Sleep and Breathing

, Volume 14, Issue 2, pp 171–174 | Cite as

Orthoimplants: an alternative treatment for SAHS?

  • Felix de Carlos
  • Juan Cobo
  • Maria Pilar Fernandez Mondragon
  • Alberto Alvarez Suarez
  • Juan Calvo Blanco
Case Report

Abstract

Abstract

Numerous sleep studies have been published recently regarding the use of intraoral devices (ODs) for the treatment of sleep apnea–hypopnea syndrome (SAHS). The effectiveness of these devices varies, however, according to the series studied (patient characteristics, parameters assessed, type of device, etc.). Two factors should always be assessed: the presence of an appropriate dental support and a possible temporomandibular joint pathology which can, on occasions, contraindicate the use of these devices.

Objectives

To use orthoimplants as orthodontic anchorages for intermaxillary elastic bands which allow a mandibular advancement to be performed as an alternative treatment to ODs in SAHS patients without appropriate dental support.

Materials and methods

Four orthoimplants were placed in an edentulous SAHS patient who did not tolerate continuous positive airway pressure (CPAP). The mandible is pushed forward using orthodontic elastic bands anchored to the orthoimplants.

Results and conclusions

Although more studies are still required, orthoimplants could be an alternative treatment for reducing snoring and the apnea–hypopnea index and increasing SaO2, which should be considered for patients who do not tolerate CPAP and lack appropriate dental support for attaching intraoral devices.

Keywords

Sleep apnea Oral appliances Orthodontic mini screws Orthoimplants 

References

  1. 1.
    Robin P (1902) Demonstration pratique sur la costruction et la mise en bouche d’un nouvelle appareil de redresement. Revue de Stomatologie Paris 9:61–590Google Scholar
  2. 2.
    Giannasi LC, Magini M, de Oliveira CS (2008) Treatment of obstructive sleep apnea using an adjustable mandibular repositioning appliance fitted to a total prosthesis in a maxillary edentoulous patient. Sleep Breath 12:91–95CrossRefPubMedGoogle Scholar
  3. 3.
    Cartwright RD, Samelson CF (1982) The effects of a nonsurgical treatment for obstructive sleep apnea: the tongue retaining device. J Am Med Assoc 248:705–709CrossRefGoogle Scholar
  4. 4.
    Cartwright RD (1985) Predicting response to the tongue retaining device for sleep apnea syndrome. Arch Otolaryngol 111:385–388PubMedGoogle Scholar
  5. 5.
    Soll BA, George PT (1985) Treatment of obstructive sleep apnea with a nocturnal airway patency appliance. New Engl J Med 313:386–387PubMedCrossRefGoogle Scholar
  6. 6.
    Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 11:1–22CrossRefPubMedGoogle Scholar
  7. 7.
    Hoekema A, Stengenga B, De Bont LG (2004) Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review. Crit Rev oral Biol Med 15(3):137–155CrossRefPubMedGoogle Scholar
  8. 8.
    Lowe A (2000) Oral appliances for sleep breathing disorders. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 3rd edn. W.B. Saunders Company, Philadelphia, pp 929–939Google Scholar
  9. 9.
    Cobo JM, de Carlos F, Suarez AA (2009) Mandibular advancement device (MAD) to treat sleep apnoea-hypopnea syndrome and chronic snoring. IFMBE Proceedings 24:349–354CrossRefGoogle Scholar
  10. 10.
    Boudewyns A, Marklund M, Hochban W (2007) Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances. Eur Respir Rev 16(106):132–145CrossRefGoogle Scholar
  11. 11.
    Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnoea. Cochrane Database of Syst Rev, CD004435Google Scholar
  12. 12.
    Ferguson KA, Cartwrigth R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and sleep apnea: a review. Sleep 29:244–262PubMedGoogle Scholar
  13. 13.
    Hoekema A, de Lange J, Stegenga B, De Bont LG (2006) Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea hypopnea syndrome. J Oral Maxillofac Surg 64:886–891CrossRefPubMedGoogle Scholar
  14. 14.
    Chasens ER, Pack AI, Maislin G et al (2005) Claustrophobia and adherence to CPAP treatment. West J Nurs Res 27(3):307–321CrossRefPubMedGoogle Scholar
  15. 15.
    Kribbs NB, Ai P, Kline LR et al (1993) Objective measurements of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147:887–895PubMedGoogle Scholar
  16. 16.
    Chen H, Lowe AA, de Almeida R, Fleetham JA, Wang B (2008) Three dimensional computer-assisted study model analysis of long-term-oral-appliance wear. Part 2. Side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod dentofacial Orthop 134:408–417CrossRefPubMedGoogle Scholar
  17. 17.
    Petit FX, Pépin JL, Bettega G et al (2002) Mandibular advancement devices. Rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J respir Crit Care Med 166:274–278CrossRefPubMedGoogle Scholar
  18. 18.
    American Academy of Sleep Medicine (2000) Cost justification for diagnosis and treatment of obstructive sleep apnea. Sleep 33(8):1017–1018Google Scholar
  19. 19.
    Schwarting S, Huebers U, Heise M, Schlieper J, Hauschild A (2007) Position paper on the use of mandibular advancements devices in adults with sleep-related breathing disorders. Sleep Breath 11:125–126CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Felix de Carlos
    • 1
  • Juan Cobo
    • 1
  • Maria Pilar Fernandez Mondragon
    • 2
  • Alberto Alvarez Suarez
    • 3
  • Juan Calvo Blanco
    • 4
  1. 1.Department of Surgery and Medical-Surgical Specialities, Area of Orthodontics, Faculty of MedicineUniversidad de Oviedo, Clinica Universitaria de OdontologiaOviedoSpain
  2. 2.Patologia y terapeutica dentalEHU-UPVLeioa, VizcayaSpain
  3. 3.Escuela Politécnica Superior de IngenieríaUniversity of OviedoAsturiasSpain
  4. 4.Hospital Universitario central de AsturiasOviedoSpain

Personalised recommendations