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A midfacial reconstruction that has been segmented between the anterior and posterior nasal spines, the dentoalveolar margin and the hard palate, including the palatine bone, but excluding the frontal process of the maxilla and the crowns of the teeth for volumetric measurement. This bone volume was measured prior to and after the midfacial redevelopment protocol
Source publication
Background/objectives/aims: Controversy exists regarding maxillary bone changes in nongrowing adults. However, previous studies have relied on two-dimensional (2D) cephalometric analyses, which may be unable to capture three-dimensional (3D) phenomena. In this study, we investigated 2D and 3D parameters to test the null hypothesis that maxillary bo...
Contexts in source publication
Context 1
... The 2D measurement pro tocol was repeated three times to determine the percentage measure ment error. Next, midface segmentation was under taken between the anterior and posterior nasal spines, the dentoalveolar margin and the hard palate, including the palatine bone, but excluding the frontal process of the maxilla and the crowns of the teeth (Fig. 4). In addition, the bony 3D volume of the midface, excluding the frontal process of the maxilla, was computed in all cases. The 3D measurement protocol was also repeated three times to determine the percentage measurement error. At 18 months, these data measurements were repeated and the findings were subjected to statistical analysis, ...
Context 2
... bone volume was 17.4 cm 3 ± 3.9 prior to treatment. The mid facial bone volume increased to 19.1cm 3 ± 2.6 after appliance therapy (p = 0.0091). The 3D measurement error was found to be 0.92%. In addition, no instances of palatal or buccal dehiscence or fenestration were found in association with any of the tooth roots in any of the subjects (see Fig. 4). These results are summarized in Tables 1 and 2 and Figures 3 to 5A to ...
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Citations
... Biomimetic oral appliance therapy differs from conventional MADs. While MADs are thought to mechanically enlarge the airway while being worn during sleep [9] , BOAT aims to mimic natural craniofacial growth and development to induce putative upper airway remodeling that persists even after the device has been removed. It has been shown that BOAT increases the midfacial bone volume in adults nonsurgically [10] , which ostensibly permits nasal breathing through an enhanced nasal airway volume [11] . ...
Background:
Mandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA.
Case summary:
An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance®, Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient's mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions.
Conclusion:
In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Long-term follow up studies are required to verify these novel findings.
... Favorable structural changes at the pharyngeal level appeared to be triggered by both manipulations of the skeletal bases: the maxilla (RPE) and the mandible (MAD). Both RPE and MAD seem to have a clinically significant impact on the dental and skeletal systems and Mid-facial bone volume can be increased by targeting the craniofacial sutures, which gives the mandible a functional space to grow [34,35]. Palatal expansion allows the enlargement of the upper jaw, improvement of the relationship between the jaws, and improvement of the function. ...
Objective:
To compare cephalometric changes of pharyngeal structures after rapid palatal expansion (RPE) with those induced by a twin block mandibular advancement device (MAD) with palatal expansion capability.
Methods:
This retrospective study investigated 55 Class II pediatric patients, divided into two groups: 29 patients treated with RPE and 26 patients treated with MAD. Lateral cephalometric measurements were compared before and after treatment.
Results:
Changes in pharyngeal airway space were statistically significant in both groups (p < 0.001) from a pre-treatment mean distance measured between the lower posterior pharyngeal wall and the hyoid bone (LPF-H) of 25.42 mm in the MAD group and 28.62 mm in the RPE group, to a post-treatment mean LPF-H of 27.96 mm in the MAD group and 31.52 mm in the RPE group.
Conclusion:
Significant changes in pharyngeal space may be obtained in Class II patients through both rapid palatal expansion and mandibular advancement devices with palatal expansion capability.
