A Comprehensive Classification of Snoring Appliances: A Systematic Review
Abstract
Background and Objective: Obstructive sleep apnea (OSA) and snoring are common conditions that adversely affect sleep quality. Snoring has several etiologies; however, difficulty in airflow through the upper airways is considered a principal mechanism. If snoring persists despite addressing the underlying causes, appliances can help reduce snoring. A variety of appliances with different mechanisms have been proposed. This review aimed to classify appliances, their mechanisms of action, and methods of fabrication.
Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed in PubMed, Scopus, and Google Scholar for studies published between 1995 and 2024 using the following keywords: mandibular advance-ment devices, obstructive sleep apnea, snoring, continuous positive airway pressure, and dentistry.
Results: Of the 200 initially identified articles, 25 relevant abstracts were selected for full-text review, and 13 studies were ultimately included in the review. This study investigated the fabrication methods and characteristics of snoring appliances. Based on the reviewed literature, appliances used for snoring and OSA management were categorized into five groups: custom-made mandibular advancement splints (MASs), prefabricated mandibular advancement devices (MADs), modified complete dentures, bite-raising appliances (BRAs), and tongue-retaining devices (TRDs).
Conclusion: A wide variety of appliances have been proposed for snoring. MASs are the most frequently reported appliances, followed by TRDs. Current evidence suggests that these appliances are primarily effective in mild and mod-erate cases.
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2. Stuck BA, Dreher A, Heiser C, et al. Diagnosis and treatment of snoring in adults-S2k Guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery. Sleep Breath 2015; 19: 135-48.
3. Ilea A, Timuș D, Höpken J, et al. Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development. Cranio 2021; 39: 472-83.
4. Lee YH. Implications of Obstructive Sleep-related Breathing Disorder in Dentistry: Focus on Snoring and Obstructive Sleep Apnea. Dent Res Oral Health 2022; 5: 74-82.
5. Chuang LP, Lin SW, Lee LA, et al. The gender difference of snore distribution and increased tendency to snore in women with menopausal syndrome: a general population study. Sleep Breath 2017; 21: 543-7.
6. Sowho M, Sgambati F, Guzman M, et al. Snoring: a source of noise pollution and sleep apnea predictor. Sleep 2020; 43: zsz305.
7. Michalek-Zrabkowska M, Wieckiewicz M, Macek P, et al. The Relationship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study. Int J Environ Res Public Health 2020; 17: 8960.
8. Counter P, Wilson JA. The management of simple snoring. Sleep Med Rev 2004; 8: 433-41.
9. Cremonini F, Poma G, Palone M, et al. Treatment of Obstructive Sleep Apnea and Simple Snoring: Efficacy of a New Mandibular Advancement Device. Appl Sci 2024; 14: 4052.
10. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8: 597-619.
11. Unnikrishnan D, Jun J, Polotsky V. Inflammation in sleep apnea: an update. Rev Endocr Metab Disord 2015; 16: 25-34.
12. Merrill RL. Temporomandibular disorder pain and dental treatment of obstructive sleep apnea. Dent Clin North Am 2012; 56: 415-31.
13. Ngiam J, Balasubramaniam R, Darendeliler MA, et al. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea.
Aust Dent J 2013; 58: 408-19.
14. Fleetham JA. Oral appliances, position papers and sleep disorders. Can Respir J 2012; 19: 305-6.
15. Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Mo Med 2017; 114: 120-4.
16. Chan AS, Sutherland K, Schwab RJ, et al. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 2010; 65: 726-32.
17. Dieltjens M, Verbruggen AE, Braem MJ, et al. Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Disordered Breathing: A Prospective Clinical Trial. JAMA Otolaryngol Head Neck Surg 2015; 141: 894-900.
18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj 2021; 372: n71.
19. Sutherland K, Deane SA, Chan AS, et al. Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea. Sleep 2011; 34: 469-77.
20. Aarab G, Lobbezoo F, Wicks DJ, et al. Short-term effects of a mandibular advancement device on obstructive sleep apnoea: an open-label pilot trial. J Oral Rehabil 2005; 32: 564-70.
21. Maguire J, Steele JG, Gibson GJ, et al. Randomised cross-over study of oral appliances for snoring. Clin Otolaryngol 2010; 35: 204-9.
22. O'Sullivan RA, Hillman DR, Mateljan R, et al. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1995; 151: 194-8.
23. Bernhold M, Bondemark L. A magnetic appliance for treatment of snoring patients with and without obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1998; 113: 144-55.
