1. ORAL APPLIANCE THERAPY CASE PRESENTATION

2. THOMAS M. GOTSIS DDS FAGD • MIDWEST DENTAL SLEEP MEDICINE INSTITUTE @ SSM DEPAUL HEALTH CENTER • BOARD OF DIRECTORS MISSOURI SLEEP SOCIETY

3. "I have no relevant financial relationships to disclose”.

4. Successful therapies of sleep disordered breathing decrease the collapsibility of the pharyngeal airway. American Academy of Sleep Medicine

5. PERFORMANCE CRITERIA FOR OSA TREATMENT

7. Treatment • The most common type of treatment is CPAP (continuous positive air pressure) • Although highly effective, patients are frequently non-compliant with CPAP • Other treatments include oral appliances, surgery and weight loss

8. SomnoMed MAS™

9. The TAP III The TAP Series • The TAP I & II & III • Developed by Dr. Keith Thornton • FDA approved for OSA • Pro’s • Fine protrusive adjustability (.25mm) • Variety of acrylics, comfortable • Some lateral mobility (TAP II) • Con’s • Advancement mechanism may slightly intrude on tongue space The TAP I

19. Airway Assessment Acoustic Reflection (Pharyngometry)

20. ACOUSTIC REFLECTION ADVANTAGES DISADVANTAGES • Non-Invasive • Free of radiation • Reproducible • Dynamic imaging modality • No weight limitation • Performed with patient in sitting position • Performed through patient’s mouth (modification of the upper airway anatomy) • Does not provide direct information on airway structures or geometry LAVIGNE, GJ, CISTULLI, PA, SMITH MT, "Sleep Medicine for Dentists", Quintessence Publishing Co., 2009, p. 62.

21. Acoustic Pharyngometry Pick-ups Microphone

22. Hypopharynx Epiglottis Oropharynx Oropharyngeal Junction, OPJ Oral Cavity 2-D Pharyngometer readings Pharyngometry Landmarks

23. Mandible is Advanced - Dilation

29. Patient had hx of chest pains. • ESS=14 • Snoring was keeping spouse from sleeping. • Did not feel refreshed upon wakening. • Excessive daytime sleepiness.

30. AHI=30 events/hr

31. Pt is CPAP-intolerant and is referred for OAT.

32. Follow-up PSG: • Occasional breakthrough snoring. • AHI=.2 events/hr • At 6 month recare the patient wearing MAD nightly. So compliance=100%