3D-Printed Mandibular Advancement Devices: Benefits and Options

Almost one in three people in Germany snores. While many dismiss it as merely annoying, it can lead to long-term strain and impairment. A mandibular advancement device (technically: Unterkieferprotrusionsschiene) is one option when snoring originates from the base of the tongue or when mild to moderate sleep apnea has been diagnosed. This article explains who may be a candidate, how we manufacture it in our laboratory using scans and 3D printing, what side effects are possible, and when statutory health insurance covers it. For more on how we treat snoring and sleep apnea in our practice, see our page on mandibular advancement devices from our laboratory.

Snoring: Still Often Underestimated

Snoring is an underestimated issue. Many people suffer from it — and not only because of the noise disturbance when a partner snores. In many cases, there is also a health risk. Therefore, snoring should not be taken lightly.

Snoring can manifest in different ways. Some people snore only lightly, while others suffer from sleep-related breathing disorders with breathing pauses such as sleep apnea. This leads to further complaints such as daytime fatigue, heart disease, and high blood pressure. Microsleep is also a common risk. In addition, sleep apnea patients are at greater risk of suffering a stroke.

Snoring is widespread, and sleep apnea is not always the cause. Middle-aged and older adults are particularly affected. The German Society for Sleep Research and Sleep Medicine (DGSM) reports the prevalence in this group as 20 to 50 percent for men and up to 25 percent for women.

Children can snore too. Some snore regularly. This significantly reduces the restorative quality of sleep. Additionally, children then feel tired during the day and suffer from difficulty concentrating. A healthy organism also requires adequate oxygen. Snoring may prevent adequate oxygen supply. A mandibular advancement device is not intended for children. If a child snores regularly, the first step is to see a pediatrician or ENT specialist, as enlarged tonsils are often the cause. If the upper jaw is too narrow, orthodontic palatal expansion may be part of the treatment.

How Does Snoring Occur?

Snoring is triggered by a narrowing of the airways. Various causes can be behind this. When the tongue muscles relax so that the tongue slips back into the throat, the airway becomes narrowed.

This creates air turbulence and vibration. The classic snoring sound results. This is also called tongue-base snoring. However, there can be other causes, such as:

• Allergies

• Jaw and dental misalignments

• Enlarged tonsils

• Anatomical features of the nose

• Soft palate and enlarged uvula

Tongue-base snoring is one of the most common forms of snoring. Depending on the cause, a different treatment is needed. For tongue-base snoring, a mandibular advancement device may be an option.

How a mandibular advancement device works

In some cases, a mandibular advancement device can provide relief. It is primarily indicated when snoring is caused by the tongue falling back into the throat. This is also called a mandibular advancement splint.

A properly fitted mandibular advancement device can treat not only snoring. It is also a recognized treatment option for mild to moderate sleep apnea.

A mandibular advancement device is custom-made based on a digital scan of your teeth. The device holds the lower jaw, tongue, and soft palate forward during sleep.

This way, the pharyngeal airway remains wide open, and the slack throat muscles are stabilized. Whether the device sufficiently improves breathing during sleep can only be determined through follow-up measurement by sleep medicine specialists.

We are happy to advise you on a custom mandibular advancement device. The diagnosis of sleep apnea is made by sleep medicine specialists; we handle the dental examination, fabrication of the device, and follow-up appointments.

Advantages of Oral Appliances

The most important benefit of a mandibular advancement device is that it can keep the airways open during sleep. Sleep deprivation and poor sleep quality can have serious long-term consequences. People with sleep apnea in particular face a number of health risks. A mandibular advancement device can help reduce these risks.

One advantage of 3D-printed models is that they can be individually adapted to the patient’s dentition. The basis is a digital scan of your teeth rather than a standard size.

Inserting and wearing a mandibular advancement device is very simple. It can be compared to a removable appliance. It is worn during sleep; it does not interfere with speaking or eating during the day. Only during the adjustment period do you wear it in the evening as well (see tips below).

There are many tips and products for snoring and sleep apnea. The device is small, worn at night, and requires no electricity or tubing. For mild to moderate sleep apnea, it is considered an accepted alternative to the mask used in continuous positive airway pressure therapy (CPAP), especially for people who cannot tolerate the mask.

In severe cases, however, the mask is unavoidable. Sleep apnea should always be examined by a specialist.

Types of Oral Appliances: What Options Are Available?

There are the following types of oral appliances:

• Monoblock appliances: They consist of one piece for both upper and lower jaw.

• Biblock devices: They consist of two separate parts, one for the upper jaw and one for the lower jaw. Both are connected by rods, joints, or bands through which the forward positioning of the lower jaw can be adjusted gradually.

Monoblock devices are one-piece and hold the lower jaw in a fixed position. Biblock devices give the lower jaw more range of motion and can be readjusted if the effect is not yet sufficient. That is why we fabricate two-piece devices.

Mandibular advancement devices are made from plastics of varying hardness. Inexpensive models are only available in standard sizes. There is then little room to adapt the device individually to the jaw.

High-quality anti-snoring devices are custom-made for each patient. Thanks to 3D printing technology, a device can be fabricated based on a digital impression.

