Snoring Treatable By Dental Device

 CASE EXAMPLES: USINGTHE FBS ORAL APPLIANCE

CASE 1

A 31-year-old male patient presented with a history of severe snoring, moderate sleep apnea, and resulting fatigue. The patient had been previously treated with somnoplasty and an uvuloectomy, resulting in only minimal improvement. CPAP had been prescribed by the medical doctor, but the patient was found to be CPAP intolerant. 
Treatment would consist of a pretreatment PSG (lab or hospital sleep test) to determine the Apnea Hypopnea Index (AHI) (the number of times the oropharygeal airway is blocked by the tongue per hour), FBS oral appliance therapy, and a post-treatment AHI. 
Including the initial visit, delivery appointment, and subsequent visits to adjust the appliance, treatment consisted of 5 appointments. It was successful in correcting the patient’s sleep problems. AHI went from 33 to 2. (See Figure 16 for the pre-and post-treatment images associated with this case.)

CASE 2
A 67-year-old male patient presented with snoring that was disturbing to his wife, and fatigue upon awakening. CPAP therapy had been previously prescribed by his medical doctor and he was found to be CPAP intolerant. Treatment would consist of a pretreatment PSG, FBS oral appliance therapy, and a post-treatment PSG. 
Treatment involved 5 appointments and was successful. AHI went from 20.1 to 2.4. (See Figures 17a and 17b for the pre-and post-treatment images associated with this case.)

CASE 3
A 67-year-old male patient with a history of severe sleep apnea presented with fatigue and morning headaches. CPAP had been previously prescribed by a medical doctor, and the patient was very unhappy with it, still waking fatigued with morning headaches.
The patient wanted a FBS oral appliance to open the airway so he could reduce the high airflow setting of the CPAP device. Treatment would consist of a pretreatment PSG, a FBS oral appliance therapy with continued use of CPAP, and a post-treatment PSG.
In this case the lateral and frontal views of this patient’s airway appear good-sized. Pretreatment AHI was 109.9. (See Figure 18 for the pre- and post-treatment images associated with this case.) This patient’s sleep study showed that he stopped breathing 109.9 times an hour. Why? The real culprit in OSA reared its head in this case: the tongue was falling back 109.9 times an hour and blocking his airway. 
Treatment success was achieved with the FBS appliance. The patient was very happy because he was able to reduce the CPAP airflow needed. His AHI went from a 109.9 (pretreatment) to 22 (post-treatment). This post-treatment AHI represented a large 
reduction from the pretreatment AHI using an oral appliance.

DISCUSSION
In all 3 of the above cases, controlling the tongue resulted in increased airways and successful results. The oral appliance tail depressed the tongue and prevented the tongue from moving posteriorly to block the airway. This resulted in reduced AHI readings and the elimination of snoring. All 3 cases demonstrated an increase of the oropharygeal airway from the lateral view. In addition, we got a very pleasant surprise when we viewed the frontal view of the same airways: the lateral width of the 3 airways all increased with minimal advancement using the expanded tails of the FBS.

CONCLUSION
The best treatment available for OSA is CPAP therapy, but its rejection rate has been estimated by some to run as high as 75%. After weight loss, the best nonsurgical treatment for snoring/OSA is an oral appliance. 
The FBS sleep appliance differs from other sleep appliances in that it has a posterior transpalatal/translingual bar and a Posterior Tongue Restrainer (tail). This controls and restrains the tongue in a manner that could not be previously achieved. In addition, utilizing 3-D imaging allows the dentist to view treatment progress and to make the appropriate changes to ensure clinical success. Utilizing these advanced oral and imaging techniques, dentistry can now realize success in treating snoring and OSA patients in the 99th percentile range, far beyond the low tolerance rates of CPAP, and well beyond the hit-and-miss success rate of the mandibular advancing technique. 
In the author’s opinion, dentists are now able to offer an option for the treatment of snoring, mild to moderate OSA, and CPAP intolerance, that can dramatically improve the quality 
and longevity of life for our patients.