of temporalis muscles. She also reports daily headaches. She wears 25 year old full upper and lower dentures with a dramatic loss of vertical dimension. The denture teeth are worn flat and there are gross prematurities. Her maximum opening is 34 mm. with a deviation to the left of 1.5 mm. Her left lateral range of motion is 6mm and the right is 11mm. Her maximum protrusion is 6mm beyond end-to-end. The patient had a PSG in 2010 and her AHI was in the mild range of 5.4 and in REM 8.0. Even with this the sleep MD prescribed a CPAP. Her RDI was 31.2 and that is pretty severe and dangerous. So, while the AHI might not make her look very sick, the RDI did. She also had very loud snoring with related arousals and other arousals of unknown origin. Her restless leg syndrome was under control with Mirapex. Her desaturations were mild but she was forever tired. On the PSG she spent 25% of her sleep time (91 minutes) with an oxygen saturation between 81 and 90%. The patient was more concerned about her pain and headaches than her OSA symptoms.
THERAPY A new set of dentures was made with the corrected vertical dimension and with good occlusion. Four implants were placed in the mandible and attached to the new lower denture. With this the patient reported a dissipation of jaw and muscle pain. This new denture was used as the baseline vertical and anterior-posterior position for establishing the jaw position for an oral appliance.
The patient’s oxygen saturations, that initially were below 90%, moved into a normal range in all but 2-.4% of her sleeping time.
CONCLUSION We took an edentulous “CPAP refusal” patient and made a modified classical dorsal fin sleep appliance for her. The appliance successfully reduced or eliminated her OSA symptoms.
A dorsal appliance was fabricated. The upper was made as a denture and the retention was excellent. If retention were not successful a reline or perhaps adhesive might have been necessary. The lower of the dorsal appliance was attached to two of the four implants and the other two implant areas were hollowed out in acrylic. The lower was very stable. The appliance was delivered on 4/18/2014.
RESULTS Two subsequent sleep studies were performed, one on 5/19/14, and one on 6/12/14. The first to “check our work” and the second as a final sleep study for the sleep MD. The first study revealed an AHI of 1.9 with an RDI of 3.1. The second showed an AHI of 2.4 and an RDI of 5.3. Both studies showed the appliance to be successful based upon AADSM guidelines. However, we feel the biggest health improvement comes from the dramatic drop in the RDI!. WWW.SLEEPGS.COM
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