Effect of a Maxillary Appliance in an Adult with Obstructive Sleep Apnea: A Case Report

Abstract

Patients who arrive at the dental office with a diagnosis of obstructive sleep apnea (OSA) are often managed with a mandibular advancement device (MAD). However, the use of MADs has been associated with temporomandibular joint (TMJ) issues. The authors describe a case report of a 64-yearold male who was treated with a novel, maxillary oral appliance. The baseline sleep study indicated an apnea-hypopnea index (AHI) of 25.6/hour with 28 episodes of snoring, and 30.9 oxygen desaturation events/hour. The patient wore the maxillary oral appliance for 10-12 hours/day and night. The midpalatal screw mechanism of the appliance was advanced once per week for six months. By the end of this time, the minimum intra-premolar width increased from 27 mm to 30 mm; the minimum intramolar width increased from 35 mm to 37 mm, and the AHI dropped to <5/hour. During this phase of treatment, the episodes of snoring decreased to 18, and the oxygen desaturation events also decreased to 5.5/hour. After a total of 14 months, the AHI remained at <5/hour, the episodes of snoring decreased further to 12, and the oxygen desaturation events decreased to 5.2/hour. Therefore, by achieving a >80% decrease in the AHI, less snoring and an improvement in oxygen saturation after 14 months, the use of a maxillary oral appliance appears to have reached resolution of OSA in an adult male.

Additional information

Notes on contributors

G. Dave Singh

Dr. G. Dave Singh was educated and trained in England. He is currently President of BioModeling Solutions, LLC. He is also Director of Continuing Education for the SMILE Foundation, U.S.A.; a senior instructor, consultant, and Fellow of the International Association for Orthodontics; Academic Fellow of the World Federation of Orthodontists; and a member of the American Academy of Craniofacial Pain, the American Academy of Dental Sleep Medicine, and a charter member of the Appliance Therapy Practitioners Association. Previously, he was a visiting professor in orthodontics (Malaysia and Indonesia), associate professor at the University of Puerto Rico, and an adjunct professor at Portland State University. He has been published extensively in orthodontic and dental literature and is coauthor of the book, “Epigenetic Orthodontics in Adults.” Dr. Singh lectures nationally and internationally in North America, Europe, Asia, and Australia.

John D. Callister

Dr. John D. Callister received his D.D.S. degree in 1976 from the Loyola Dental School in Chicago. He is a member of the following organizations: Utah Dental Association, American Dental Association, American Academy of Craniofacial Pain, and the American Academy of Dental Sleep Medicine. Dr. Callister has been in private dental practice in Payson, Utah since 1976. In the last 10 years, he has expanded his practice to include the treatment of patients with temporomandibular disorders and obstructive sleep apnea.