Mandibular Advancement Devices with Dental Implants for Obstructive Sleep Apnoea

Mandibular Advancement Devices with Dental Implants for Obstructive Sleep Apnoea

What are Mandibular Advancement Devices with Dental Implants?

Mandibular advancement devices (MADs) are oral appliances that are used for the treatment and management of obstructive sleep apnoea (OSA), and come in a variety of shapes, materials and types, with custom-made ones far superior to prefabricated ones. You can read the following posts on our website for more information:

Mandibular advancement devices with dental implants go a step further and are for more complex patients. Not everyone is a suitable candidate for the usage of MADs, as their effectiveness is dependent on the patient’s oral and dental health, as well as the number of teeth they have. In fact, according to Petit et al. (2002), MADs are unsuitable for up to 34% of patients due to dental limitations.

*Disclaimer: The terms ‘Orofacial Pain Specialist’, specialistspecialisation and any of its variations are made within the context of the USA and not Singapore. The designation of ‘qualified sleep dentist’ is only used in the sole context of the European Academy of Dental Sleep Medicine, an organisation founded and governed by university and hospital-based practitioners which sets the standards of competency in the practice of Dental Sleep Medicine across Europe; dental sleep medicine is not an established dental specialty in Singapore. Please refer to our Disclaimers and FAQ pages for more information.

How an implant can anchor the MAD to the mouth in the lack or absence of teeth
(Source: Park et al., 2021. https://doi.org/10.1093/jcde/qwaa067)

When Mandibular Advancement Devices are Not Suitable for Obstructive Sleep Apnoea Treatment

Obstructive sleep apnoea (OSA) is a growing problem worldwide of multifactorial aetiology. Many factors can contribute to OSA, such as an individual’s neuromuscular control, respiratory arousal threshold and anatomy, which can be further affected negatively by obesity (Hamoda et al., 2018).

The main contributors to the contraindication of mandibular advancement device usage are edentulism (lack of teeth), TMJ disorders (temporomandibular joint disorders) and periodontal disease. These factors can also feed into a vicious cycle and give rise to obstructive sleep apnoea, with edentulism highly correlated with it (Petit et al., 2002).

Obstructive sleep apnoea is also more prevalent in older adults, due to age-related changes in sleep physiology (Okuno et al., 2023). In addition, oral and dental health tend to decrease as one ages, and the individual may start to lose teeth (become edentulous).

The lack of teeth not only diminishes the vertical dimension of the oral cavity, but also changes the position of the tongue and jaw, and reduces the ability to retain mandibular advancement devices (Amornvit et al., 2014). The loss of teeth in itself can contribute to upper airway obstruction during sleep as well (Hamoda et al., 2018). In general, a minimum of 6 – 10 teeth are required per arch, and the position of these teeth matter as well (Verbraecken et al., 2022). As can be seen, the relationship between OSA, ageing, oral and dental health are ultimately linked.

What are Dental Implants?

A dental implant is a metal, screw-like post that replaces the root of a missing tooth, and is usually made of titanium. The part that extends out is the ‘abutment’, and a ‘crown’ covers the top to give it the appearance of a real tooth. They resemble real teeth in function, aesthetics and structure, and last for a long time. The biggest benefit of dental implants is the support it lends to your new teeth, as it restores full chewing power.

They are able to fit in so well with your mouth due to their biocompatibility. This means that they are non-toxic, so your body will not reject them as foreign material. Thus, they are able to fuse with your bone to form a solid foundation. Daily care and maintenance for dental implants are the same as with real teeth. They do not slip out like dentures tend to do, and there are no annoying clicking sounds, or augmentation of your sense of taste either.

Dental Implants - The Second Permanent Tooth
9 Reasons Why Dental Implants are Good Infographic

Dental implant procedures also have a high success rate of about 95%. Having said that, factors such as smoking, diabetes and poor dental hygiene can reduce this. How it plays out will depend on every individual’s circumstance. But on average they have a 20 year life span, and have been known to last for up to 50 years.

Something important to take note of is that there is no special licensing required for dentists to place dental implants, so it is crucial that you do your research before you entrust your precious teeth to one. In a bid to save on costs, some dentists may use substandard fixtures or equipment, rush through the process, or do not ensure that there is enough bone density before placing them.

