disordered breathing, which concluded that intraoral devices reduce the number of sleep apnea events, reduce daytime sleepiness, and improve the quality of life. These devices have a positive effect on the cardiovascular system.
Who is shown with protrusion tires
Splints are recommended as a starting therapy for:
- primary snoring
- upper airway resistance syndrome
- mild to moderate obstructive sleep apnea (AHI up to 25 events per hour)
- patients with CPAP- intolerance (Continuouspositive- airway-pressure).
Mandibular protrusion splint design
Modern splints are custom-made, two-piece systems that are placed on the upper and lower jaw before bed. The lower splint keeps the jaw in protrusion (approximately 75% of the maximum possible forward extension).
How are protrusion splints made
For the custom-made splint, the dentist makes silicone impressions of the upper and lower jaw. In addition, bite registration is performed to clearly show how far the lower jaw should be extended so that the upper airways do not collapse. To do this, the doctor asks the patient to push the lower jaw forward as much as possible several times. This extension is documented by means of a special fork with a measuring ruler, and in this position the silicone impression is taken.
Tires - Custom Made or Bulk Ready Made?
A clinical study in Antwerp shows that Finished thermoplastic splints cannot
used in the treatment of breathing disorders during sleep, in contrast to individually made protrusion splints, since they do not provide the required therapeutic effect. Protruded splints must have high retention in order to stay on the dentition overnight, only in this case the forward position of the jaw is maintained, which guarantees the opening of the upper airways.
Increasingly, patients who are on CPAP therapy seek alternative treatment options while traveling,
or when they want to do their hobby. People live longer, while remaining active, so at the age of 60, many people want to travel, go hiking, go boating, live in tents, which is not feasible with a CPAP device and the lack of outlets nearby. In contrast, a protrusion splint can always fit in a backpack or pocket.You can make an appointment with the doctor Kulyasov Grigory Valerievich.
Kulyasov Grigory Valerievich
Doctor of the highest category, Member of the International Association for Interdisciplinary Dentistry (IAAID), 14 years of experience
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