الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This randomized clinical trial was conducted to assess the influence of Monoblock and modified Biblock mandibular advancement appliance (MAA) fabricated by CAD/CAM technology for treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) and to improve the patient’s sleep quality by reducing or eliminating snoring and respiratory pauses during sleep.
Twenty adult patients with mild-moderate OSAHS diagnosed by full polysomnography (PSG) were selected for this study. All patients had adequate nasal air flow capacity and can perform at least 7 mm of protrusive jaw movement distance. Patients’ age ranged from 30 to 50 years old. Patients with Body mass index (BMI) more than 35 kg/m2 or history of alcohol consumption and exaggerated gag reflex were excluded from the study.
Patients were randomly allocated into two equal groups (n=10), Monoblock group (control) and modified Biblock group (Study). Each patient received two MAAs for treatment of OSAHS with two different mandibular advancement level (MAL) stages, 50% then 75% of the maximum mandibular advancement distance.
Both designs of MAAs used in the present study were designed and fabricated by CAD/CAM technology.
During six months follow up period, all patients with their appliances were evaluated after each three months acclimatization period of each stage, through CBCT scan for upper airway (UA) measurements, overnight full PSG to detect changes in the vital parameters previously recorded at the initial investigation, questionnaires; STOP-BANG Questionnaire (SBQ) as OSA screening tool and (USE-OA) Questionnaire for ease of appliance usability and patient satisfaction.
This study had the following results;
• UA measurements, volume and linear antero-posterior (AP), showed statistical significant favorable increase in Biblock group in relation to Monoblock group at 50% and 75% MAL stages.
• For cross sectional UA measurements, there was statistical insignificant increase between the studied groups, while within the same group the UA measurements showed statistical significant favorable increase at 75% MAL stage.
• Regarding the vital parameters recorded through PSG, Apnea Hypopnea Index (AHI), Respiratory Disturbance Index (RDI), Oxygen Desaturation Index (ODI), Snore Index and Snore episodic (%TST) showed statistical significant favorable decrease in Biblock group in relation to Monoblock group at 50% and 75% MAL stages. However, other parameters such as; Minimal Oxygen Saturation (SPO2%), Baseline O2 saturation, Average min saturation showed statistical insignificant increase between the studied groups, while within the same group, they showed statistical significant favorable increase at 75% MAL stage.
• Acceleration index of HR, Average HR, Total arousal index and Index of increase in BP showed statistical insignificant decrease between the studied groups, while within the same group, they showed statistical significant favorable decrease at 75% MAL stage. On the same line, Deceleration index of HR showed statistical significant decrease in percentage change between the studied groups at 50% and 75% MAL stages and within the same group, it showed statistical significant favorable decrease at 75% MAL stage.
• Concerning Average systolic Blood Pressure, there was no statistical significant difference either between the studied groups or within the same group. However, Average diastolic Blood Pressure showed statistical significant decrease within Biblock group only.
• With regard to SBQ, all patients’ scores in both groups showed low risk for OSA at 75% MAL stage. Furthermore, most of questions of USE-OA Questionnaire among Biblock group showed favorable high scores in relation to Monoblock group. Additionally, all patients of Biblock group represented strong satisfaction with their MAA while Monoblock group ranged between satisfaction and fairly satisfaction.
from this study, it can be concluded that;
• Modified Biblock MAA with elastics presented favorable treatment option for OSAHS patients regarding improvement in upper airway measurements and recorded full PSG vital parameters when compared to Monoblock MAA.
• 75% MAL in either MAA designs was successful in improving patient’s sleep quality by reducing or eliminating snoring and respiratory pauses during sleep in comparison to 50% MAL.
• Mandibular advancement appliances (MAAs) provided a therapeutic effect for OSAHS patients by protruding the mandible relative to the maxilla, simultaneously advancing the tongue and reducing the propensity for upper airway collapse during sleep.
• Either Monoblock or Biblock MAA produced UA measurements and sleep quality improvement in OSAHS patients’ condition.