Upper air way /fixed orthodontics courses

TREATMENTOF UPPERTREATMENTOF UPPER
AIRWAY SLEEPAIRWAY SLEEP
DISORDER - PATIENTSDISORDER - PATIENTS
WITH DENTAL DEVICESWITH DENTAL DEVICES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS

 1.INTRODUCTION1.INTRODUCTION
 2.TYPES2.TYPES
 3.ANATOMY3.ANATOMY
 4.DIAGNOSIS4.DIAGNOSIS
 5.SIGNS AND SYMPTOMS5.SIGNS AND SYMPTOMS
 6.TREATMENT OPTIONS.6.TREATMENT OPTIONS.

7.COMMON TECHNIQUE AND7.COMMON TECHNIQUE AND
PROCEDURESPROCEDURES
8.DIFFERENT TYPES OF ORAL DEVICE8.DIFFERENT TYPES OF ORAL DEVICE
9.EXPECTATION AND HOME CARE9.EXPECTATION AND HOME CARE
10.KEY POINTS FROM RECENT10.KEY POINTS FROM RECENT
ARTICLESARTICLES
11.CONCLUSION11.CONCLUSION
12.BIBLIOGRAPHY12.BIBLIOGRAPHYwww.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTIONINTRODUCTION

 Sleep disorders of the upper airwaySleep disorders of the upper airway
are generally the result of a conditionare generally the result of a condition
or disease that causes when theor disease that causes when the
patient assumes a supine position andpatient assumes a supine position and
goes to sleep.goes to sleep.
 UASDUASD are becoming commonlyare becoming commonly
recognized by the medical and dentalrecognized by the medical and dental
communities.communities.

TYPESTYPES

TYPES
SNORING
OSA
UARS

ANATOMYANATOMY

 Soft tissue muscularSoft tissue muscular
tube.tube.
 Extends fromExtends from oral andoral and
nasal cavitiesnasal cavities up to theup to the
bronchial tubes.bronchial tubes.

 The activity of theThe activity of the
Tensor veliTensor veli
Levator veli palatiniLevator veli palatini
GenioglossusGenioglossus
GeniohyoidGeniohyoid
maintain the position ofmaintain the position of
soft palate, uvula,soft palate, uvula,
tongue, and hyoid bonetongue, and hyoid bone
in position away fromin position away from
the posterior wall of thethe posterior wall of the
pharynx.pharynx.

SNORINGSNORING

TONGUE
UVULA
PHARYNGAL WALLS
HYOID BONE
SOFT PALATE
What is snoring?What is snoring?
What is the reason for snoring?What is the reason for snoring?www.indiandentalacademy.comwww.indiandentalacademy.com

OSA & UARSOSA & UARS

Complications Of OSA.Complications Of OSA.
Causes of OSA.Causes of OSA.
What is OSA?What is OSA?
AROUSALSAROUSALS

DIAGNOSISDIAGNOSIS

DIAGNOSISDIAGNOSIS
TEST
POLYSOM
NOGRAM
OBESITY
HISTORY
BLOOD
PRESSURE
ALCOHOL
AND
SEDATIVE
TONGUE SIZE,
TMJ,
PERIODONTALSTATUS,
ARCH SIZE,
MAXIMUM PROTRUSIVE
MOVEMENT,
MAXIMUM MOUTH OPENING.
SLEEP
POSITION,
ARESTED
BREATHING
DURING
SLEAPING

SIGNSSIGNS
ANDAND
SYMTOMSSYMTOMS

HYPERTENTION
RETROGNATHIC
CONSUMES ALCOHOAL
LATE IN NIGHT
OVERWEIGHT
NO
ADEQUATE
AMOUNT OF SLEEP
HAS LARGE NECK
MAY AWAKE FROM
SLEEP GASPING FOR AIR

TREATMENTTREATMENT
OPTIONOPTION

TREATMENT OPTION
BEHAVIOUR
MANAGEMENT
CPAP
HOFFSTEIN 1992
SURGERY
ORAL DEVICES
MEDICATION
WEIGHT LOSS
SEDATIVES
REDUCE ALCOHOL UPPP
LAUPPP
TONSILITIES
ADENITIES
TRACHEOSTOMY
MANDIBLE ADVANCEMENT
AND HYOID LIFT
TRD
MAD

COMMONCOMMON
TECHNIQUESTECHNIQUES
AND PROCEDURESAND PROCEDURES

OBATANING THE DESIRED
PROTRUSIVE POSITION
OF THE MANDIBLE
FABRICATION DIFFERENT
ORAL DEVICES
SINGLE POSITION
STOCK DEVICES
SINGLE POSITION
LABORATORY FABRICATION
MADs
TONGUE RETAINING DEVISE- TRDs
ADJUSTABLE STOCK MADs
ADJUSTABLE LABORATORY
FABRICATED MADs

OBATANING THE DESIRED PROTRUSIVE POSITION
OF THE MANDIBLE
CAST IS OBTAINED
INTEROCCLUSAL RECORDS
MORALES 1996
GEORGE GAUGE
RETRUSIVE
PROTRUSIVE
ONE PIECE DEVICE

