p apnea prosthesis

for dentate

odney 6. Knudson, DMD, MS,a Jack alph MontalvoC Wilford U. S. Air Force Medical Center, Lackland

B. Meyer, Air Force

patients

Jr., DMD,b

and

Base, Tex.

This article describes clinical and laboratory techniques for the fabrication of a sleep apnea prosthesis for a dentate patient. The treatment objective is to posture the mandible at an increased vertical and protrusive position to diminish or eliminate the collapse of the base of tongue into the oropharynx. During fabrication of the prosthesis, cephalograms are used to evaluate spatial change between the base of the tongue and the posterior pharyngeal wall. (J PROSTHET DENT

1992;68:109-11.)

The views expressed herein are those of the authors and do not necessarily reflect the views of The United States Air Force, The United States Army, or The Department of Defense. aLieutenant Colonel, U.S. Air Force, DC; Chief of Maxillofacial Prosthetics. bLieutenant Colonel, U.S. Army; Chief of Maxillofacial Prosthetics. CDental Technician for Maxillofacial Prosthetics. 10/l/37563

Fig. Pig. Pig. Pig.

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onservative treatment of obstructive sleep apnea (OSA) includes weight loss, changes in sleep posture, drug therapy, nasal continuous positive airway pressure (CPAP), and placement of an intraoral prosthesis.1-3 Meyer and Knudson1 have described the fabrication of a prosthesis for the prevention of obstructive sleep apnea for the edentulous patient.4 This article describes a technique for the

1. Blocked

out master casts with outline of design. casts mounted with wax interocclusal 2. Blocked out master 3. Occlusal view of wax-up on duplicated casts. 4. Anterior view of wax4rp on duplicated casts.

DENTISTRY

record.

109

KNUDSON,

Fig. Fig. Fig. Fig.

fabrication tient.

5. 6. 7. 8.

AND

MONTALVO

Sleep apnea prosthesis polished and fitted to mounted master casts. Maxillary and mandibular segments joined with visible light-cured resin. Sleep apnea prosthesis in place. Sleep apnea prosthesis with clasps.

of a sleep apnea prosthesis

for the dentate

pa-

1. Obtain accurate maxillary and mandibular master casts with an irreversible hydrocolloid impression material. 2. Block out hard and soft tissue undercuts on master casts with block-out wax (Fig. 1). 3. Duplicate blocked out master casts with reversible or irreversible hydrocolloid. 4. Make a wax interocclusal record at an increased vertical and protrusive jaw position. (We recommend an initial incisal edge-to-edge position at a 12 to 15 mm vertical opening.) Allow patient 15 to 20 minutes to accommodate to this position and to assess any immediate signs of muscle or temporomandibular joint (TMJ) discomfort. Cephalograms may be made at this time to assess the spatial changes in the oropharynx. 5. Using the wax record, mount the master casts and cross-mount the blocked out duplicate casts in a semiadjustable articulator (Fig. 2).

110

MEYER,

6. Wax the maxillary and mandibular portions of the sleep apnea prosthesis with baseplate wax on mounted duplicate casts that have been painted with two coats of tinfoil substitute (Al-Cote, L. D. Caulk, Division, Dentsply International, Inc., Milford, Del.). Flow a thin layer, approximately 2 mm, of baseplate wax within the confines of the design. Flame this layer of wax to create a smooth flat surface that is approximately half the intermaxillary space. The wax should overlap the incisal edged and buccal surface 3 mm and extend onto the soft tissue palatolingually. A plastic packing sheet or tinfoil 0.0005 inch thick can be used to maintain independence of the maxillary and mandibular portion. Leave 1 to 2 mm separation between the maxillary and mandibular surfaces to facilitate the joining of the two portions after processing (Figs. 3 and 4). 7. Invest and process in heat-cured clear acrylic resin according to accepted standards. 8. After deflasking, polish the external surfaces and fit each portion to the mounted master casts and intraorally before joining the portions (Fig. 5).