... On the post-treatment CBCT scan, the following craniofacial parameters showed improvements: the minimum, mid-sagittal, retropalatal distance; the minimum, medio-lateral, retropalatal width; the minimum retropalatal area in the axial plane; the minimum, mid-sagittal, retroglossal distance; the minimum, medio-lateral, retroglossal width; the minimum retroglossal area in the axial plane; the surface area of the posterior nasal apertures at level of the posterior nasal spine in the axial plane; the minimum inferior nasal concha distance from the nasal septum on the left side; the transpalatal bone width at cervical margin of the mesio-palatal cusps of the first molars, and the 3D airway volume, measured from the level of the posterior nasal spine to the inferior border of C3/ hyoid bone. [4][5][6] in combination with mandibular repositioning [7,8]; but it does not include an anterior headgear component that might pull on the cervical spine. After written informed consent was obtained, the patient elected to undergo surgical reduction of the mandibular tori [9,10] followed by BOAT, since these devices are FDA-cleared for use in mild to moderate cases of OSA in adults. ...
Background
A sleep study of a 56-year old male with excessive daytime sleepiness demonstrated an AHI of 16.4hr⁻¹ with 13% of total sleep time in REM sleep and a mean oxygen desaturation (SpO2) of 86%.
Clinical presentation
On intra-oral examination, it was found that the patient had maxillary hypoplasia and bilateral torus mandibularis. A 3D cone-beam CT (CBCT) scan was taken, and 28 craniofacial parameters were measured. Surgical reduction of the mandibular tori followed by biomimetic oral appliance therapy (BOAT) was initiated. After 14 months, a post-treatment CBCT scan revealed that 70% of parameters measured had improved. Therefore, another sleep study was performed with no device in the mouth. This follow-up home sleep test demonstrated that the AHI fell to 5.3hr⁻¹hr; with 27% REM sleep, and a mean SpO2 of 93% without any device in the mouth.
Conclusion
These findings suggest that BOAT might be able to restore sleep in certain adult cases.
... 7-8). It is likely that BOAT promotes circum-maxillary sutural remodeling (induced midfacial morphogenesis) by inducing a biomolecular response that deploys the same physiologic mechanisms used in passively-growing adults, undergoing an osteogenetic-orthodontic protocol [16]. In osteogenetic-orthodontics, we suggest that the mechanisms of sutural homeostasis are evoked that produce an enhanced midfacial complex as evidenced by the growth of the nasal cavity in adults [17]. ...
Open Journal Clinical Medical Case Reports 2(4), 2016
... Therefore, all authors were blinded in terms of appliance allocation. BOAT is designed to address upper airway deficiencies and to correct maxillo-mandibular hypoplasia in both children and adults91011121314151617. All biomimetic oral appliances used in this study had: 6 anterior 3-D axial springs™, a beaded pharyngeal extension, a midline screw, bilateral occlusal coverage, retentive clasps, and a labial bow (Figure 1), but only half of the biomimetic appliances incorporated a mandibular repositioning nighttime component (Figure 2).Figure 2: The mandibular repositioning nighttime appliance (mRNA appliance®) that was prescribed for the other half of the sample with: anterior 3-D axial springs™, a midline screw, bilateral occlusal coverage, retentive clasps, a labial bow and a lower mandibular advancement component. ...
... Therefore, BOAT appears to correct sleep disordered breathing in subjects with severe OSA possibly using a different corrective mechanism than MADs, such as craniofacial correction and non-surgical, upper airway remodeling or " Pneumopedics " . This pneumopedic notion is supported by preliminary work that indicates midfacial bone volume [12] and nasal cavity volume [9] increases in adults undergoing BOAT, as well as morphologic changes in the upper airway [10,13,17], which we refer to as upper airway remodeling or pneumopedics. Pneumopedics may be regarded as an epigenetic phenomenon in the sense that morphologic changes are elicited in craniofacial locations remote from the site(s) of genetic change [24], as predicted by the spatial matrix hypothesis [25]. ...
Journal of Sleep Disorders & Therapy 2016, 5:1, 2016
... Therefore, all authors were blinded in terms of appliance allocation. BOAT is designed to address upper airway deficiencies and to correct maxillo-mandibular hypoplasia in both children and adults91011121314151617. All biomimetic oral appliances used in this study had: 6 anterior 3-D axial springs™, a beaded pharyngeal extension, a midline screw, bilateral occlusal coverage, retentive clasps, and a labial bow (Figure 1), but only half of the biomimetic appliances incorporated a mandibular repositioning nighttime component (Figure 2).Figure 2: The mandibular repositioning nighttime appliance (mRNA appliance®) that was prescribed for the other half of the sample with: anterior 3-D axial springs™, a midline screw, bilateral occlusal coverage, retentive clasps, a labial bow and a lower mandibular advancement component. ...
