Clinical impact of 2 types of oral appliances - Narval cadcam vs Narval non-cadcam - on upper airway volume in obstructive sleep apnea patients

Abstract

Two custom-made mandibular repositioning device (MRD) designs were evaluated in a randomized cross over study: Computer aided design (CAD)/computer-aided manufacturing (CAM) or nonCADCAM processes. Study aim was to assess the impact of two MRD on OSA patient’s oropharyngeal airway volume (OV). Methods: 12 OSA patients randomized in the study. A polygraphy, a dental cone beam computed tomography exam were performed at baseline. Patients were treated 1 month with each MRD. At FU, a polygraphy and a cone beam were performed. Results: Age: 53±9 y, BMI: 27±4 kg/m², mean apnea hypopnea index (AHI): 22±7.8 /h, mean oxygen desaturation index (ODI): 19±6 /h, mean occlusal vertical dimension (OVD): 64±5 mm, mean oropharyngeal airway volume: 20\xa0007±4442 mm3. At FU: OV improved significantly with Narval CADCAM (27 732±7381 mm3 (p=0.008)) vs Narval non-CADCAM (23812 ± 9538 mm3, (p=NS)). AHI with CADCAM and nonCADCAM decreased respectively to 11±6.3 evt/h (p=0.005) and 14.7±12 evt/h (p=0.083). ODI with CADCAM and nonCADCAM decreased respectively to 12±7 (p=0.011) and 14±13 (p=0.074). Occlusal Vertical Dimension OVD was significantly smaller with CADCAM (73±5 mm) than non-CADCAM (75±5mm), p=0.003. Multivariate linear regression revealed a significant link between the difference of OVD variation and OV changes in the 2 MRD (p=0.018) Conclusion: CADCAM MRD increased OV more efficiently than non-CADCAM device. This difference is likely due to a smaller OVD.