**16. Side effects of oral appliance therapy**

*13.3.1. Individualized TRD appliance construction*

186 Current Approaches in Orthodontics

bulb part to place the tongue.

*13.3.2. Fabricated TRD appliance construction*

floss is removed and measured.

small, medium, and large.

ing, and non-esthetic appearance.

treatment [10, 11].

**14. Palate lifting appliances (PLA)**

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

ing amount, in order to place the hollow bulb part.

**c.** The correct type and size are chosen for the patient.

**15. OPAP appliances (oral appliance + CPAP device)**

**b.** Maximum opening, left and right lateral excursion, and maximum protrusion measured.

**c.** The appliance is constructed using a position 75% of the patients' maximum protrusion. Vertical opening amount differs patient to patient, but it is more than MAD vertical open-

**d.** The appliance is fabricated from soft copolymer material like a monobloc with a hollow

**a.** The tongue is measured by wrapping a piece of dental floss around the tongue. Then, the

**b.** The fabrication appliances have two types, edentulous and dentulous, and three sizes,

TRD-type appliances are found to be effective in mild to moderate OSA treatment. They decrease AI, HI, AHI, oxygen desaturation, and excessive daytime sleepiness and increase minimum oxygen desaturation and genioglossus muscle activity. But the patient compliance is low with TRDs because of the irritation in the tongue, hypersalivation, uncomfortable feel-

They are used in patients who have a thick and enlarged soft palate. The appliance supports and stabilizes the soft palate, prevents soft palate blocking the airway, and reduces the vibration of soft palate leading to snoring. But they are uncomfortable appliances and the patient compliance rates are very low. Because of this reason, they are not frequently used in OSA

nCPAP device applies very high pressure and high airflow rate which leads to irritation of nasal, oral, and throat mucosa and decreases patient compliance. When MAD-type oral appliances are combined with CPAP device, the pressure given by nCPAP diminishes; irritation

**d.** The bulb appliance is moistened and compressed and the tongue is inserted.

There are very few side effects of oral appliances when compared to other treatment alternatives. Researches have reported that patients prefer treatment with an OA over surgery or CPAP appliance, and compliance with OA has been reported to be 40–80%.

The side effects of OA therapy can be divided into two groups:

