Lower oropharyngeal airway changes in Korean adults following biomimetic oral appliance therapy
Mandibular advancement devices (MADs) are used for the management of mild to moderate obstructive sleep apnea (OSA) in adults. However, in patients with a prognathic mandibular phenotype, there may be a risk of worsening the facial profile. Since maxillary expansion appears to be beneficial in pediatric OSA, biomimetic oral appliance therapy (BOAT) was investigated in this study to determine its effects on the lower oropharyngeal airway. After obtaining informed consent, 13 consecutive Korean adults participated in this study. A customized, FDA-registered, biomimetic upper oral appliance (DNA appliance®, Vivos Therapeutics, Inc., USA) was constructed for each individual who was instructed to wear the device 12-16hrs/day. After the 12-18 month review, a follow-up 3D cone-beam CT scan was undertaken with no device in the mouth. Pre- and post-treatment measurements were compared statistically. The mean age of the sample was 25yrs (7 females; 6 males). The mean treatment time was 16.3 months. Post-treatment: the minimum retroglossal distance increased from 12.8mm to 13.5mm (p < 0.01); the minimum mediolateral retroglossal width remained unchanged (p > 0.05); the minimum retroglossal area in the axial plane increased from 273.1mm2 to 351.74mm2 (p < 0.05); both the angle of the lower central incisors to the mandibular plane and the gonial angle remained unchanged (p > 0.05), indicating that dento-skeletal parameters remained stable. Biomimetic oral appliance therapy appears to be able to improve some lower oropharyngeal airway parameters, and likely represents an alternative choice to MADs. However, additional studies on the effect on sleep parameters are needed.
Professor G. Dave Singh is a US citizen, born, educated, and trained in England, UK. He holds three doctorates: Doctor of Dental Medicine; Ph.D. in cleft palate development, and a doctorate in Orthodontics. He has published over 200 articles in peer-reviewed journals. He is a Board Member of the American Sleep and Breathing Academy, a Member of the World Sleep Society, an Academic Fellow of the World Federation of Orthodontists, and a Fellow of the International Association for Orthodontics. Currently, he is the Founder and Chief Medical Officer, Vivos Therapeutics, Inc. USA and Adjunct Professor, Sleep Medicine, Stanford University, USA.