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Determination Of Therapeutic Position for An Effective Mandibular Advancement In Sleep Apnea
Purpose: Obstructive sleep apnea (OSA) is a common life-threatening disease among adults. Mild to moderate cases of OSA can be successfully treated using oral appliances. The mandibular advancement advice (MAD) is the most commonly used appliance. The aim of this case report is to describe and manufacture a new and specific closing key, the ideal target position for determining the therapeutic effect of a MAD used for the treatment of a patient with moderate OSA.
Case report: A 55-year-old female patient complaints of snoring and sleep apnea. The patient who was diagnosed with moderate OSA (Apnea/Hypopnea Index, AHI = 25) had previously been given continuous positive air pressure (CPAP) therapy. However, our patient could not use the device because she was CPAP intolerant. In the intraoral examination and the result of the polysomnography test (PSG) of the patient, it was seen that the patient with CPAP intolerance was suitable for MAD treatment. Airway measurements were made with lateral cephalometric x-rays from the patient (mandibular plane-hyoid perpendicular 'MP-H: 25' and posterior airway distance 'PAS: 3'). It was scored according to the Epworth sleepiness scale (ESS: 17). A newly designed airway metric guide (jig) was used to record the bite in the optimum mandibular position, which targets the recommended amount of protrusion and the degree of anterior vertical opening (7mm/4mm) for effective treatment of the middle apnea group. Clinical examination was performed with PSG (AHI = 5), cephalometric x-ray (MP-H:1, PAS:6 and ESS:6) 3 months after the delivery of the splint in terms of therapeutic effect and patient compliance.
Conclusion: Jig is helpful to clinicians in determining the effective treatment position of the oral appliance. The purpose of jig design and features is accuracy in determining the therapeutic position.Determining the optimum protrusion and vertical position of the mandible using this system is very important in the management of sleep disorders to maintain the airway patency stably throughout the night.