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Mandibular advancement orthosis

A mandibular advancement orthosis is a removable oral appliance that is custom-made by a dentist or orthodontist trained in sleep care and is used to treat obstructive sleep apnea and snoring. The appliance is designed to clear the upper airway and facilitate airflow during sleep by moving the lower mandible forward a few millimetres.

The orthosis is made up of gutters that cover the upper and lower teeth and, depending on the model, a traction or push mechanism that allows the lower mandible to be moved forward incrementally until the breathing interruptions and snoring disappear completely.

Who benefits from this therapy?

The wearing of a dental orthosis can be a first-line treatment for mild to moderate sleep apnea and can serve as an alternative solution when therapy with a continuous positive airway pressure (CPAP) device is poorly tolerated or ineffective.

However, not all patients with apnea can benefit from a mandibular advancement orthosis. Ideally , they should meet the following criteria:

  • A small neck size (no overweight)
  • A sufficient number of teeth per arch (at least 8 teeth on top and 8 on the bottom)
  • Healthy gums and well-anchored teeth
  • Teeth of sufficient height (not too worn)

Who prescribes it?

After arriving at a diagnosis of sleep apnea, sleep specialists will recommend this treatment if they believe it can be beneficial. They may also suggest dentists or orthodontists who are familiar with the fabrication of mandibular advancement orthoses. The dentist or orthodontist will then determine whether the patient’s dentition and occlusion allow the use of an orthosis.

It should be noted that the purchase of a mandibular advancement orthosis without a doctor’s prescription or a consultation with a dentist or orthodontist (e.g., online) is strongly discouraged. Only a dentist or orthodontist trained in sleep apnea can design an orthosis tailored to a patient’s morphology, make the required adjustments and ensure a follow-up with the doctor.

How does it work?

The treatment is simple: the orthosis must be worn during sleep.

Here are the main steps for the treatment:

  1. Diagnosis and prescription by the doctor
  2. Dental impression by the dentist or orthodontist
  3. Fabrication of the orthosis
  4. Fitting of the appliance
  5. Maintenance instructions
  6. Fabrication of a “morning appliance” in order to reposition the jaws after wearing the orthosis all night
  7. Adjustments by the dentist or orthodontist
  8. Sleep test (polysomnography or cardiorespiratory polygraphy) to validate the effectiveness of the treatment (in case of failure, repeat steps 7 and 8)
  9. Annual ( or semi-annual ) follow-up by the dentist or orthodontist