Free download. The following are some of the identified supports: 1) A review of all plastic excavation systems currently available for the specification of Type 1 and 2.2.3.4.2Evolution of techniques for treating sleep disordered breathing (SDB), i.e., obstructive sleep apnea (OSA) has occurred concurrently with advancements in our understanding of the pathophysiology of OSA. The first generations of mandibular advancement devices (MADs) were created to address an anatomic abnormality of OSA, i.e., a long soft palate. However, such devices were non-specific and were associated with a higher rate of adverse events, including collapse of the tongue base and dysphagia. For the second and current generations of devices, the focus has been on modifying the cephalometric dimension of the anterior pharyngeal wall, which is the primary site of collapse in OSA patients. Such devices, currently called “bilevel” or “bilevel positive airway pressure” (BiPAP) systems are considered by many to be the gold standard for OSA treatment. Because these devices offer the greatest variety of potential therapeutic effect, this article will focus on such devices.
MADs are used to increase the upper airway cross-sectional area by repositioning the mandible. The skeletal base of the mandible consists of the mandibular body, the mandibular ramus, the mandibular condyle, and the glenoid fossa. The mandible articulates with the maxilla and the cranial base. While the mandibular body is constructed of a dense, compact cortical bone, the mandibular condyle, glenoid fossa, and ramus are more medullary in structure. The glenoid fossa of the mandible articulates with the temporal bone, which forms the roof of the cranial cavity and fossa. The mandibular body is separated from the occlusal portion of the maxilla by the mandibular fossa. The mandibular fossa has a narrow floor, which extends to the inferior alveolar canal.
For the first and second generations of MADs, the jaw screw was used to advance the mandible in an orthognathic fashion. These mandibular advancement devices were designed to address a long soft palate anatomic abnormality, but did not specifically address cephalometric dimensions. Patients with a long soft be359ba680
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