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Oral appliance management of obstructive sleep apnea: a case report.

Obstructive sleep apnea (OSA) and snoring are common related conditions with major health and social implications. OSA is a progressive disease with symptoms of daytime sleepiness and chronic cardiovascular morbidity A mandibular advancement oral appliance is the only nonsurgical management modality available if continuous positive airway pressure (CPAP) cannot be tolerated. A patient who had been diagnosed with OSA was successfully treated but developed a posterior open bite and symptomatic temporomandibular joints (TMJ). An integrated approach to managing his OSA and TMJ conditions enabled him to have a comfortable and stable bite and to continue using his obstructive sleep apnea appliance. Management of OSA with an oral appliance should be handled by a dentist who is trained and experienced in the overall care of oral health, temporomandibular joints, dental occlusion, and associated structures. A team approach starting with the diagnosis of OSA by a physician and management by a dentist is described.

Humans↗

Fix-A-Nator--a fixed bionator technique.

A simplified and efficient technique to correct Skeletal II's and/or short lower facial height is presented. This is a fixed technique that can achieve, in certain cases, the same result as a Bionator. This technique is called Fix-a-Nator. The advantages of fixed over removable appliance are 1. forces are continuous, and 2. better patient compliance. Disadvantage is that it may not be effective in some patients with lateral tongue thrusts, wich would prevent super erupting of posterior teeth.

Activator Appliances↗

Interocclusal appliances--indications and clinical routines in general dental practice in Sweden.

The aim of this study was to analyse what kind of interocclusal appliances that are used in general dental practice in Sweden, the indications for such treatment, to what extent a clinical status is recorded before treatment, as well as the routines for evaluation of treatment results. The study was a retrospective analysis of patient records from 320 adult patients who had been treated by general dental practitioners in the Public Dental Service in Sweden. For comparison a group of 88 consecutive patients who had received interocclusal appliance therapy at a specialist clinic was used. The most common indication for treatment with hard acrylic stabilisation appliances, as well as with soft appliances, was occlusal wear due to tooth grinding. The second most common indication for treatment with hard acrylic stabilisation appliances was pain from masticatory muscles, while the second most common indication for soft appliances was tension-type headache. Treatment with soft appliances was more often combined with other treatment modalities compared to treatment with hard acrylic stabilisation appliances. Large variations were found between the 3 general dental clinics and the specialist clinic in respect of treatment indications, combinations with other treatment modalities, recording of clinical findings, follow-ups and evaluation of treatment results. General conclusion should, however, be made with caution due to the risk of selection bias. From the results of this study it is obvious that treatment with soft appliances is common in general dental practice in Sweden, despite the lack of scientific support for their efficacy, as well as effectiveness, compared to hard acrylic stabilisation appliances. There is an obvious need for investigations of the decision-making processes among dentists when performing treatment with interocclusal appliances, as well as for randomised controlled studies concerning efficacy and effectiveness of soft appliances.

Adult↗

The use and fabrication of a self-retaining surgical guide for controlled implant placement: a technical note.

A technique for using a surgical guide construction with a self-retaining feature, which has proven to be a significant improvement for stage 1 surgical procedures, is described. This design is more convenient to use than previously described occlusal extension splints. It maintains the concepts for ideal fixture placement that have proven so valuable in creating both a functionally and esthetically uncompromised prosthesis supported by implants.

Dental Implantation, Endosseous↗

[A longitudinal analysis of dysfunctional TMJ pathology: an assessment of a sample of patients undergoing nonsurgical therapy].

One the different interpretation of the pathological and clinical evolution of TMJ dysfunctions, the most-common of these pathologies is the condyle-disk uncoordination. This study analyzes the evolution of the treatment on the sample of patients affected by TMJ dysfunction and examined at the maxillo-facial department of the University of Rome "La Sapienza". After the TMJ dysfunction has been diagnosed the patients were informed of the individual therapeutic program which consisted of a temporary and definitive occlusal therapy. The aim of this scientific work is to control the efficiency within this therapeutic program in relation to the uncoordination of TMJ. In order to validate this approach the study was compared with another that considered the evolution of TMJ pathology in patients examined at the first diagnostic, visit but who had not undergone any treatment.

Adolescent↗

Cephalometric evaluation of pharynx, soft palate, adenoid tissue, tongue, and hyoid bone following the use of a mandibular repositioning appliance in obstructive sleep apnea patients.

The aim of this study was to evaluate the pharynx, soft palate, adenoid tissue, tongue, and hyoid bone when a mandibular repositioning appliance was used for managing patients with obstructive sleep apnea. Lateral cephalograms of 45 adult obstructive sleep apnea patients from the Lancaster Cleft Palate Clinic were taken without the appliance and some days later with the device in the mouth. This device was used during sleep for improving patients' respiration. Twenty-four cephalometric variables were evaluated. When the appliance was in the mouth, significant alterations (P < .001) were observed in the distances: (a) between anterior and posterior pharyngeal walls at the level of the second and third cervical vertebrae, respectively; (b) between the most superior point of the tongue and the maxillary plane; and (c) between the hyoid bone and the mandibular plane, ramus plane, cervical vertebrae tangent, mandibular symphysis, gonion, and third and fourth cervical vertebrae. The results of this study indicate that significant changes in pharyngeal space, hyoid bone, and tongue positions take place in obstructive sleep apnea patients when a mandibular repositioning device is used.

Adenoids↗