*13.3.1. Individualized TRD appliance construction*


of nasal, oral, and throat mucosa decreases; and patient compliance and treatment success increase. The adaptation of CPAP and MAD appliance should be done by a dental sleep spe-

Contemporary Treatment Approaches to Obstructive Sleep Apnea Syndrome

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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

**1.** Short-term side effects of OA therapy: Excessive salivation or dry mouth, TMJ sounds and/ or TMJ pain, tooth pain, odd bite feeling in the morning, gum irritation, tenderness in masticatory muscles, or myofascial pain. These complications are generally mild and transient

**2.** Long-term side effects of OA therapy: OA therapy for OSAS patients is a lifelong treatment. Skeletal, dental, and occlusal changes can occur from OA therapy in 2 or more years' time. Craniofacial changes related to long-term oral appliance use can be determined with cephalometric investigations. Skeletal changes generally occur after average treatment duration of 5 years. The changes can be summarized as more downward and forward position of the mandible, increased lower facial height, decreased overbite and overjet, retroclination of the maxillary incisors, proclination of the mandibular incisors, changes in molar relationship, and curve of Spee flattening. Long-term use of OA also makes differences in upper airway configuration. Palatal length decreases and pharyngeal area increases in time. These changes can be due to the loss of edema caused by snoring and repetitive apneas [10, 32–38].

OA therapy is an effective and safe long-term therapy for patients with snoring, mild to moderate OSAS. However, the efficiency varies on many factors including the type of OA, materials used for fabrication, piece number of appliance (monobloc or bibloc), titration ability

**a.** Positive changes in PSG test: Decrease in AHI, AI, HI, arousal score, increase in blood

**b.** Positive subjective feedback of patients: Decrease or quitting snoring and decrease in day-

(titrable or untitrable), and degree of sagittal and vertical mandibular displacement.

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:

**17. Efficacy and success of oral appliance therapy**

The efficacy criteria of oral appliance therapy in OSA are:

**c.** Enlargement of pharyngeal airway area [10–12, 25, 28, 31, 32]

oxygen saturation, sleep time, and efficiency

time sleepiness

cialist [10, 18].

[10, 11, 19, 20].

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

