MDSA Pty Ltd

Custom Made Dental Sleep Appliance- Bringing peace to the home

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Unit 6/51 Nimmo St
Middle Park 3206
VIC AU
Tel +61 4 18563941
Fax +61 3 96908733

Appliances

(1) Tongue retainer.

There are not many available, however they have been well researched and shown to be effective in selective patients. Patient compliance and acceptance is a problem for long term use. Useful for patients with limited or no teeth.

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(2) MonoBlocks or Fixed Devices.

These are by far the most common available. Can be useful as a trial splint or where economics dictate what a patient should have.

However TMJ problem's are universally reported with them because they lock the jaw and mouth into a fixed position. Total disaster for bruxers.

They offer no adjustment, therefore they have to be remade if further protrusion is needed (which is common after a patient has worn a splint for a few months). The common complaint is "it worked ok at the start but I have started to snore again".

While they are cheap, the complications from side effects and costs associated with having to remake, make it expensive therapy.

Tend now only to be sold by mail order or advertised over the air or in papers. Not used often by Dental Sleep Dentists.

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(3) Flimsy Trial Splints.

There are not many of these available. Traditionally made from all plastic with plastic side hinges. Can be useful as a trial splint.

Most supply with a repair kit to replace hinges when they break. The real question is if they break when wearing them which is while you are asleep where do the broken bits go?

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(4) Adjustable Mandibular Repositioning Appliances.

These are by far the largest group and the first of the adjustable, based on traditional orthodontic principals, devices or components.

They have a variety of different configurations but all have the one major problem, lack of lateral movement.

Those that have metal hinges on the side have been reported to caused teeth movement and eruptions.

Often to make further adjustments during treatment can be very difficult and complicated leading to extended periods to acclimatize patients with this type of device.

This was reported in a study using this style of appliance published in the Am.J, respir.crit.care med Volume 163, number 6, May 2001.(page 6 - results-study population)

A Randomized, Controlled Study of a Mandibular Advancement Splint for Obstructive Sleep Apnea. by MEHTA et al AJRCCM Vol 163 2001.....The mean acclimatization period (wash in period) was 19.7± 8.8 weeks ( range, 5 to 40 wks )...

Oral appliance Therapy Improves Symptoms in OSA by Helen Gotsopoulos etal AJRCCM Vol 166 2002 ...The acclimatization to the MAS was 8±4 wks ( range, 2-22wks )

They are also very expensive to make and tend to be made only by large commercial orthodontic labs.

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(5) Titratable Mandibular Repositioning Appliances.

(A) The first of these was the TAP which allowed full lateral movement and titration while in situ.

The downside of the appliance is

(a) Only made by commercial labs

(b) uses a combined acrylic plate with boil and bite filler for retention. Filler breaks down and not very durable.

Very rigid and hard on teeth causing tooth soreness and ache

(c) Large lingual bar in the bottom plate impedes the tongue coming forward.

(d) an external winder has to be used till the right advancement is obtained (can be for some weeks) once the winder is cut off no post adjustment can be obtained.

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(B) The MDSA® Component concept Appliance.

The most versatile and clinically proven to be an effective alternative to CPAP for the treatment of Snoring and Mild to Moderate Sleep Apnea.

Efficacy of Positive Airways Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea. M Barnes et al. Am Jnl Resp Cr C M June 2004.

...In the wash-in period it was advanced weekly by the study dentist as tolerated by subjects, until the maximum comfortable protrusion was reached, taking up to 3 weeks.

Clinically tested to overcome the problems, limitations and side effects associated with all other oral appliances.

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For full details on the MDSA® refer to opening page of website.