title: Compliance and efficacy of titratable thermoplastic versus custom mandibular advancement devices.
abstract: OBJECTIVE
  To share our experiences treating patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) with titratable thermoplastic (TPD) and custom-made mandibular advancement devices (MAD) and to compare these devices in terms of objective improvement and cure and treatment success (improvement/cure plus adherence at 6 months).
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Patients with OSAHS who failed or refused both continuous positive airway pressure (CPAP) and surgery had a titratable oral appliance fitted. Patients were offered an office-fitted TPD or a custom-made dentist-fitted device. Assessment included pretreatment and appliance-titration polysomnography (PSG). Improvement was defined as ≥ 50% apnea-hypopnea index (AHI) reduction plus posttreatment AHI <20, and cure was defined as AHI <5. Patients were contacted at 1 and 6 months regarding treatment adherence.
  
  
  RESULTS
  A total of 180 patients (123 TPD, 57 custom) with complete PSG data were reviewed. Improvement/cure were significantly better with the custom device overall (91.2%/71.9% vs 77.2%/52.0%, P = .024/.012). Adherence data at 1 and 6 months were obtained from 128/180 and 119/180 patients, respectively. Using an intention-to-treat analysis, those lost to follow-up were considered nonadherent. Adherence at 1/6 months was 64.9%/50.9% for custom versus 53.7%/32.5% for TPD (P = .156/.018), yielding treatment success rates (with initial improvement/cure) of 49.1%/40.4% for custom versus 27.6%/17.1% for TPD (P = .005/<.001) at 6 months.
  
  
  CONCLUSIONS
  Custom-fit devices achieve higher rates of objective improvement and cure of OSAHS than TPD at the time of titration-PSG. TPDs have a high acceptance rate, low cost, and reasonable initial improvement and cure rates of 77.2% and 52.0%, respectively, but significantly poorer 6-month compliance.
authors.affiliation: Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois 60602, USA. hednnek@aol.com
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Craig
authors.initials: C
authors.lastname: Hamilton
authors.forename: Christian G
authors.initials: CG
authors.lastname: Samuelson
authors.forename: Kanwar
authors.initials: K
authors.lastname: Kelley
authors.forename: Kristine
authors.initials: K
authors.lastname: Pearson-Chauhan
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.forename: Renwick
authors.initials: R
authors.lastname: Taylor
authors.forename: Alexander
authors.initials: A
authors.lastname: Maley
authors.forename: Martin A
authors.initials: MA
authors.lastname: Hirsch
mesh_terms: D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*