24. Smith AM, Battagel JM. Non-apneic snoring and the orthodontist: the effectiveness of mandibular advancement splints. J Orthod 2004; 31: 115-23.
25. Izci B, McDonald JP, Coleman EL, et al. Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint. Respir Med 2005; 99: 337-46.
26. Gauthier L, Laberge L, Beaudry M, et al. Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study. Sleep Med 2009; 10: 329-36.
27. Tripathi A, Gupta A, Sarkar S, et al. Changes in Upper Airway Volume in Edentulous Obstructive Sleep Apnea Patients Treated with Modified Mandibular Advancement Device. J Prosthodont 2016; 25: 453-8.
28. Kao HH, Lin YC, Chiang JK, et al. Effects of a novel oral appliance on snoring in adults: A pilot study. J Dent Sci 2022; 17: 521-7.
29. Banu F, Jeyapalan K, V AK. Custom-Made Dual-Functional Oral Appliance for Management of Obstructive Sleep Apneic Completely Edentulous Patient. Cureus 2021; 13: e16656.
30. Aarab G, Lobbezoo F, Hamburger HL, et al. Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig 2010; 14: 339-45.
31. Almeida FR, Furuyama RJ, Chaccur DC, et al. Complete denture wear during sleep in elderly sleep apnea patients--a preliminary study. Sleep Breath 2012; 16: 855-63.
32. Emami E, Lavigne G, Feine JS, et al. Effects of nocturnal wearing of dentures on the quality of sleep and oral-health-related quality in edentate elders with untreated sleep apnea: a randomized cross-over trial. Sleep 2021; 44: zsab101.
33. Chen Q, Zou D, Feng H, et al. Will wearing dentures affect edentulous patients' breathing during sleep? Sleep Breath 2017; 21: 589-94.
34. Krishnamurthy P, Maheswari U, Mohamed K. Effect of Prosthetic Rehabilitation on Airway Space in Edentulous Patients with Obstructive Sleep Apnea- a Preliminary Observational Study. J Dent (Shiraz) 2023; 24: 382-8.
35. Krishnamurthy P, Banu F, Kumar VA. Impact of Complete Denture and Mandibular Advancement Device in the Management of Completely Edentulous Obstructive Sleep Apneic Individuals: A Systematic Review with Meta-Analysis. J Dent (Shiraz) 2023; 24: 84-94.
36. Tripathi A, Gupta A, Tripathi S, et al. A novel use of complete denture prosthesis as mandibular advancement device in the treatment of obstructive sleep apnea in edentulous subjects. J Dent Sleep Med 2014; 1: 115-9.
37. Chiang JK, Lin YC, Yu HC, et al. Long-term benefits of a new oral appliance on adult snoring: a trend analysis. Multidiscip Respir Med 2022; 17: 824.
2. Stuck BA, Dreher A, Heiser C, et al. Diagnosis and treatment of snoring in adults-S2k Guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery. Sleep Breath 2015; 19: 135-48.
3. Ilea A, Timuș D, Höpken J, et al. Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development. Cranio 2021; 39: 472-83.
4. Lee YH. Implications of Obstructive Sleep-related Breathing Disorder in Dentistry: Focus on Snoring and Obstructive Sleep Apnea. Dent Res Oral Health 2022; 5: 74-82.
5. Chuang LP, Lin SW, Lee LA, et al. The gender difference of snore distribution and increased tendency to snore in women with menopausal syndrome: a general population study. Sleep Breath 2017; 21: 543-7.
6. Sowho M, Sgambati F, Guzman M, et al. Snoring: a source of noise pollution and sleep apnea predictor. Sleep 2020; 43: zsz305.
7. Michalek-Zrabkowska M, Wieckiewicz M, Macek P, et al. The Relationship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study. Int J Environ Res Public Health 2020; 17: 8960.
8. Counter P, Wilson JA. The management of simple snoring. Sleep Med Rev 2004; 8: 433-41.
9. Cremonini F, Poma G, Palone M, et al. Treatment of Obstructive Sleep Apnea and Simple Snoring: Efficacy of a New Mandibular Advancement Device. Appl Sci 2024; 14: 4052.
10. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8: 597-619.
11. Unnikrishnan D, Jun J, Polotsky V. Inflammation in sleep apnea: an update. Rev Endocr Metab Disord 2015; 16: 25-34.
12. Merrill RL. Temporomandibular disorder pain and dental treatment of obstructive sleep apnea. Dent Clin North Am 2012; 56: 415-31.
13. Ngiam J, Balasubramaniam R, Darendeliler MA, et al. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea.
Aust Dent J 2013; 58: 408-19.