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1992

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68

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1

SLEEPAPNEAPROSTHESIS

9. With a visible light-curing resin (Triad, Dentsply, York, Penn.) join the maxillary and mandibular portions on the articulator. Autopolymerizing resin can be used instead of a visible light-cured resin. Create an anterior orifice to permit oral ventilation (Figs. 6 and 7). 10. Instruct the patient on insertion and care of the prosthesis. 11. If additional retention is needed, wrought wire Adams or ball clasps can be incorporated in the wax-up (Fig. 8). At the follow-up appointment, the prosthesis is checked for stability and retention. The treatment objectives include absence of muscle discomfort or TMJ symptoms. If muscle or TMJ discomfort develops, the prosthesis should be separated and rejoined at a decreased vertical, protrusive position.

described. With the mandible positioned in an opened vertical protrusive position, the airway may remain patent and signs and symptoms of obstructive sleep apnea may be reduced or eliminated. Before impression-making and prosthesis fabrication, restorative and periodontal therapy should be completed. It is highly recommended that the patient return to the referring physician for follow-up polysomnography to confirm the efficiency of the prosthesis. REFERENCES 1. Meyer JB, Knudson RC. The sleep apnea syndrome: Part II. treatment. J PROSTHET DENT 1990;63:320-4. 2. Clark RW. Sleep apnea. Prim Care 1979;6:653-79. 3. Guilleminault C, Dement WC, eds. Sleep apnea syndromes. New York: Alan R Liss Inc, 1978. 4. Meyer JB, Knudson RC. Fabrication of e prosthesis to prevent sleep apnea in edentulous patients. J PROSTHET DENT 1990;63:448-51.

Reprintrequests to: A clinical and laboratory technique for the fabrication of a sleep apnea prosthesis for the dentate patient has been

DR. RODNEY C. KNUDSON DEPARTMENT OF MAXILLOFACIAL WILFORD HALL USAF MEDICAL LACKLAND AFB, TX 78236-5300

PROSTHETICS CENTER/SGDP

Clinical evaluation of the gingiva around single-crystal sapphire endosseous implant after experimental ligature-induced plaque accumulation in monkeys Yasumasa asaki Hiroshima

Akagawa, Hashimoto, University

DDS, DDS, School

PhD,a PhD,c

of Dentistry,

Toshikado and

Matsumoto,

Hiromichi

Hiroshima,

Tsuru,

DDS, DDS,

PhD,b

PhDd

Japan

This study was performed to evaluate clinical changes of the gingiva with plaque accumulation around the single-crystal sapphire implant. Four implants were inserted into mandibular and maxillary edentulous regions, and the superstructure was inserted 1 month after insertion of the implants in each of nine monkeys. Plaque control was maintained for 3 months after insertion to set up the baseline. Plaque was allowed to accumulate on one side by placing the ligature around the implant and natural teeth without any plaque control, and on the other side plaque control was continued for 9 months. Both the implant and natural teeth on the ligature side showed a significant increase in the clinical parameters of plaque index, gingival index, and probing depth. No significant difference was obtained between the implant and natural teeth. These findings indicate that plaque control is of great importance for maintaining the health of peri-implant gingiva. (J FROSTMET

Supported aAssociate

DENT 1992;68:111-5.)

by Ministry Professor,

of Education grant No. 62460390. Department of Removable Prosthodon-

tics. bPostgraduate Student, Department of Removable Prosthodontics. cAssistant Professor, Department of Removable Prosthodontics. dProfessor and Chairman, Department of Removable Prosthodon-

tics. 10/l/36926

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he health of the tissue around an endosseous dental implant is essential for long-term success.l In particular, the health of the peri-implant gingiva is critical because it can provide a potential pathway for the invasion of oral microorganisms. Several investigators have evaluated the histologic structures of the gingiva around endosseous dental implants, and the gingiva around single-crystal

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