Oral appliance treatment for obstructive sleep apnoea patients with severe dental condition

This clinical report introduces and evaluates the use of a mandibular advancement oral appliance (OA) attached to a denture base for the treatment of obstructive sleep apnoea syndrome (OSAS) in a patient presenting severe dental problems and multiple missing teeth. It concerned a 58-year-old man with moderate OSAS (apnoea index (AI): 15·9h^-1; apnoea hypopnea index (AHI): 21·7h^-1), presenting ten remaining teeth (maxilla: 5, mandible: 5) and important dental and periodontal problems. A treatment OA comprising both maxillary and mandibular parts was fabricated with an acrylic resin base, simulating the structure of a conventional removable partial denture (RPD). The polysomnography examination performed after the use of the OA showed the treatment induced a significant decrease in OSAS symptoms (AI: 0·7h^-1, AHI: 8·2h^-1). All the necessary dental and periodontal treatments were performed to assure the reestablishment of oral health. The treatment OA was modified after each treatment to adapt it to each new oral condition. After 18months, once the oral health was reestablished with seven remaining teeth (maxilla: 5, mandible: 2), final RPDs and final OA were fabricated. Polysomnography with final OA showed a similar positive result with respect to OSAS symptoms. No side effects related to the OA treatment were detected during the 3-year follow-up. To keep a sound oral condition, periodical dental care was performed by specialists in both periodontal and prosthodontic clinics. This clinical report shows the feasibility of treating OSAS patients with OA even in the presence of severe oral conditions and multiple missing teeth.