... Therefore, BOAT appears to correct sleep disordered breathing in subjects with severe OSA possibly using a different corrective mechanism than MADs, such as craniofacial correction and non-surgical, upper airway remodeling or " Pneumopedics " . This pneumopedic notion is supported by preliminary work that indicates midfacial bone volume [12] and nasal cavity volume [9] increases in adults undergoing BOAT, as well as morphologic changes in the upper airway [10,13,17], which we refer to as upper airway remodeling or pneumopedics. Pneumopedics may be regarded as an epigenetic phenomenon in the sense that morphologic changes are elicited in craniofacial locations remote from the site(s) of genetic change [24], as predicted by the spatial matrix hypothesis [25]. ...
Journal of Sleep Disorders & Therapy 2016, 5:1, 2016
... Therefore, all authors were blinded in terms of appliance allocation. BOAT is designed to address upper airway deficiencies and to correct maxillo-mandibular hypoplasia in both children and adults91011121314151617. All biomimetic oral appliances used in this study had: 6 anterior 3-D axial springs™, a beaded pharyngeal extension, a midline screw, bilateral occlusal coverage, retentive clasps, and a labial bow (Figure 1), but only half of the biomimetic appliances incorporated a mandibular repositioning nighttime component (Figure 2).Figure 2: The mandibular repositioning nighttime appliance (mRNA appliance®) that was prescribed for the other half of the sample with: anterior 3-D axial springs™, a midline screw, bilateral occlusal coverage, retentive clasps, a labial bow and a lower mandibular advancement component. ...
... Therefore, BOAT appears to correct sleep disordered breathing in subjects with severe OSA possibly using a different corrective mechanism than MADs, such as craniofacial correction and non-surgical, upper airway remodeling or " Pneumopedics " . This pneumopedic notion is supported by preliminary work that indicates midfacial bone volume [12] and nasal cavity volume [9] increases in adults undergoing BOAT, as well as morphologic changes in the upper airway [10,13,17], which we refer to as upper airway remodeling or pneumopedics. Pneumopedics may be regarded as an epigenetic phenomenon in the sense that morphologic changes are elicited in craniofacial locations remote from the site(s) of genetic change [24], as predicted by the spatial matrix hypothesis [25]. ...
Journal of Sleep Disorders & Therapy 2016, 5:1, 2016
... In fact, the protocol described here has been used to treat mild, moderate and even cases of OSA [10][11][12]. Specifically, the device has been shown to increase midfacial bone and nasal cavity volume in adults [13][14]. In a study of adult patients with mild to moderate OSA, several subjects showed that the AHI dropped to < 5hr -1 with no appliance in the mouth when the sleep study was performed [11]. ...
A 27-year-old woman was referred to our office for a dental assessment regarding temporomandibular joint pain. On initial screening, she was found to be at high risk for obstructive sleep apnea, and subsequently underwent polysomnography, which revealed an apnea-hypopnea index of 118 hr-1. Her condition was initially controlled with continuous positive airway pressure therapy, which she did not tolerate well. Therefore, treatment proceeded with biomimetic oral appliance therapy. After 10 months of combined continuous positive airway pressure therapy and biomimetic oral appliance therapy, the apnea-hypopnea index fell to 1 hr-1 and obstructive sleep apnea could not be observed with or without the appliances in situ. We conclude that combined continuous positive airway pressure therapy and biomimetic oral appliance therapy might represent a potential cure for severe cases of obstructive sleep apnea in certain patients.
... Until more recently, some dental professionals have concerned themselves largely with facial development in children, while the esthetic concerns of adults have been somewhat neglected. Recently, however, an increased midfacial bone volume in adults treated with a non-surgical, biomimetic oral device was demonstrated [13]. Biomimetic oral appliance therapy (BOAT) was also shown to have beneficial effects in adults with mild, moderate and even severe obstructive sleep apnea [14,15]. ...