How Mandibular Advancement Devices with Dental Implants Can Help Patients Who Lack Teeth

Whilst more research and long-term follow up still need to be done in relation to MAD use for edentulous patients, implant retained mandibular advancement devices show promise in various case studies.

The procedure can look quite different for each patient, as it depends on the positions of their remaining teeth, and the quality of their oral and dental health. If their teeth are of poor quality, they might need to be extracted in order to place the mandibular advance device with dental implants. This should generally be avoided unless absolutely necessary. Your dental sleep specialist and/or orofacial pain specialist should discuss the implications, pros and cons with you first, after doing a thorough physical and clinical examination.

If you’re found to be a suitable candidate for mandibular advance devices with dental implants, your dental sleep specialist will craft a custom-made oral appliance after the dental implants have been placed, and given time to adapt to your mouth. Modifications made to the mandibular advance device might span over a few sessions, in order to increase the space of airflow from mandible (lower jaw) protrusion, without overdoing it, which can have detrimental effects instead (Amornvit et al., 2014).

How Nourish Dental Sleep & TMJ Care Can Help with Obstructive Sleep Apnoea in Edentulous Patients

Dr. Eric Chionh runs the practice at Nourish Dental Sleep & TMJ Care in Singapore, together with a dedicated team. He is formally trained in Oral Medicine and Orofacial Pain, with over 20 years of hands-on experience. He holds a Singapore Dental Council approved qualification in these areas, and is also a recognised *specialist in Orofacial Pain/TMD on the American Board of Dental Specialties (ABDS) and American Dental Association (ADA).

Dr. Chionh is a *qualified sleep dentist under the European Academy of Dental Sleep Medicine (EADSM), and has a keen interest in Pain and Sleep Dentistry, including Obstructive Sleep Apnoea. Having started his practice doing a lot of dental implants, he is also knowledgeable about their variability, and patient suitability.

He is passionate about his work and improving his patients’ quality of life using the latest evidence-based medicine and guidelines. He believes that knowledge can empower patients, and enjoys taking the time to discuss treatment options and concerns that they may have.

Nourish Dental Sleep & TMJ Care also uses suitable technology to assist with the proper diagnosis and management of obstructive sleep apnoea, TMD and orofacial pain. Visit our About page to learn more about Dr. Eric Chionh and his credentials, and our Services page to view all services that our clinic provides.

References:

  • Amornvit, P., Bajracharya, S., Rokaya, D., Keawcharoen, K., & Supavanich, W. (2014). Management of Obstructive Sleep Apnea with Implant Retained Mandibular Advancement Device. World Journal of Dentistry, 5(3), 184–189. https://doi.org/10.5005/jp-journals-10015-1285

  • Hamoda, M. M., Kohzuka, Y., & Almeida, F. R. (2018). Oral Appliances for the Management of OSA: An Updated Review of the Literature. Chest, 153(2), 544–553. https://doi.org/10.1016/j.chest.2017.06.005

  • Okuno, K., Wang, L., & Almeida, F. R. (2023). Focus of dental sleep medicine on obstructive sleep apnea in older adults: A narrative review. Journal of Prosthodontic Research, 68(2), 227–236. https://doi.org/10.2186/jpr.JPR_D_23_00047

  • Park, J., Ahn, S.-J., Lee, H., & Noh, G. (2021). Implant placement in the removable mandibular advancement device for completely edentulous patients: A finite element study. Journal of Computational Design and Engineering, 8(1), 140–148. https://doi.org/10.1093/jcde/qwaa067
  • Petit, F.-X., Pépin, J.-L., Bettega, G., Sadek, H., Raphaël, B., & Lévy, P. (2002). Mandibular Advancement Devices. American Journal of Respiratory and Critical Care Medicine, 166(3), 274–278. https://doi.org/10.1164/rccm.2008167

  • Verbraecken, J., Dieltjens, M., Beeck, S. O. de, Vroegop, A., Braem, M., Vanderveken, O., & Randerath, W. (2022). Non-CPAP therapy for obstructive sleep apnoea. Breathe, 18(3). https://doi.org/10.1183/20734735.0164-2022