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. 2023 Mar;27(1):389-397.
doi: 10.1007/s11325-022-02601-6. Epub 2022 Mar 29.

Mandibular advancement device: prescription in adult dental sleep medicine - guideline of the German Society of Dental Sleep Medicine

Olaf Bernhardt  1 , Nikolaos Nikitas Giannakopoulos  2   3 , Markus Heise  4 , Alexander Meyer  5 , Dagmar Norden  6 , Jörg Schlieper  7 , Horst Kares  8
Affiliations

Mandibular advancement device: prescription in adult dental sleep medicine - guideline of the German Society of Dental Sleep Medicine

Olaf Bernhardt et al. Sleep Breath. 2023 Mar.

Abstract

Purpose: Obstructive sleep apnea (OSA) may result in severe health onditions, reduces quality of live, and affects high percentages of the adult population. Due to recent changes in the German health care regulations, mandibular advancement devices (MAD) will become available as a treatment option for OSA to a greater extent for general dentists and their patients.

Methods: A guideline development group consisting of nine members representing four German dental and medical organizations was formed, in order to provide critical information and orientation to the main stakeholders (dentists and patients), regarding the use of MAD for the treatment of OSA within dental sleep medicine.

Results: This guideline aims to inform physicians and dentists, particularly those with acquired qualification/specialization in sleep medicine (or in the diagnosis and treatment of sleep-related breathing disorders), as well as experts, payers, and patients. It delivers recommendations on technical requirements for MAD prescription and fabrication, clinical procedures, maintenance, and follow-up procedures.

Conclusion: A MAD should be designed for long-term therapy and must be a custom made, adjustable, bimaxillary retained two-splint system equipped with adjustable protrusive elements. The fabrication in a dental laboratory should be based on dental impressions or scans and three-dimensional registrations of the starting position taken with a bite gauge.

Keywords: Clinical procedure; Dental sleep medicine; Guideline; Mandibular advancement device; Obstructive sleep apnea.

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Conflict of interest statement

All the guideline authors and participants disclosed their potential conflicts of interest (COI) before starting work on the guideline using the AWMF’s “Disclosure of Conflicts of Interest” form (version date: May 23, 2018). The originals are kept on file by the guideline coordinator. The conflict of interest disclosure forms were jointly reviewed and evaluated by all the guideline development group members during the online conference on October 6, 2020. Horst Kares, Nikolaos Giannakopoulos, Markus Heise, Alexander Meyer, and Dagmar Norden had no conflict of interest and no competing interest. Olaf Bernhardt was found to have a low-level COI (with no consequences), and Joerg Schlieper was found to have a high-level conflict of interest regarding MAD type, design, and adjustability. Since his expertise was indispensable, it was decided to exclude him from the discussions and voting on the relevant topics and to merely grant him the opportunity to submit his comments and opinions in writing.

Figures

Fig. 1
Fig. 1
Clinical algorithm for mandibular advancement device (MAD
See this image and copyright information in PMC

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