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The aim of oral appliances is to improve upper airway patency, thereby preventing pharyngeal collapse during sleep. Various imaging techniques have demonstrated increased upper airway dimensions with mandible or tongue protrusion.

X Rays
Adjustable or titratable appliances allow the mandible to be moved forward in increments over a period of weeks to months. These appliances are titrated to symptom improvement or resolution, and then the patient has a follow-up overnight evaluation of the impact of the oral appliance on their AHI score and other sleep variables.


Mechanism of Action:

• Advanced tongue forward
• Increased pharyngeal volume
• Stretch soft palate
• Increase genioglossal activity
• Pharyngeal change is more medial-lateral than AP
• Lowers tongue position
• Advances the mandible to widen oropharynx
• Enlarge airway at the velopharynx
•Genioglossus tone
•Stabilizes the upper airway by increasing airway size in both the retropalatal and retroglossal area- and by reducing closing pressure
•Stabilization of the mandible and hyoid bone prevents posterior
rotation of mandible and retrolapse of tongue during sleep
• Activates upper airway muscles leading to upper airway patency
• Upper airway tone
• More advancement leads to greater efficacy of appliance in AHI


Risk Benefit Ratio and Normal Side Effects of OAT

• Side effects are NOT greater with more protrusion
• Minor and temporary. These can occur at any stage during treatment; are minor in severity, tend to resolve in a short period of time or are easily tolerated if they do not resolve and they do not prevent regular use of the appliance
• Significant and persistent TMJ problems were rare
• No relationship was found between manifestation of side effects and the degree of
protrusion or the initial malocclusion

 
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