... The biomimetic oral device that was worn to promote an increase in midfacial bone volume also achieved overall facial enhancement (Figure 3). The biomimetic device widened the smile by remodeling the maxilla and likely increased maxillary volume [13]. Aging also affects the skin, the facial contour, the dentition and periodontium, the facial and masticatory muscles, the facial skeleton and the temporomandibular joints. ...
Biomimetic oral appliance therapy (BOAT) has been shown to increase midfacial bone volume in adults non-surgically. This study tests the hypothesis that facial enhancement can also be achieved using BOAT. In this investigation, 12 adults underwent BOAT by a dentist with advanced training in BOAT. The following craniofacial parameters were measured on standardized lateral photographs; frontonasal angle; nasolabial angle; labiomental angle, and thyromandibular angle. The mean configurations were also subjected to statistical analyses, principal components analysis (PCA), and finite-element analysis (FEA). The results showed that the mean labiomental angle improved from 126.3° to 134.0° (p<0.01) and the mean thyromandibular angle improved from 126.5° to 118.6° (p<0.01). The mean, pre-and post-treatment craniofacial configurations, however, were not statistically different when tested using PCA (p>0.05), with the first two principal components accounting for approx. 70% of the total shape change. But, using FEA, the submandibular region showed a relative 32% decrease in size and the labiomental region also showed a 20% relative size-decrease. Therefore, this study supports the notion that BOAT may enhance facial appearance non-surgically in adults.
... Following a diagnosis of mild to moderate OSA, a biomimetic, upper Daytime-Nighttime Appliance (DNA appliance®; Figure 1) was prescribed for each subject. The biomimetic oral appliance therapy (BOAT) is designed to correct maxillo-mandibular hypoplasia in both children and adults [8][9][10][11][12][13][14][15][16]. The biomimetic oral appliance used in this study had: 6 (patented) anterior 3-D axial springs TM , a beaded pharyngeal extension, a midline screw, bilateral occlusal coverage, retentive clasps, and a labial bow ( Figure 1a). ...
... Thus, rather than ignore or overlook these adaptive changes, in this present study we utilized a clinical protocol that putatively harnesses the corrective mechanisms of the craniofacial system, similar to orthodontic treatments. Indeed, increases in 3D midfacial bone volume after BOAT have been reported in adults [15] and initial studies confirming increased nasal cavity volumes have also been found after BOAT in adults [16]. Thus, the target of correction in this study is the upper airway, and the intention of this study was to determine whether BOAT might be advantageous as an alternative to MADs and CPAP in the management of patients with mild to moderate OSA. ...
Introduction: While Continuous Positive Airway Pressure (CPAP) is widely used to manage Obstructive Sleep Apnea (OSA), compliance can be problematic in some cases. These patients are often referred for Mandibular Advancement Devices (MADs) but there is less evidence of their efficacy in severe cases. We investigated the use of biomimetic oral appliance therapy (BOAT) to test the hypothesis that severe cases of OSA can be addressed using BOAT.
Materials and Methods: 15 consecutive adults aged >21 yrs with severe OSA that were unable to comply with CPAP according to a medical physician were treated using BOAT with or without primary mandibular advancement by a dentist with advanced training in dental sleep medicine. The mean Apnea-Hypopnea Index (AHI) of the sample was calculated prior to and after BOAT with no appliance in the mouth during the sleep studies. The findings were subjected to statistical analysis, using paired t-tests.
Results: Prior to treatment the mean AHI of the study sample was 45.9 hr-1 ± 10.5. A follow-up sleep study at 9.7 mos. ± 1.9 showed a 64% decrease in AHI to a mean value of 16.5 hr-1 ± 8.8 after BOAT (p<0.01) with no appliance in the mouth during the post-treatment sleep studies. Results for those without primary mandibular advancement were: 46.6 hr-1 ± 12.9 pre-treatment vs. 13.9 hr-1 ± 10.5 after BOAT (p<0.01); and for those treated with initial mandibular advancement: 45.2 hr-1 ± 8 pre-treatment vs. 19.5 hr-1 ± 6 after BOAT (p<0.01).
Conclusions: BOAT may be a useful method of managing severe cases of OSA in adults, and represents an alternative to CPAP and MADs. However, long-term follow up is needed to reach more definitive conclusions on these initial findings.