Comment on Dao et al. Retrospective Analysis of Real-World Data for the Treatment of Obstructive Sleep Apnea with Slow Maxillary Expansion Using a Unique Expansion Dental Appliance (DNA). Pathophysiology 2023, 30, 199-208.

I found the recent article by Dao et al. titled "Retrospective analysis of real-world data for the treatment of obstructive sleep apnea with slow maxillary expansion using a unique expansion dental appliance (DNA)" [...].

Midfacial development and the wisdom of teeth: A case series.

The alignment of third molars has largely been overlooked by orthodontists. Since difficulties arise during their eruption, a plethora of surgical procedures is advocated for their management, including prophylactic extraction. This case series describes the use of midfacial development in 4 patients and illustrates successful patterns of third molar eruption.

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.

Virtual Surgical Planning: Modeling from the Present to the Future.

Virtual surgery planning is a non-invasive procedure, which uses digital clinical data for diagnostic, procedure selection and treatment planning purposes, including the forecast of potential outcomes. The technique begins with 3D data acquisition, using various methods, which may or may not utilize ionizing radiation, such as 3D stereophotogrammetry, 3D cone-beam CT scans, etc. Regardless of the imaging technique selected, landmark selection, whether it is manual or automated, is the key to transforming clinical data into objects that can be interrogated in virtual space. As a prerequisite, the data require alignment and correspondence such that pre- and post-operative configurations can be compared in real and statistical shape space. In addition, these data permit predictive modeling, using either model-based, data-based or hybrid modeling. These approaches provide perspectives for the development of customized surgical procedures and medical devices with accuracy, precision and intelligence. Therefore, this review briefly summarizes the current state of virtual surgery planning.

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.

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.

Effect of a maxillary appliance in an adult with obstructive sleep apnea: a case report.

Patients who arrive at the dental office with a diagnosis of obstructive sleep apnea (OSA) are often managed with a mandibular advancement device (MAD). However, the use of MADs has been associated with temporomandibular joint (TMJ) issues. The authors describe a case report of a 64-year-old male who was treated with a novel, maxillary oral appliance. The baseline sleep study indicated an apnea-hypopnea index (AHI) of 25.6/hour with 28 episodes of snoring, and 30.9 oxygen desaturation events/hour. The patient wore the maxillary oral appliance for 10-12 hours/day and night. The midpalatal screw mechanism of the appliance was advanced once per week for six months. By the end of this time, the minimum intra-premolar width increased from 27 mm to 30 mm; the minimum intramolar width increased from 35 mm to 37 mm, and the AHI dropped to < 5/hour. During this phase of treatment, the episodes of snoring decreased to 18, and the oxygen desaturation events also decreased to 5.5/hour. After a total of 14 months, the AHI remained at < 5/hour, the episodes of snoring decreased further to 12, and the oxygen desaturation events decreased to 5.2/hour. Therefore, by achieving a > 80% decrease in the AHI, less snoring and an improvement in oxygen saturation after 14 months, the use of a maxillary oral appliance appears to have reached resolution of OSA in an adult male.

Effect of the DNA ApplianceTM on migraine headache: case report.

The relationship between migraine headaches and craniofacial architecture remains tenuous. Indeed, there is a lack of evidence linking migraines to orthodontic status. However, this case report may be one of the first to document the effect of a biomimetic, orthodontic appliance eliminating symptoms associated with migraine headaches.

Bruxism and temporal bone hypermobility in patients with multiple sclerosis.

In this study, the authors investigated the link between jaw clenching/bruxism and temporal bone movement associated with multiple sclerosis (MS). Twenty-one subjects participated in this study (10 patients with MS and 11 controls). To quantify the change in intracranial dimension between the endocranial surfaces of the temporal bones during jaw clenching, an ultrasonic pulsed phase locked loop (PPLL) device was used. A sustained jaw clenching force of 100 lbs was used to measure the mean change in acoustic pathlength (delta L) as the measure of intracranial distance. In the control subjects the mean delta L was 0.27 mm +/- 0.24. In subjects with MS the mean delta L was 1.71 mm +/- 1.18 (p<0.001). The increase in magnitude of bi-temporal bone intracranial expansion was approximately six times greater in subjects with MS compared to controls. Therefore, jaw clenching/bruxism is associated with more marked displacement of the temporal bones and expansion of the cranial cavity in patients with MS than in control subjects.