14. Fleetham JA. Oral appliances, position papers and sleep disorders. Can Respir J 2012; 19: 305-6.
15. Goyal M, Johnson J. Obstructive Sleep Apnea Diagnosis and Management. Mo Med 2017; 114: 120-4.
16. Chan AS, Sutherland K, Schwab RJ, et al. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 2010; 65: 726-32.
17. Dieltjens M, Verbruggen AE, Braem MJ, et al. Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Disordered Breathing: A Prospective Clinical Trial. JAMA Otolaryngol Head Neck Surg 2015; 141: 894-900.
18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj 2021; 372: n71.
19. Sutherland K, Deane SA, Chan AS, et al. Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea. Sleep 2011; 34: 469-77.
20. Aarab G, Lobbezoo F, Wicks DJ, et al. Short-term effects of a mandibular advancement device on obstructive sleep apnoea: an open-label pilot trial. J Oral Rehabil 2005; 32: 564-70.
21. Maguire J, Steele JG, Gibson GJ, et al. Randomised cross-over study of oral appliances for snoring. Clin Otolaryngol 2010; 35: 204-9.
22. O'Sullivan RA, Hillman DR, Mateljan R, et al. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1995; 151: 194-8.
23. Bernhold M, Bondemark L. A magnetic appliance for treatment of snoring patients with and without obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1998; 113: 144-55.
24. Smith AM, Battagel JM. Non-apneic snoring and the orthodontist: the effectiveness of mandibular advancement splints. J Orthod 2004; 31: 115-23.
25. Izci B, McDonald JP, Coleman EL, et al. Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint. Respir Med 2005; 99: 337-46.
26. Gauthier L, Laberge L, Beaudry M, et al. Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study. Sleep Med 2009; 10: 329-36.
27. Tripathi A, Gupta A, Sarkar S, et al. Changes in Upper Airway Volume in Edentulous Obstructive Sleep Apnea Patients Treated with Modified Mandibular Advancement Device. J Prosthodont 2016; 25: 453-8.
28. Kao HH, Lin YC, Chiang JK, et al. Effects of a novel oral appliance on snoring in adults: A pilot study. J Dent Sci 2022; 17: 521-7.
29. Banu F, Jeyapalan K, V AK. Custom-Made Dual-Functional Oral Appliance for Management of Obstructive Sleep Apneic Completely Edentulous Patient. Cureus 2021; 13: e16656.
30. Aarab G, Lobbezoo F, Hamburger HL, et al. Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig 2010; 14: 339-45.
31. Almeida FR, Furuyama RJ, Chaccur DC, et al. Complete denture wear during sleep in elderly sleep apnea patients--a preliminary study. Sleep Breath 2012; 16: 855-63.
32. Emami E, Lavigne G, Feine JS, et al. Effects of nocturnal wearing of dentures on the quality of sleep and oral-health-related quality in edentate elders with untreated sleep apnea: a randomized cross-over trial. Sleep 2021; 44: zsab101.
33. Chen Q, Zou D, Feng H, et al. Will wearing dentures affect edentulous patients' breathing during sleep? Sleep Breath 2017; 21: 589-94.
34. Krishnamurthy P, Maheswari U, Mohamed K. Effect of Prosthetic Rehabilitation on Airway Space in Edentulous Patients with Obstructive Sleep Apnea- a Preliminary Observational Study. J Dent (Shiraz) 2023; 24: 382-8.
35. Krishnamurthy P, Banu F, Kumar VA. Impact of Complete Denture and Mandibular Advancement Device in the Management of Completely Edentulous Obstructive Sleep Apneic Individuals: A Systematic Review with Meta-Analysis. J Dent (Shiraz) 2023; 24: 84-94.
36. Tripathi A, Gupta A, Tripathi S, et al. A novel use of complete denture prosthesis as mandibular advancement device in the treatment of obstructive sleep apnea in edentulous subjects. J Dent Sleep Med 2014; 1: 115-9.
37. Chiang JK, Lin YC, Yu HC, et al. Long-term benefits of a new oral appliance on adult snoring: a trend analysis. Multidiscip Respir Med 2022; 17: 824.
| Files | ||
| Issue | Vol 8 No 3-4 (2023): Summer-Autumn | |
| Section | Review Article(s) | |
| Keywords | ||
| Mandibular advancement devices; Obstructive sleep apnea; Snoring; Continuous positive airway pressure; Dentistry | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Jahangiri M, Shayegh SS. A Comprehensive Classification of Snoring Appliances: A Systematic Review. J Sleep Sci. 2026;8(3-4):90-99.
