Oral appliance treatment for obstructive sleep apnoea in a patient with severe dental condition: case report

Aim. Obstructive sleep apnea (OSA) is a chronic disorder of sleep and breathing characterized by recurrent obstruction of the upper airway. Oral appliances can be recommended to treat moderate-severe OSA when nasal continuous positive airway pressure (nCPAP) treatment is not tolerated. Insufficient number of teeth in maxillary and mandibular jaws is considered a contraindication to oral appliance therapy. The purpose of this case presentation is to report the use and results of a modified mandibular advancement device (MAD) as complete denture in an edentulous upper jaw patient with a severe OSA. Methods. A 77-year-old male patient was referred from the Neurological Institute “C. Mondino” with a history of snoring and excessive daytime sleepness to evaluate the chance of a MAD treatment. An overnight polysomnography revealed an apnea/hypopnea index (AHI) of 30,5 events per hour of sleep always supine with a lowest oxygen saturation of 71%, an average oxygen saturation of 90,9%, an oxygen desaturation index of 29,5 and a time with saturation under 90% of 18.7%. The patient had a severe dental condition: complete edentulous on the upper jaw and 9 teeth remaining on the lower. A SomnoDent® Flex Edentulous was prepared for the patient. Upper Edentulous splint covers the palate in the same way as a full upper denture. The minimum number of teeth required on the lower arch may vary based on the patient’s dentition. Advantages: — Full range of mouth opening — Superior retention and comfort — Easily adjustable. The mandibular part was designed as a removable partial denture. The support and retention of the device relied mainly on its adaptation to the mucous membrane of edentulous parts to avoid overloads on the remaining teeth. The maxillary and mandibular parts were fixed at 70% of the maximum protrusion of the mandible. Results. During treatment, the patient reported a favorable sleeping pattern, but he signaled initially pain caused by sores in the upper anterior region solved with denture adhesive pads. Snoring, wake gasping, and choking were reduced drastically and she also reported improved sleep at night without apneas and his daytime drowsiness had diminished considerably. After a follow up period of 54 months, AHI was decreased from 30,5 to 5,6 with device. Significant decrease of AHI, changing in the oxygen desaturation index (from 29,5 to 5,5) and modification in lowest oxygen saturation (from 71 to 81) were recognized during device use with an overnight polysomnography. Conclusion. This clinical report describes the technique of fabricating and results of oral device for an edentulous patient. The patient was satisfied with the modified device. The significant decrease in the AHI and the increase in minimum pulse oximetric saturation show that the oral appliance described in this case report can be a useful treatment modality in OSA patients with insufficient number of teeth in their dental arches.