A mandibular repositioning device (MRD) is one of the many treatment options available for sleep apnea patients. It is a custom-made, adjustable oral appliance available from a dentist that holds the lower jaw in a forward position during sleep. This mechanical protrusion expands the space behind the tongue, puts tension on the pharyngeal walls to reduce collapse of the airway and diminishes palate vibration.
Clinical studies show that custom-made MRDs are effective in treating mild to moderate obstructive sleep apnea (OSA) and snoring. They reduce symptoms that go with OSA too, like daytime sleepiness and fatigue. MRDs also help people with severe OSA who have not been been able to adhere to continuous positive airway pressure (CPAP) treatment.1-4
Indications for custom MRDs*
MRDs are the first line of treatment for mild to moderate obstructive sleep apnea (OSA) patients who:
- Do not adhere to PAP treatment
- Prefer MRDs over PAP treatment
- Fail behavioral treatment measures
- Are inappropriate candidates for or fail to comply with CPAP
MRDs are the second line treatment for severe OSAS (AHI>30) after CPAP trial.
*American Academy of Sleep Medicine Practice Parameters, Update 2006
Sleep specialists and dental practitioners collaborate to treat sleep-disordered breathing
MRD treatment flow
As part of the multidisciplinary approach, each provider in the sleep network plays a vital role in monitoring patient success. It is important to monitor treatment progress as a team to ensure efficacy.
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1. Vecchierini MF et al. Efficacy and compliance of mandibular repositioning device in obstructive sleep apnea syndrome under a patient-driven protocol of care. Sleep Med 2008;9(7):762-769
2. Dookun, R. 18 month assessment of 54 patients referred for treatment of anti-social snoring [AHI =30/hr] with a custom Mandibular Repositioning Device (MRD). Paper presented at the World Association of Sleep Medicine and Canadian Sleep Society Congress 2011
3. Geraads et al. First intention management of obstructive sleep apnea syndrome (OSAS) by custom-made mandibular advancement device: the medium-term results. Prospective study by the General Hospital Pneumologists College (CPHG). Rev Pneumol Clin 2010;66(5);284-292
4. Cheze L et al. Impact on temporomandibular joint of two mandibular advancement device designs, ITBM - RBM 27 (2006) 233.237
Discover the advantages of Narval™ CC
The Narval CC is a new generation of mandibular repositioning device (MRD) designed specifically for the treatment of adult obstructive sleep apnea (OSA). The patented Optimized Retention of the Mandible (ORM) articulation maintains the mandible in an advanced position leading to effective treatment and high compliance.
- Computer-aided design (CAD) enables high degree of customization to suit the complex dental anatomy of each individual patient
- Computer-aided manufacturing (CAM) using selective laser sintering of a biocompatible polymer material guarantees consistent, industrial-strength manufacturing
- Use of polyamide for a slim, lightweight device that is highly resilient and durable
Narval CC features and benefits
The patented ORM articulation maintains the mandible in an advanced position.
- Increase in upper airway caliber at most levels and especially at the oropharynx1
- Decrease in collapsibility of the upper airway2
- Strong and flexible connecting rods are easy to change so dentists can provide fast, accurate customized solutions with quick adjustments to patients’ needs as treatment progresses
- Patented physiological articulation parallels the occlusal plane, allowing for natural and free movement
- Comfortable and flexible device creates minimal impact on teeth and gums with no effect on dental hygiene, tissue irritation, overloading of the dentition or compromising of periodontal tissues
- Innovative, state-of-the-art materials enable a device that is strong and comfortably light
Learn More
1. Vecchierini MF et al. Efficacy and compliance of mandibular repositioning device in obstructive sleep apnea syndrome under a patient-driven protocol of care.
Sleep Med 2008;9(7):762-769
2. Dookun, R. 18 month assessment of 54 patients referred for treatment of anti-social snoring [AHI =30/hr] with a custom Mandibular Repositioning Device (MRD). Paper presented at the World Association of Sleep Medicine and Canadian Sleep Society Congress 2011
Many payors may cover oral appliances for the treatment of OSA. If covered, payment typically falls under the Durable Medical Equipment (DME) payment category.
Please note treating a medical condition requires establishing medical necessity and billing medical insurance. Dental offices should contact payors to verify coverage for HCPCS code E0486 for custom fabricated oral appliances prior to billing. Some payors may require dental providers to register as a DME supplier or become in-network, other payors may permit out-of-network billing on behalf of the patient. It is important for providers to contact individual payors directly to confirm policy coverage, coding and payment.
The reimbursement fast facts will assist you in understanding Medicare coding and coverage.
Reimbursement hotline
To speak with a Customer Service representative about your specific reimbursement questions, call our toll-free hotline at (800) 424-0737 and choose option 4.
For commercial payor questions such as coverage, reimbursement and documentation requirements, it is best to contact payors directly to verify a patient’s covered benefits.
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