Changes in 3D nasal cavity volume after biomimetic oral appliance therapy in adults

Berlin and Epworth Surveys to Predict Obstructive Sleep Apnea for Adults on Biomimetic Oral Appliance Therapy: A Nonrandomized Clinical Trial

Background

Two questionnaires (Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS)) are the widely used screening instruments for subjects suffering from sleep disorders. Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. The biomimetic oral appliance therapy (BOAT) offers an alternative nonsurgical method, which can improve symptoms and indices of OSA on objective sleep testing.

Aim

To describe testing the ability of BQ and EES for prediction of BOAT outcomes during OSA.

Methods

Seventeen adults (9 males, 8 females; age, mean (SD): 45.76 (10.31), BMI mean (SD): 33.5(13.43)) who underwent an overnight sleep study were diagnosed by a sleep specialist physician. The BQ and EES were recorded before and after BOAT treatment. Subjects with mild-to-moderate OSA had 2 months of follow-up visits and underwent a final overnight sleep study to measure apnea-hypopnea index (AHI). The subjects were asked to wear the appliance for 10–12 hours/day and at night. Findings were analyzed statistically using paired t-tests.

Result

As per sleep test results, pre-BOAT AHI measures versus post-BOAT AHI measures showed significant improvement. Comparing the BQ before versus after treatment showed that at the pretreatment stage, 66.0% of patients had high-risk score, whereas 34% had low-risk score. After treatment, 66.0% of patient had low-risk scores, whereas 34% had high-risk scores. As for the ESS, treatment resulted in significant reduction of total score from 10.43 ± 6.32 to 5.00 ± 5.20 (P < 0.01, paired t-test). Finally, there was a mild negative correlation between AHI and each of the BQ and ESS scores that was not statistically significant (r = −0.420, N = 26, P > 0.05, and r = −0.41, N = 26, P > 0.05, respectively).

Conclusion

The BOAT device may provide a useful form of therapy to improve OSA-related PSG parameters such as AHI. Both BQ and ESS were predictive to improvements detected by the sleep study during BOAT device use.

Changes in pneumatization of the maxillary air sinuses in Korean adults following biomimetic oral appliance therapy

Objective

For the treatment of obstructive sleep apnea in adults, mandibular advancement devices (MADs) are often used. Since adults with a prognathic mandibular phenotype are at risk of developing an unfavorable facial profile, midfacial development using biomimetic oral appliance therapy might provide a suitable alternative. However, the effect of this procedure on the maxillary air sinuses is unknown; therefore, changes in sinus pneumatization were investigated in this study.

Methods

After obtaining informed consent, 16 consecutive Korean adults with midfacial hypoplasia had 3D cone-beam (CB) CT scans taken, and biomimetic upper appliances (DNA appliance®, Vivos Therapeutics, Inc., USA) were constructed.

All subjects were instructed to wear the device 12–16 h/day. Each month, examination for the progress of midfacial development was recorded. Post-treatment, a follow-up 3D CBCT scan was undertaken with no device in the patient's mouth. Pre- and post-treatment linear and volumetric measurements were obtained using appropriate software, and compared statistically using t-tests.

Results

The mean age of the sample was 25.0 yrs ± 8.7. The mean treatment time was 15.5 mths ± 5.2. Post-treatment, the transpalatal bone width increased from 35.3 mm ± 3.0 to 38.5 mm ± 2.0 (P < 0.001); the maxillary air sinus volume on the left side increased from 18.8 cm³ ± 6.5 to 20.0 cm³ ± 6.0 (P < 0.05), and from 18.5 cm³ ± 5.7 to 19.7 cm³ ± 5.8 (P < 0.05) on the right side.

Conclusions

Biomimetic oral appliance therapy may be able to increase the maxillary air sinus volume in adults. In view of these preliminary findings, further studies on the effect of enhanced pneumatization on paranasal sinus function and sleep parameters are warranted.

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

BACKGROUND

Mandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA.

CASE SUMMARY

An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance^®, Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient’s mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions.

CONCLUSION

In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Long-term follow up studies are required to verify these novel findings.

Changes in pediatric paranasal sinuses following biomimetic oral appliance therapy: 3 case reports

Objective: In this pilot study, craniofacial changes associated with biomimetic oral appliance therapy (BOAT) were investigated to test the hypothesis of non-surgical remodeling of the maxillary air sinuses in rhinosinusitis.Methods: Three consecutive Korean patients (mean age 9.3 yrs) presented to a dental office with a history of chronic rhinosinusitis. After obtaining informed consent, 3D cone-beam CT scans were taken that showed circumferential mucosal thickening and inflammatory maxillary sinus disease, obstructed ostiomeatuses, and enlarged inferior turbinates. All cases were treated using BOAT (DNA appliance®).Results: Approximately 10 months after BOAT, the paranasal sinuses were aerated without mucosal thickening; the sinus walls were intact, and the ostiomeatal units were patent. All mean craniofacial parameters measured increased, except the transpalatal bone width, which remained unchanged.Discussion: Although enhancement of the maxillary air sinuses through non-surgical remodeling is suspected in these three cases of pediatric rhinosinusitis, additional studies are warranted.

Restoration of sleep using a novel biomimetic protocol for adult OSA: Clinical case report

BACKGROUND

A sleep study of a 56-year old male with excessive daytime sleepiness demonstrated an AHI of 16.4hr^-1 with 13% of total sleep time in REM sleep and a mean oxygen desaturation (SpO₂) of 86%.

CLINICAL PRESENTATION

On intra-oral examination, it was found that the patient had maxillary hypoplasia and bilateral torus mandibularis. A 3D cone-beam CT (CBCT) scan was taken, and 28 craniofacial parameters were measured. Surgical reduction of the mandibular tori followed by biomimetic oral appliance therapy (BOAT) was initiated. After 14 months, a post-treatment CBCT scan revealed that 70% of parameters measured had improved. Therefore, another sleep study was performed with no device in the mouth. This follow-up home sleep test demonstrated that the AHI fell to 5.3hr^-1hr; with 27% REM sleep, and a mean SpO₂ of 93% without any device in the mouth.

CONCLUSION

These findings suggest that BOAT might be able to restore sleep in certain adult cases.