[OSA in adults: Role of the mandibular advancement device (MAD)]. / Troubles respiratoires obstructifs du sommeil de l'adulte : place de l'orthèse d'avancée mandibulaire.

Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/ hypopnea syndrome (OSA). Oral appliances advance the mandible and tongue, enlarge and stabilize the upper airways during sleep. Clinical examination is used to select candidates for oral appliances and a particular appliance for a given patient. Titration of the advancement will optimize its effectiveness by resolving subjective clinical symptoms. Polygraphic or ventilatory polysomnography controls the effectiveness of the treatment (IAH reduction, increase of oxygen saturation and improvement of the main symptoms). Clinical follow-up is required to assess longterm outcomes, side effects and treatment adherence. Oral appliances are effective in the short-term provided they achieved a 50% reduction in IAH and complete symptom resolution.

Success rate of the EVL evolution implants (SERF): a five-year longitudinal multicenter study.

The purpose of this study was to evaluate the success rate of the SERF EVL evolution implants (Décines, France) through a 5-year longitudinal multicentric study. Patients from 3 clinicians working in 3 different private practices (Grenoble, Nice, and Paris) and familiar with this implant system were included in this study; 413 patients and 1198 implants were followed over 5 years. The implant sites and implant types were recorded at the time of placement. The patients were followed yearly and controlled at the end of the study. The criterion for treatment evaluation or success was a qualitative variable related to 4 possible treatment outcomes: success, failure, ailing, and lost (dropout patients). Different variables (sex, bone quantity and quality at the implant site, location) were submitted to the chi-square test. A survival curve was established over 5 years according to the Kaplan Meyer method. The clinical follow-up was 3.1 +/- 1.2 years (ie, 1 to 6 years). At the end of this follow-up period, 1163 implants were classified as successful, 19 as failures, 12 as ailing, and 4 as lost (dropout). This implant system thus presented an overall success rate of 97.08%, over 5 years, independent of implant location, and for patient indications commonly encountered in private practice.