Craniofacial changes in patients with Class III malocclusion treated with the RAMPA system.

OBJECTIVE: The underlying etiology of Class III malocclusion may be associated with cranial base morphology. The aim of this study is to test the efficacy of a Right-Angled Maxillary Protraction Appliance (RAMPA) System in Asian subjects with Class III malocclusions. MATERIALS AND METHODS: 27 homologous landmarks were digitized from lateral cephalographs for 10 pre-pubertal Japanese children (mean age 95 months) with skeletal Class III malocclusion prior to and after RAMPA treatment. The mean, pre- and post-treatment craniofacial configurations were computed using Procrustes superimposition, and subjected to principal components analysis (PCA), and finite-element analysis (FEA). RESULTS: The mean treatment time was 22.5 months. All patients showed significant craniofacial change with correction of anterior and/or posterior crossbite. The mean, pre- and post-treatment craniofacial configurations were statistically different when tested using PCA (p < 0.001), with the first two principal components accounting for 97% of the total shape change. Using FEA, the anterior cranial base showed a relative 12-32% increase in size. The midfacial and mandibular regions, as well as the oropharyngeal airway showed large relative size-changes. CONCLUSION: This study suggests that the anterior cranial base may be targeted in the correction Class III malocclusions.

Upper airway detection and visualization from cone beam image slices.

This paper describes a method developed to assist in the detection and reconstruction of a three dimensional (3D) model of the human upper airway using cone beam computed tomography (CBCT) image slices and a 3D Gaussian smoothing kernel. The segmented and reconstructed volumetric airway is characterized by the corresponding three principal axes that are selected for viewing direction orientation via rotation and translation. These axes are derived using the 3D Principal Component Analysis (PCA) result of the rendered volume. To finely adjust the view and access airway, the major and minor axes of each slice are also computed using the two dimensional (2D) PCA in the respective planes. The exterior volume view is visualized in two modes, namely, a solid surface (volume details transparent to user) view and a nontransparent (volume detail accessible) view. This functionality provides an application driven use of the 3D airway in CBCT based anatomy studies. The extracted information may be useful as an imaging biomarker in the diagnostic assessment of patients with upper airway respiratory conditions such as obstructive sleep apnea, allergic rhinitis, and other related diseases; as well as planning orthopedic/orthodontic therapies.

Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study.

BACKGROUND/AIM: It is accepted that sports mouthguards decrease the incidence of dental injuries in athletes, but the value of oral orthotics in the prevention of concussion/mild traumatic brain injuries in footballers remains contentious. However, previous investigations have primarily studied non-customized mouthguards without dental/temporo-mandibular joint examinations of the subjects. Therefore, the aim of this study is to determine whether the use of a customized mandibular orthotic after temporo-mandibular joint assessment reduces the incidence of concussion/mild traumatic brain injuries in high-school football players. MATERIALS AND METHODS: Using a longitudinal, retrospective design, data were collected from a cohort of football players (n = 28) over three seasons using a questionnaire. The mean age of the sample prior to the use of the customized mandibular orthotic was 17.3 years +/- 1.9. Prior to deployment, dental records and temporo-mandibular joint evaluations were undertaken, as well as neurocognitive assessment, including history of concussion/mild traumatic brain injuries. After establishing optimal jaw position, a customized mandibular orthotic was fabricated to the new spatial relations. RESULTS: The mean age of the sample after three seasons was 19.7 years +/- 2.0. Prior to the use of the customized mandibular orthotic, the mean self-reported incidence of concussion/mild traumatic brain injuries was 2.1 +/- 1.4 concussive events. After the deployment of the customized mandibular orthotic the number of concussive events fell to 0.11 +/- 0.3 with an odds ratio of 38.33 (95% CI 8.2-178.6), P < 0.05. CONCLUSION: The preliminary results of this study suggest that a customized mandibular orthotic may decrease the incidence of concussion/mild traumatic brain injuries in high- school football athletes, but a comprehensive study is required to confirm these initial findings. Furthermore, additional research is necessary to indicate the possible mode(s) of action of a customized mandibular orthotic in the prevention of concussion/mild traumatic brain injuries.