Fabrication of an Obstructive Sleep Apnea Prosthesis M. Ted Wong,BS,DDS, *Jack B.Mtyeq Jr, DMD, 7 Ted Hammond, BS, ODs,$ William W.Nagy, DDS$ Obstructive sleep apnea, a sleep disorder, is becoming more prevalent and requires prompt and effective treatment by the dental and medical specialties. Conservative treatment modalities (ie, intraoral devices that prevent or minimize airway obstruction by the tongue) are recommended for treating mild to moderate forms of OSA. This article describes a simplified technique for fabricating an intraoral OSA prosthesis. J Prosthod 1:69-72. This is a U.S. government work. There are no restrictionson its use.
INDEX WORDS: obstructive sleep apnea, intraoral OSA prosthesis, fabrication technique
bstructive sleep apnea (OSA) is a sleep disorder characterized by obstruction of the upper airway, which results in cessation of air flow in thc presence of continuous respiratory effort. The obstruction is usually caused by the tongue and/or soft palate. Patients with OSA show hypersomnolence (excessive daytime sleepiness), heavy snoring during sleep periods, and dkturbed/restless sleep. Other symptoms include morning headaches and nausea, psychological and behavioral problems, anxiety, and sexual dysfunction. Studies have shown that patients with OSA can develop hypercapnia, hypoxia, hypertension, polyqthemia, and cardiac dysrhythmias.1-3 Treatment modalities for OSA include surgery (tracheostomy, uvalopalatopharyngoplasty), drugs (protriptoline, oxygen), corrcction of sleep posture,
From the United States Annz)Dental [email protected]
, Fort Sam IIowlon, Sail Antonio, TX. *Major, United States Army; and Senior Resident, Adcanced Pmsthodonlic Raiden9 Prop-am. jLznttenant Colonel. &t&d States Arngi; and Asirtant Director, Adc'onced Prosthodontic R e d e n 9 Propun; Chid Madllofaeial Pmsthodonticc. $Major, ljniitd Statcc Amy; and Senior RPsidPnl,Ar~iinncEdProsthodoitic Resideng Progrnm. $Coloml, United State.c Am?; Pmgram Dirrctor, Aduanced Proslhodonlic Resideny Program; C h i d Fixed Prosthodontics. Presented us a table clinic at ihe American Collece of Prosthodontists Annual Meetinf, Reno, AVAbvember 8 1991. The airuir mpessed herein are thuse uf thu authins and do not necexsari[~~ s gthr l'nited Statr,s A n y or the Deparlmenl qf the D$me. A d d r m repint requerts to: Major 121. 7'ed Worig, 14310 iVacugdutheJ Rd.Apt. 180.7, San Antotiin, TX 78247-1970. This i.r a L!S.goouernment mmk. Thm arr no restrictions on its use. 1059-941~i 9210101-0014~0.vo10
continuous positive air pressure, and intraoral devices (tongue retainers, mandibular repositioners)? The following instructions outline a simple method for fabricating a mandibular repositioning prosthesis for the treatment of OSA. The goal of this prosthesis is to posture the mandible and tongue in an anterior position and prevent the tongue from obstructing the aim ay.
Technique The first step is to obtain maxillary and mandibular casts. Then the casts are prepared for fabrication of vacuum-formed splints which will be used to retain the maxillary and mandibular segments of the prosthesis. The teeth are surveyed to determine heights of contour (Fig 1). By using 0.06 inch or 0.08 inch clear splint material, vacuum-formed splints are made on both casts (Fig 2). Splint material is cutaway using a Robinson's hard bristle brush; (a) leaving thc splint material to extend bclow the survey lines by 1.0 mm on the buccal and labial surfaces and (b) extending the lingual border of the splints 5 to 10 mm onto gingival tissue. The excess is removed and the edges of the splint material are smoothed. Next, the fit arid retention of the maxillary and mandibular segments are checked. Ifnecessary, the intaglio surface is relined (with autopolymerizing acrylic resin) to increase the retention. 'The occlusal surfaces (cuspid to molar region) of the segments are extended using bonding agent and visible-light curing resin (Triad, Dentsply, York, PA). Enhance the bonding of thc rcsin to the splint
Journal ofPmthodonti, Vol 1.No 1 (Sebternbd,1992:bb69-72
Figure 1. Prepared and survryed casts.
material by roughening the splint surface with a coarse stone. The height of the extensions is evaluated intraorally. Ideally, there should be 1.0 mm of clearance between the maxillary and mandibular extensions at the established mandibular position (Figs 3 and 4). A mandibular position is established at the protrusive end-to-end incisal relationship, 5 to 8 mm greater than the physiological rest position. This position is recorded using a softened wedge of
baseplate wax, located in the incisor area (maxillary and niandibular segments should be in place) (Fig 5). Visible light-curing gel is added to the occlusal surfaces of the segments, which are placed in the
Figure 3. Occlusal extensions using Triad.
Figure 2. Vacuum formed splint material.
Figure 4. Evaluating segments intraorally.
Sepmber 1992, Volume I , Number 1
Figure 5. Establish mandibular position using wax record.
Figure 6. Add Triad Gel extraorally.
Figure 7. Remove segments from mouth and complete contouring.
Figure 8. Finished prosthesis in place.
Making an Obstmrtive Sleepilpnea Prostheric
mouth, and the mandible is positioned using the wax wedge. The gel is cured intraorally to join the maxillary and mandibular segments. Finally, the prosthesis is removed and the contours are conipleted cxtraorally, finished, and polished (Figs 6, 7, and 8).
Summary OSA is becoming a widespread disorder that requires multidisciplinary intervention b~7the medical and dental community. Conservative treatment modalities, such as oral prostheses, should be used bcfore irreversible surgical procedures, especially for mild to moderate OSA. Several oral prostheses, successfully
Wong et a1
used in treating OSA, are described in the literature but require sophisticated equipment and involve considerable clinical and laboratory time. This article describes a practical, simplified technique for fabricating an OSA prosthesis. The technique requires only two appointments and minimizes the number of laboratory procedures required.
References 1. Walrlhorn RF:Sleep Apnea Syndrome. AFY I 9%; 149:149-162 2. Morgan EJ: Sleep Apnea Syndrome. W V McdJ 1979;75:1~2-1& 3. Mcyer JB, Knudson RC: The sleep apnra syndrome. Part I: Diagnosis.J Prosthet Dent 1989;62:675-679 4. Meycr JB, Knudson RC: The slecp apnea syndrome. Part 11: Treatment. J Prosthet Dent 1990;63:320-324