The journal SLEEP February 2006 (1) recommendations of the American Academy of Sleep Medicine validated the indications for mandibular advancement splints in sleep disordered breathing.
Custom MRDs are recommended as 1st Line Treatment
- In mild to moderate OSA for patients who:
- Prefer MRDs over CPAP
- Do not respond to CPAP
- Are inappropriate candidates for CPAP
- Fail behavioural measures treatment
- In Primary Snoring for patients who do not respond or are not appropriate candidates for behavioural measures treatment.
Custom MRDs are recommended as 2nd Line Treatment
- Severe OSAS (AHI>30) in case of failure of an initial trial of CPAP
Definitive Contra-indications
- It is not possible to treat patients with:
- Complete removable dentures
- Missing lower posterior molars on one or both sides of the mandible
- Maximum mandibular advancement of less than 5 mm
- Biomechanics: number and arrangement of elements of the remaining dentition, denture.
- Fully removable bottom (unless attached to implants)
- Infectious : Infectious diseases and complications of local dentition and periodontium
- Functional : Some dental problems , musculo-articular skeletal neurological or psychiatric
- Short teeth, insufficient teeth per arch and quadrant (i.e. ~4 minimum per quadrant), absent lower molars and insufficient undercuts to retain the device
- Temporo-mandibular joint pain: unadvised - to be discussed between patient and a TMJ / occlusion specialist
- Patients with a record of TMJ osteoarthritis should not be treated with an MRD
Temporary Contra-indications
- Periodontal disease: must be treated by the patient’s dentist before MRD treatment
- Cysts and mouth ulcers: should be treated by the patient’s dentist before MRD treatment
- Teeth to be extracted, prosthesis to be fitted, temporary prosthesis to be replaced - ask the patient to be treated by their usual dentist before they are fitted for an MRD.
- Undergoing dental restorations, requiring or having had recent dental extractions.