Comparison of efficacy and usability of custom mandibular advancement devices fabricated with the conventional method and digital workflow: A pilot clinical study.

PURPOSE: To compare the effects of fabricating methods of custom monoblock mandibular advancement devices (MADs) on usability and efficacy in patients with mild and moderate obstructive sleep apnea (OSA). MATERIALS AND METHODS: Digitally fabricated custom MADs (dMADs) were produced for 11 OSA participants who had previously used conventionally fabricated custom MADs (cMADs). The participants answered a modified usability questionnaire for both MADs, and the average scores that were given to the questionnaire were evaluated by age, sex, and body mass index (BMI), and the scores of cMADs and dMADs were compared. After 6 months of usage of each MAD, the apnea-hypopnea index (AHI), mean and lowest oxygen saturations, and total sleep time were measured for efficacy assessment. Data were analyzed with Cronbach's alpha, Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, one-way repeated measures analyses of variance, and Bonferroni tests (α = 0.05). RESULTS: Cronbach's alpha was found at 0.834 and 0.722 for the conventional and digital questionnaires, respectively. The usability scores of the dMADs were significantly higher than those of cMADs (p = 0.013). There was no difference in usability scores in terms of sex or BMI (p > 0.05). No statistically significant difference was found for cMAD (p = 0.113) among age groups; however, there was a significant difference for dMAD (p = 0.046). The AHI, mean, and lowest oxygen saturation values were significantly affected by MAD usage (p < 0.001). However, total sleep time values did not differ after the MAD treatments (p > 0.05). Significantly lower AHI and significantly higher lowest oxygen saturation values were observed with dMAD, while both appliances led to similar results for mean oxygen saturation and total sleep time values (p > 0.05). CONCLUSIONS: Participant usability scores were higher for digitally manufactured MADs than conventionally manufactured MADs. However, both conventional and digital MADs were found effective in decreasing the AHI levels and increasing the mean and lowest oxygen saturation values of the participants.

Fabrication of a Mandibular Advancement Device Using a Fully Digital Workflow: A Clinical Report.

Obstructive sleep apnea (OSA) is a common disorder among adults with a potential to be life-threatening. Continuous positive airway pressure is the gold-standard for the treatment of OSA, but patient compliance may be reduced due to various reasons. Mild to moderate cases of OSA can be treated reliably and successfully using oral appliances, and the mandibular advancement device (MAD) is the most frequently used appliance. The aim of this clinical report is to present a fully digital workflow for fabrication of a custom non-adjustable MAD using computer aided design/computer aided manufacturing and additive manufacturing for the treatment of a patient with moderate OSA.

Levels of Cytokines in Gingival Crevicular Fluid during Rapid Maxillary Expansion and the Subsequent Retention Period.

OBJECTIVE: To monitor the effects of rapid maxillary expansion (RME) on bone metabolic activities during and after 3 months of retention. STUDY DESIGN: Fifteen patients with a mean age of 12.9 ± 0.6 years were treated with a bonded expansion device, activated 2 turns per day. The retention period was 3 months. Clinical periodontal parameters were recorded at baseline and after retention. Gingival crevicular fluid (GCF) samples were collected from maxillary first molars from the compression sides at baseline, then at 1 and 10 days and after retention. Tension side samples were obtained at baseline and after retention. Interleukin-1beta (IL-1ß), transforming growth factor beta1 (TGF-ß1), prostaglandin E2 (PGE2) and nitric oxide (NO) levels were specifically measured. RESULTS: Periodontal parameters increased significantly after retention relative to baseline values. Levels of IL-1ß, TGF-ß1 and PGE2 increased on day 10, and decreased after retention on the compression side. NO levels were elevated on day 10, and remained higher after retention on the compression side. Tension side cytokine levels remained higher relative to baseline values after retention. CONCLUSIONS: The results of this study indicate the importance of ongoing adaptive bone activities after 3 months of retention with RME, which should be considered questionable as an effective retention period.