Another option is boil-and-bite devices. They are made from a thermoplastic material. The device is heated in a water bath and molded so that it is individually adapted to the dentition.

At JUST KFO, you receive a two-piece, adjustable device from our in-house master dental laboratory, which we fabricate using 3D printing based on a digital scan.

How your mandibular advancement device is created with us: from diagnosis to follow-up

1. Sleep medicine evaluation: Whether sleep apnea is present and how severe it is is determined by measurement in a sleep laboratory or at home with a measuring device (polygraphy). Even if no one has noticed breathing pauses so far, the measurement is useful: those affected often do not notice breathing pauses during sleep themselves, and a device should not mask untreated sleep apnea.

2. Dental examination: We check teeth, gums, and temporomandibular joints. The teeth must provide enough stability for the device, and the temporomandibular joint should be able to tolerate the forward positioning of the lower jaw.

3. Scan instead of impression: With the intraoral scanner, we capture both dental arches and the position of the lower jaw in the desired forward position.

4. Planning and 3D printing in the practice laboratory: The device is planned on the computer and printed in our master dental laboratory based on the digital scan.

5. Insertion and gradual adjustment: The lower jaw is initially advanced only slightly and then adjusted in small increments until snoring decreases and the device is well tolerated. After the adjustment phase, we schedule follow-up appointments every six to twelve months.

6. Outcome assessment: In cases of sleep apnea, sleep medicine measures again with the device in place to determine whether the breathing pauses have decreased sufficiently.

Using a 3D-printed mandibular advancement device: What should you watch out for?

In principle, a printed mandibular advancement device only helps people who suffer from tongue-base snoring. If many teeth are missing or a removable denture is worn, the appliance often lacks the necessary retention. Whether it is still possible in an individual case is something we clarify during the examination.

In order to wear a mandibular advancement device, the teeth must be able to withstand a certain amount of pressure. An examination by a dentist is therefore essential before using a device for snoring.

Furthermore, an anti-snoring device does not help with every type of snoring. Depending on the cause, the device may have no effect. It is therefore essential to know exactly where the snoring comes from in each individual case.

Those who snore and grind their teeth can combine a mandibular advancement device with a night guard. However, this should be clarified on a case-by-case basis.

For maximum hygiene, you should clean the 3D-printed mandibular advancement device after each use. It is best to clean it with a manual toothbrush. Placing the device in a denture cleaning solution is suitable for cleaning areas that are not reachable with the brush.

Possible side effects

In the first few weeks, some people report a feeling of tension in the jaw or teeth in the morning, increased salivation, or a dry mouth. This often subsides once you get used to the appliance. With years of wear, the bite may change slightly. For this reason, regular checkups are part of the treatment, even if the appliance is working well. Persistent jaw joint pain is a reason to adjust the protrusion.

Adjustment period with mandibular advancement devices

Getting used to a mandibular advancement device is a matter of individual variation. We have a few tips for you that will help you get through the first period with your new device more quickly and easily:

1. Wear the mandibular advancement device in the evening to get used to it gradually. If you insert it only shortly before going to bed, it may disrupt your sleep. Watching television is a good time to do this, for example. You are distracted and not constantly thinking about the sensation in your mouth.

2. Be patient. At the beginning, wearing the device can be quite uncomfortable. Give yourself time to adjust to the changed situation.

3. Don’t overdo it. Of course, a mandibular advancement device can only help if you wear it all night. For the beginning, however, it is enough to wear the appliance only briefly and later for a few hours at a time.

4. Stay in touch with your doctor. If you have questions or concerns, you should discuss them with your treating dentist. We are here for you if you are unsure about using the appliance and need help.

Snoring: When to See a Doctor?

When a mandibular advancement device makes sense and when you should have your snoring examined is difficult for many people to assess. Some don’t even notice that they snore heavily. Often, it’s the partner who notices it. However, there are a few signs that indicate a visit to the doctor is advisable.

If you don’t feel rested after sleeping, suffer from daytime fatigue, and notice your ability to concentrate declining, you should get examined. A specialist can determine the cause of your snoring and initiate further steps. In some cases, the path to a mandibular advancement device first leads through a sleep laboratory.

When statutory health insurance covers the mandibular advancement device

The basis is a resolution by the Gemeinsamer Bundesausschuss dated November 20, 2020. Statutory health insurance covers the appliance when three conditions are met: a medically confirmed obstructive sleep apnea in an adult, a CPAP therapy with a breathing mask that cannot be used successfully, and a referral by a contract physician with sleep medicine qualifications. Fabrication, adjustment, and monitoring are then carried out in our practice. For simple snoring without sleep apnea, the appliance is a private service. For private services, we offer interest-free installment payments up to 18 months directly through the practice; for those with supplementary insurance, we support you with the necessary documentation.

When a 3D-Printed Mandibular Advancement Device Is Worth It

Mandibular advancement devices are a well-researched option for tongue-base snoring and mild to moderate sleep apnea. Whether they are suitable in your individual case is determined by sleep medicine diagnostics and dental examination. We are happy to advise you at our practice in Cologne-Rodenkirchen, Hauptstr. 50, or by phone at 0221 93 53 020.

FAQ: Frequently Asked Questions About 3D-Printed Mandibular Advancement Devices