A snoring splint (synonyms: mandibular protrusion splint; snoring therapy device) is a therapeutic device that expands the upper airway by protrusion (advancement) of the lower jaw, thereby preventing snoring sounds and treating apnea (breathing cessation) conditions. The device consists of one transparent rigid plastic splint each for the upper and lower jaw. Both splints are connected by metal or plastic bars positioned in the buccal oral vestibule (space between the cheeks and teeth) or interocclusally (between the rows of teeth), which allow the lower jaw some lateral freedom of movement but fix it in a ventrally (forward) displaced position. During sleep, the muscular tension of the body decreases, including the tone of the pharyngeal and lingual muscles. When the sleeper is in a supine position, the tongue falls back, narrowing the airway between the tongue and the pharyngeal wall. The constricted airflow causes soft tissues, such as the soft palate, to flutter, resulting in the typical snoring sounds, which can be up to 90 decibels loud and are not harmful to the snorer’s health, but can considerably reduce the quality of the partner’s sleep. However, if the upper airways are not only narrowed but completely blocked, obstructive apnea states (respiratory arrest due to blockage) are the result, in which breathing can stop for between ten seconds and two minutes before the brain ends the resulting oxygen deficiency with a wake-up reaction. If the breathing cessations occur regularly and frequently, the deep sleep phases that are important for restful sleep are significantly reduced, which can have serious health consequences.
Indications (areas of application)
The use of a snore therapy device is already recognized for mild snoring to moderate (moderately severe) cases of obstructive sleep apnea. In this case, the diagnosis should be made in advance in an interdisciplinary manner by the ENT physician, internist or pulmonary specialist as well as a sleep laboratory. In more severe cases, surgical measures or nocturnal positive pressure ventilation with an nCPAP (“continuous positive airway pressure“, positive pressure ventilator; nCPAP mask n=nasal) may be necessary. If the nCPAP is not accepted by the patient, treatment can also be carried out with a snore therapy device. The fabrication of the snore therapy device must be preceded by a comprehensive diagnosis of the teeth, the temporomandibular joint, and the functional movements, since the splints include all the teeth and they are subjected to stresses by the splint; in addition, the advancement movement of the mandible must not be restricted by diseases of the temporomandibular joint.
The procedure
- Impression of upper and lower jaw
- Construction bite: the upper and lower jaws are brought into positional relation to each other by a wax bite or other transfer appliance in a pre-displaced position of the lower jaw. This guarantees that the tongue is prevented from falling back by the appliance. The mandible is fixed in a position that is 50% of the maximum possible advance. In addition, the occlusal blocking (required distance between the rows of teeth) is determined during registration.
- Splint fabrication: in the dental laboratory; these are stable, transparent plastic splints made by thermoforming technique, which cover the crowns of the teeth, but not soft tissue parts of the mouth such as gingiva (gums) or palate. The delicate design contributes to wearing comfort and constricts the oral cavity as little as possible. In the buccal (space between the cheeks and teeth) or interocclusal (located towards the cheek or between the rows of teeth) area of the splints, the connecting bars are positioned.
- Insertion of the splint: in the patient’s mouth, fine adjustment of the mandibular position is still possible with telescopic metal bars.
In any case, the patient must expect a period of acclimatization, whose accompanying symptoms such as increased salivation, pressure on the teeth or muscle tension should decrease through consistent wearing. The following recommendations can be made concomitantly:
- Weight reduction: the soft tissues surrounding the airways store fat; thus, weight loss also creates more space in the area of the airways.
- Prefer a sideways sleeping position
- Avoid alcohol and rich meals in the evening
