**12.3. MAD treatment mechanism**

MADs displace the mandible, suprahyoid, and genioglossus muscles anteriorly. This anterior movement prevents oropharyngeal airway obstruction. The forward and downward displacement of the mandible also decreases the gravitational effect of the tongue in supine position and enlarges the velopharynx by stretching the palatoglossal and palatopharyngeal arches (**Figures 1** and **2**).

**Figure 1.** One-piece, non-activation MAD appliance.

**12. Mandibular advancement devices (MADs)**

tongue root and posterior region of the oropharynx.

**a.** Upper and lower dental impressions are taken.

design does not affect the treatment success.

ment [10–12, 17, 19, 23, 25–30].

**12.2. MAD contraindications**

MAD appliance construction:

least 5 or 6 millimeters.

**12.3. MAD treatment mechanism**

bite position.

**12.1. MAD indications**

184 Current Approaches in Orthodontics

MADs were first described by Pierre Robin in 1934 in the treatment of a patient with micrognathia as a modified monobloc in order to reposition the mandible in a more forwarded position and open the airway. This advancement makes the attached soft tissues and tongue

MAD appliances can be divided into several groups: monobloc-style one-piece or twin block-style two-piece, available to activation or unavailable to activation, teeth-supported or teeth- and tissue-supported, and soft- or hard-materialed. All of these appliances increase the distance between soft palate and posterior wall of the pharynx and enlarge the space between

Tooth- and tissue-supported, soft-materialed, activation-optioned MAD appliances are reported to be more successful in OSAS treatment. One-pieced or two-pieced appliance

MAD-type oral appliances are found the most effective type of oral appliances in OSAS treat-

Normal or reduced facial height, patients have at least eight teeth per arch, patients who have

The patients with thick and enlarged soft palate, periodontal disease, and TMJ problems.

**b.** Maximum opening, left and right lateral excursion, and maximum protrusion are measured. **c.** The appliance is constructed using a position 75% of the patients' maximum protrusion. Vertical opening amount changes individually. But it is recommended to open the bite at

**d.** Bite registrations in centric occlusion and advanced position are obtained. A George gauge and light-body impression material can be helpful in stabilizing the construction

**e.** The MAD appliance fabricated from soft acrylic, hard acrylic, silicone-based, or Essix-

MADs displace the mandible, suprahyoid, and genioglossus muscles anteriorly. This anterior movement prevents oropharyngeal airway obstruction. The forward and downward

based materials according to the type of the chosen appliance.

normal soft palate thickness and normal positioned soft palate, and obese patients.

stretch and stabilize; by this way, oro- and hypopharyngeal airways enlarge.

**Figure 2.** Two-piece, activation-optioned MAD appliance.
