Using Dental Implants As an Aid For Treating Sleep Apnea

PRESS RELEASE: Dec 13,2009. This is the first presentation of an innovative method to treat sleep apnea utilizing dental implants. I have been treating sleep apnea for over 25 years for non-compliant CPAP patients. The two main treatments for holding the airway open are Mandibular Advancement Appliances (MAD) and Tongue Retaining Devices (TRD) Examples of these appliances can be seen at http://www.ihatecpap.com/oral_appliance.html

Dr Bryan Keropian has created a new type of oral appliance the Full Breath Appliance that works by holding the tongue down and preventing collapse by an extension on the appliance that goes over and behind the tongue to prevent collapse. I would describe it as using “brute force” to maintain an open airway. His patients prefer it to CPAP, he he reports success that allowed him to receive several FDA approvals. The advantage to his appliance is that it does not advance the mandible, move teeth or cause significant bite changes. It is a single arch appliance and can be combined with jaw avancement. The disadvantages are the considrable bulk however that is now being reduced by Bryan utilizing a Mandibular lower appliance instead of a Maxillary upper appliance upper appliance. I took Bryan’s course Decmber 12th in Chicago and was impressed that this appliance could be used to for some patients

An article in Sleep and Breathing (abstract reprinted below) describes the use of dental implants and elastics to treat patients with insufficient support a mandibular advancement appliance. Frequently these patients are only given the option of TRD’s or tongue retaining devices. Dental implants can be used a support of individual teeth, bridges or implants and can also be used to retain sleep appliances. This report discusses using elastics connected directly to the implants to retain mandibular advancement.

I would like to suggest an appliance that holds the tongue forward by a strap running over the tongue with a tail similar to the Full Breath Appliance but instead of attatching it to a lower appliane it could snap directly onto the implants using standard dental attatcments such as the locator. The implants could be placed behind the last molar and a bar would be snapped in at night to hold the tongue down and forward. The cast bar would be customized for each patient and would have minimal bulk. Ideally it would have an area where acrlic or composite material could be added chairside for additional customization. A area could be designed on the bar to allow use of elastics, hinges, clips or other devices to attatch to an upper appliance if mandibular advancement was also desired.

This concept utilizing an implant retained bar has not been previously patented or presented to my knowlege. I am putting it out to the public for free use as I believe it would have a valuable place in sleep medicine. I believe that this would be a customized appliance made for patients who did not qualify for removable appliances. The bar would be made from FDA approved dental materials, implants and connectors though a stronger snap might be required than those currently available.

Dr Shapira is a Diplomate of the American Board of Dental Sleep Medicine and treats obstructive sleep apnea utilizing oral appliances. He places and restores implants in his Delany Dental Care (www.delanydentalcare.com) office. He holds several patents on devices for early minimally invasive removal or wisdom teeth and collection of stem cells. His practice largely dedicated to treatment of sleep and TMJ disorders. He also runs Chicagoland Dental Sleep Medicine Associates (http://www.chicagoland.ihatecpap.com/).

PubMed absrtact
Sleep Breath. 2009 Sep 18. [Epub ahead of print] Orthoimplants: an alternative treatment for SAHS?
de Carlos F, Cobo J, Fernandez Mondragon MP, Alvarez Suarez A, Calvo Blanco J.

Department of Surgery and Medical-Surgical Specialities, Area of Orthodontics, Faculty of Medicine, Universidad de Oviedo, Clinica Universitaria de Odontologia, C/Catedrático José Serrano, s/n 33006, Oviedo, Spain, fcarlos@uniovi.es.
Numerous sleep studies have been published recently regarding the use of intraoral devices (ODs) for the treatment of sleep apnea-hypopnea syndrome (SAHS). The effectiveness of these devices varies, however, according to the series studied (patient characteristics, parameters assessed, type of device, etc.). Two factors should always be assessed: the presence of an appropriate dental support and a possible temporomandibular joint pathology which can, on occasions, contraindicate the use of these devices. OBJECTIVES: To use orthoimplants as orthodontic anchorages for intermaxillary elastic bands which allow a mandibular advancement to be performed as an alternative treatment to ODs in SAHS patients without appropriate dental support. MATERIALS AND METHODS: Four orthoimplants were placed in an edentulous SAHS patient who did not tolerate continuous positive airway pressure (CPAP). The mandible is pushed forward using orthodontic elastic bands anchored to the orthoimplants. RESULTS AND CONCLUSIONS: Although more studies are still required, orthoimplants could be an alternative treatment for reducing snoring and the apnea-hypopnea index and increasing SaO2, which should be considered for patients who do not tolerate CPAP and lack appropriate dental support for attaching intraoral devices.