FABRICATION DIFFERENT ORAL DEVICES
SINGLE POSITION STOCK DEVICES
THERA SNORE DEVICE
HARD RESIN TRAY
FLANGE
OCCLUSAL PLANE
1
2

LONG HOOK
MAXILLA
HARD PLASTIC TRAY
SINGLE POSITION
LABORATORY FABRICATION MADs
A DEVISE USED ADJUST THE PROTRUSIVE AND RETRUSIVE MOVEMENT
WIRE
PLASTIC LEDGE MANDIBLE
EXTENDING FROM
CANINE TO CANINE
ADJUST
ABLE
STOCK
MADs
.25

ADJUSTABLE LABORATORY
FABRICATED MADs
ADJUSTABLE
PM SCREW
BUCCAL SIDE
POLY VINYL
SILOXANE
WAX BITE
RETENTION IS
IMPORTANT

TONGUE RETAINING DEVISE- TRDs
TABS
HOLLOW BULB
TEMPLETS WITH
BLUE TO
WIDE YELLOW
RIDGES
INDICATION

COMPLTED
TRD
INSERTED
NOTE THE
TONGUE
RETAINED
WITH
IN THE
HOLLOW BULB
RETENTION
IS NOT
IMPORTANT
GOAL OF
DEVICE
6h SLEEP
PROBLEMS CLEAN

INSERTION AND THERMOPLASTIC FILL MATERIAL
TERMOPLASTIC MATERIAL
COOL AND OPAQUE
AFTER HEATING
MADs

A LARGE FLAME SHAPED ACRYLIC BUR
USED FOR TRRIMING

 MANDIBULARMANDIBULAR
MOVEMENTMOVEMENT
 UsedUsed
 0.25mm/night/2week0.25mm/night/2week
 Problem TMJProblem TMJ
 ScrewScrew
TITRATION

FOLLOW UP CARE
EXPECTA TIONS AND HOME CARE
WHAT THE PATIENT SHOULD EXPECT
HOME CARE

KEY POINTSKEY POINTS
FROM RECENTFROM RECENT
ARTICLESARTICLES

 1.Marie-louise waker-engstorm and others 41.Marie-louise waker-engstorm and others 4
year follow up of treatment with dentalyear follow up of treatment with dental
appliances or UPPP in patients with OSA-appliances or UPPP in patients with OSA-
Chest.2002;121:739-746Chest.2002;121:739-746
In patients treated with dental appliancesIn patients treated with dental appliances
or UPPP for mild to moderate sleepor UPPP for mild to moderate sleep
apnea for 4 years the studyapnea for 4 years the study
concludedconcluded
that the dental appliances group showedthat the dental appliances group showed
significantly higher success compared tosignificantly higher success compared to
UPPP groupUPPP group www.indiandentalacademy.comwww.indiandentalacademy.com

 Ivanhoe JR and others-The teaching andIvanhoe JR and others-The teaching and
treatment of upper air way sleep disordertreatment of upper air way sleep disorder
in north American schools-J Prosthet dentin north American schools-J Prosthet dent
2003 mar;89(3):292-2962003 mar;89(3):292-296
In this study a list of questions was sent toIn this study a list of questions was sent to
all north American dental school toall north American dental school to
determine which school includes treatment ofdetermine which school includes treatment of
UAS.UAS.
This study shows lower than half of theThis study shows lower than half of the
school included this part -school included this part -their curriculumtheir curriculum
and this lack of inclusion, is due to lack ofand this lack of inclusion, is due to lack ofwww.indiandentalacademy.comwww.indiandentalacademy.com

CONCLUSIONCONCLUSION

 Upper air way sleep disorders are commonlyUpper air way sleep disorders are commonly
recognized by medical and dentalrecognized by medical and dental
communitiescommunities
 Patients are now referred to dentists forPatients are now referred to dentists for
treatment of these conditionstreatment of these conditions
 One piece device and two piece adjustableOne piece device and two piece adjustable
device with thermoplastic fill materials aredevice with thermoplastic fill materials are
used for most patients to achieve satisfactoryused for most patients to achieve satisfactory
results.results.

BIBLIOGRAPHYBIBLIOGRAPHY

 1.John Beumer; Maxillo facial1.John Beumer; Maxillo facial
rehabilitation and surgical considerationrehabilitation and surgical consideration
 2.Varoujan A Chalian;Maxillo facial2.Varoujan A Chalian;Maxillo facial
prosthesis –multi disciplinary prosthesis.prosthesis –multi disciplinary prosthesis.
 3.Thomus d Taylor; clinical maxillo facial3.Thomus d Taylor; clinical maxillo facial
prostheticsprosthetics
 4.Grants human anatomy.4.Grants human anatomy.

 5.Marie louise walker engstrom and others5.Marie louise walker engstrom and others
4 year follow up of treatment with dental4 year follow up of treatment with dental
appliance or UPPP in patients with OSAappliance or UPPP in patients with OSA
Chest 2002; 121:739-746Chest 2002; 121:739-746
6.Ivanhoe JR and others-teaching and6.Ivanhoe JR and others-teaching and
treatment of upper air way disorder intreatment of upper air way disorder in
north American dental school-J Prosthetnorth American dental school-J Prosthet
dent 2003;mar89(3):292-296dent 2003;mar89(3):292-296

Upper air way /fixed orthodontics courses

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