Implant-retained oral appliances: a novel treatment for edentulous patients with obstructive sleep apnea-hypopnea syndrome

Objectives: Mandibular repositioning appliances (MRAs) are a viable treatment alternative in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Because these appliances require retention in the patient's dentition, edentelous patients generally do not qualify for this treatment. This study describes our experiences with an implant-retained MRA in the treatment of edentulous OSAHS patients. Patients and methods: Six edentulous OSAHS patients were included in this study. Standard treatment consisted of the placement of four endosseous dental implants in the mandible and the construction of a new maxillary denture and a mandibular overdenture. Subsequently, an MRA was made. After a habituation and adjustment period, the effect of treatment was evaluated with polysomnography. Treatment was considered effective in cases where it yielded an apnea-hypopnea index <5. Results: Of the six patients included, two did not tolerate the MRA because of pressure-induced discomfort on the labial mucosa in the maxilla. These two patients were offered an implant-retained overdenture and MRA in the maxilla. One of the two patients proceeded with this secondary treatment. Of the five patients completing the follow-up polysomnography, effective OSAHS treatment was attained in four. Conclusions: The results from this study suggest that an implant-retained MRA in the mandible is a viable treatment modality in edentulous OSAHS patients. Because the therapeutic effectiveness of this treatment may be compromised by excessive pressure of the MRA on the labial mucosa in the maxilla, we suggest that an implant-retained MRA in the maxilla be offered as a secondary treatment in selected patients

Two-part implants inserted in a one-stage or a two-stage procedure - A prospective comparative study

Objective: The aim of this study was to evaluate the feasibility of using a two-part implant system in a one-stage procedure and to monitor the microflora in the peri-implant area in relation to clinical and radiographic outcome. Material and Methods: After randomisation, 40 edentulous patients (Cawood & Howell class V-VI) received two IMZ implants in the anterior mandible inserted by either a one-stage (n=20) or a two-stage (n=20) surgical procedure for overdenture treatment. A standardised clinical and radiographic evaluation was performed after denture insertion as well as 6 and 12 months thereafter. Twelve months after loading, peri-implant samples were collected and analysed for the presence of putative periodontal pathogens using culture technique. Results: No striking differences were found between the two groups with regard to the clinical parameters during the evaluation period. The mean bone loss in the first year of functioning was 0.6 mm in both groups. With regard to the gingiva score, plaque score, bleeding score or bone loss between T0 and T12, no associations were found with the presence of the cultured microorganisms. An association was present between pockets greater than or equal to4mm and the presence of Peptostreptococcus micros in the two-stage group. Conclusions: The short-term results indicate that two-part implants inserted in a one-stage procedure may be as predictable as inserted in the common two-stage procedure. The peri-implant sulcus can and does harbour potential periodontal pathogens without significant signs of tissue breakdown