The success of mouthpiece treatment for sleep apnea is significantly affected by how the patient adopts to the use of the mouthpiece. The mouthpiece is used for a relatively many hours a day, so its tolerability and comfort become of great value. Better comfort when choosing therapies even exceeds the degree of effectiveness of the treatment. This occurs in the preference for mouthpiece therapy for sleep apnea patients over a more efficient CPAP device, due to the significantly better comfort of the mouthpiece. The same importance of comfort also arises in the comparison between mouthpieces operating on different operating principles. Chin-moving MAA instruments have almost completely supplanted other mouthguard type options with their more convenient comfort. In a comparison of mouth device models, studies had found that patients benefited better from sleep apnea mouthpiece made individually in dental laboratories than from general commercial sleep apnea mouthpieces. Because of this, dental laboratory-made sleep apnea mouth devices are also the most widely used.
The compact size of the product brings comfort to the mouthpiece. The mouth device, which is shaped thin and small, feels comfortable in the mouth and gives space to the tongue. In this case, the tongue is not as easily pressed into the throat. The Narval CC facial mouth device models and the cap-part facial device model have made room for the tongue by leaving the lingual surface of the incisors completely open at the front. The lack of components increases compactness, which also reduces abrasions on the mucosa. The compactness of the handles and the placement in the vicinity of the rail increase the comfort of use. In the monoblock and the front-mounted T-Tap rail, the buccal side is kept completely free of protruding handles.
Material choices affect the comfort of the mouth device. If the mouthguard has a soft inner surface, it rests comfortably against the teeth and does not squeeze. It is also flexible when inserted and removed. Such a structure can be found on Silensor-sl, SomnoDent and T-Tap devices, for example.
Jaw movements and normal opening and closing of the mouth increase patient comfort, as well as the ability to breathe through the mouth. Mouthguards with handlebars allow a small lateral movement. The T-tap mouth device is the only one that allows proper lateral movement. Mobility increases the invisibility of the device and thus the comfort of use.
What is the efficiency of a sleep apnea mouth device?
Although the clinical efficacy of mouthpiece therapy reaches the same class as CPAP therapy in mild to moderate sleep apnea due to its convenience, the used mouthpiece must also be effective in its other properties in order to be useful in the treatment of sleep apnea. A custom-made mouthpiece has been found to be a more effective option for treating sleep apnea than a commercial thermoplastic device.
The transfer of the shafts to a larger protrusion, i.e. titration, contributes to the success of the mouth device treatment and prevents the plateau phase of effectiveness. This makes the adjustable frames more efficient. The degree of protrusion at the start affects the efficiency of the frame only up to 50%. Thereafter, no significant increasing effect on efficiency was obtained in the initial protrusion, but the efficiency is achieved precisely by gradually increasing the protrusion.
The effectiveness of the treatment is also affected by factors other than the amount of protrusion. In mouthpiece treatment, efficiency consists of the sum of the influencing factors. A device with good efficiency should also be very comfortable to use. Minimizing side effects increases patient commitment to treatment. The suitability of the sleep apnea device model for the patient in question, the severity of sleep apnea, and consideration of contraindications affect the effectiveness and success of mouthpiece treatment. Efficiency for mouthpiece utilization and can be viewed using a micro recorder. The DentiTrack recorder added to SomnoDent provides accurate information on treatment commitment and progress.
Holding the frame against each other prevents snoring and a reduction in the air space in the throat due to the opening of the mouth. Compression-based mouthpieces: Herbst and IST, where the handles are attached to the top rail at the rear and the bottom rail to the front, the rails are attached to each other with small rubber loops to ensure efficiency. In traction-based rails: Silensor-sl, Narvall CC and SomnoDent, where the frames are inverted, the rail automatically stays together.
Sleep apnea mouthpiece and minimization of jaw joint symptoms
By increasing efficiency, also by increasing protrusion, the jaw joint positions itself beyond its normal position, causing strain and discomfort on the jaw joint. Minimizing jaw joint symptoms contributes to the success of mouthpiece treatment. Frames that are attached to each other increase mouthpiece efficiency but reduce jaw joint movements and comfort.
Studies show that sleep span mouthpieces that do not allow jaw movements at all are more likely to cause more jaw joint symptoms than mouthpieces where lateral movements are possible. In mouthpieces that allow lateral movements, the joint fluids can move freely in the joint membrane. This prevents joint pain and possible changes in the bite. In compression-based mouthpieces (Herbst and IST), lateral movements should also be considered so that the handles do not impede movements.
The strain on the jaw joint can also be relieved by moving the axis of rotation of the handles upwards by turning the brackets upside down and by lifting the upper rail bracket with the wings parallel to the rail and the jaw line. The force of the mouthpiece to stay together is then based on traction. This reduces the load on the jaw joint by 10% more than traditional compression-based rails. The traction-based rails are Silensor-sl, Narvall CC and SomnoDent.
Durability of sleep apnea mouthpieces
The rail is subjected to large biting forces during the night, which are difficult for the patient to control during sleep. The brackets in particular are subjected to the greatest forces, which can easily break the mouthpiece. By taking into account the pressure on the brackets, durability can thus be increased. On acrylic rails (Herbst and IST), the brackets can be attached as close to the tooth surface as possible to increase durability. Alternatively, the handles are available with detachable and reattachable rubber pin parts. These prevent the rail from breaking in high biting forces.
The more the rail allows movements within the protrusion limits, the less pressure is applied to the rail. Plastic handles provide flexibility in movement. The s-shaped twin arms of the Silensor-sl and the telescopic arms of the Herner and IST allow the jaw to move forward. On the T-Tap moutpiece, the bite pressure is relieved by moving the fastening part completely forward and laterally. With SomnoDent, mobility is facilitated by keeping the rails in place with guide wings.
The durability is increased by the rigidity brought by the thickness of the rail and the coverage of the teeth in a suitable proportion so that the comfort of use is not compromised. New materials: laser sintered polyamide and SMH B-Flex enable durable solutions, offering a two-year warranty on SomnoDent and Narvall CC rails.
The versatility of the sleep apnea mouthpiece
The success of sleep apnea mouthpiece care is enhanced by taking individual needs into account with different device models. Cad / Cam technology combined with durable 3D printed material allows Narvall CC products to select a rail model suitable for the patient’s anatomical structures and bite by changing the coverage of the teeth. Somnomed has different models in its selections and is the only one available on a toothless upper jaw mouthpiece model. With different materials: acrylic, hard tensile plastic, combination of hard and soft plastic, laser sintered polymer and SMH B-Flex offer a variety of options and features on the mouthpieces when it is desired to affect fit, comfort, durability and flexibility.