Predicting treatment response to mandibular advancement therapy using a titratable thermoplastic device



Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. We describe the use of a trial of a titratable thermoplastic MAD to predict treatment outcomes with a custom-made MAD.

Materials and methods

Patients treated with a thermoplastic MAD as a trial before custom-made MAD manufacturing were included in the study. Sleep recordings and clinical outcomes assessed after 6 months of treatment with each device were compared. Predictive utility of thermoplastic MAD to identify custom-made MAD treatment success defined as a reduction greater than 50% and final apnea-hypopnea index (AHI) less than 10 events/h was evaluated.


Thermoplastic MADs were installed in 111 patients, but only 36 patients were finally treated with both devices and were included in the analysis. A significant correlation was observed between the impact of the two devices on the AHI (r=0.85, p<0.0001), oxygen desaturation index (r=0.73, p<0.0001), snoring index (r=0.85, p<0.0001), and Epworth sleepiness scale (r=0.77, p<0.0001). A high positive predictive value (86%) but a low negative predictive value (46%) was observed regarding AHI decrease.


Similar impacts of both MADs were observed on major OSA severity markers and symptoms. The ability of thermoplastic MAD to indicate likelihood of success with custom-made MAD will require further controlled studies.

Clinical relevance

Thermoplastic MADs could represent a useful and easily implemented tool to predict the likelihood of success of a custom-made MAD as treatment for OSA.

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This work was funded by the Institut de Recherche en Santé Respiratoire (IRSR) des Pays de la Loire (9 rue du landreau – BP 77132 – 49071 Beaucouze cedex, France). The content of this manuscript is solely the responsibility of the authors.

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Correspondence to Wojciech Trzepizur.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval was obtained from the University of Angers Ethics Committee and the “Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé” (07.207bis).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

WT and NM report non-financial support from ASTEN. FG reports grants and personal fees from RESMED, personal fees and non-financial support from SEFAM, personal fees from CIDELEC, personal fees and non-financial support from NOVARTIS, personal fees from ACTELION, non-financial support from BOEHRINGER INGELHEIM, personal fees and non-financial support from AIR LIQUIDE SANTE, non-financial support from ASTEN, and personal fees and non-financial support from NYXOAH unrelated to the submitted work.

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Trzepizur, W., Adrian, B., Le Vaillant, M. et al. Predicting treatment response to mandibular advancement therapy using a titratable thermoplastic device. Clin Oral Invest (2021).

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  • Sleep apnea
  • Custom-made mandibular advancement device
  • Thermoplastic mandibular advancement device