Selecting sleep-disordered-breathing appliances. Biomechanical considerations.

BACKGROUND: Dentists who wish to provide sleep-disordered-breathing therapy have many different mandibular advancement devices, or MADs, from which to select. Documented research directly about the variations in MADs is sparse. TYPES OF STUDIES REVIEWED: The author reviewed dental and medical literature dealing with biological and mechanical principles affecting the function of MADs.
RESULTS: The author found that MADs vary in four major areas: freedom of mandibular movement, amount and rigidity of dental coverage, amount of mandibular advancement and amount of bite opening. Each of these areas appears to affect the appliance's efficacy, safety or both. The main potential detrimental effect of MADs is occlusal shifting. The author presents biological and mechanical considerations in an attempt to determine the optimum parameters for each of the MAD variation areas. The MAD must be constructed in a manner and with material that secures the mandible in its optimum position. The optimum mandibular position needs to be captured and transferred to the articulator with an accurate construction bite. CLINICAL IMPLICATIONS: MAD therapy may last a lifetime. Therefore, dentists must consider the efficacy and the safety of an MAD when selecting an appliance. Since occlusal shifting appears to be the main potential detrimental effect, dentists should consider all available means to monitor and minimize these changes.