Dental Sleep Medicine Insider August 2016 | Page 17

Figure 3, Panthera D-SADTM Oral Appliance Figure 4, Micro2® Sleep Device

MICHAEL GELB, DDS

Dr Michael Gelb, DDS
and Dr. Edlir Dume
DDS practice dental
sleep medicine at
The Gelb Center of
New York which
offers integrated
medical treatment
including pain management for head
pain, neck pain, TMJ,
facial & neck pain,
and jaw pain and
other dysfunctions
including headache,
snoring, and sleep
apnea.
www.gelbcenter.com

EDLIR DUME, DDS

in the right TM joint, and, on closing, the jaw went back and to the
right by 2 mm. We also found a late
closing click in the right TM joint.
Tongue level is a level 3. Mallampati
shows a class III airway.
DIAGNOSTIC IMPRESSION:
1. Obstructive sleep apnea.
2. Disk displacement with reduction,
right temporomandibular (TM) joint.
3. Capsulitis, right TM joint.
We started with a lower repositioning appliance and Airway Centric
Gelb appliance (ACG) to manage the
TMJ symptoms during the day, and a
Panthera D-SAD™ oral appliance(Fig
3) with anterior bump. The anterior
bump relieves the forces to the TMJ
during the night. The patient’s appliances were inserted on December
11, 2015. We saw the patient in January, and he told us the pressure in
his head was better. We inserted the
Panthera appliance on January 12,
2016.
The patient was feeling much better
overall and more refreshed; however, the Panthera was too tight. On
February 5, 2016, he started feeling
pressure in his head again since we
advanced him. He also felt pressure
in the lower anterior teeth. He was
still wearing the ACG during the day,
and his ear pain was much better.
After several appointments it was
clear his symptoms were improving but the Panthera device was too
tight and not comfortable enough

to maintain compliance, so we tried
the MicrO2® (Fig 4). We saw the patient again. He told us he preferred
the MicrO2® over the Panthera. We
issued him an ApneaLink Air home
sleep study. This patient went down
from an AHI of 32 to an AHI of 4.4
(The RDI was 5.4 with an ODI of 6.1.).
In patients where the patient is feeling anterior tooth pressure, it may
not be indicated to use a 3D printed
appliance.
In summary, the MicrO2®, a digitally
milled appliance out of PMMA, may
fit the needs of a patient where comfort is the key to success, especially
where TMJ sensitivity is a concern.
Patient comfort can be an important
driver of compliance. Compliance is
an important aspect for achiev ing
effective oral appliance therapy outcomes for the treatment of Obstructive Sleep Apnea. Choosing the right
appliance to achieve patient comfort is a critical selection criterion.