The Experts below are selected from a list of 7938 Experts worldwide ranked by ideXlab platform
Peter A Cistulli - One of the best experts on this subject based on the ideXlab platform.
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a randomized controlled study of a mandibular advancement splint for obstructive sleep apnea
American Journal of Respiratory and Critical Care Medicine, 2001Co-Authors: Atul Mehta, Jin Qian, Peter Petocz, Ali M Darendeliler, Peter A CistulliAbstract:Although there is increasing interest in the use of oral Appliances to treat obstructive sleep apnea (OSA), the evidence base for this is weak. Furthermore, the precise mechanisms of action are uncertain. We aimed to systematically investigate the efficacy of a novel mandibular advancement splint (MAS) in patients with OSA. The sample consisted of 28 patients with proven OSA. A randomized, controlled three-period (ABB/BAA) crossover study Design was used. After an acclimatization period, patients underwent three polysomnographs with either a control oral plate, which did not advance the mandible (A), or MAS (B), 1 wk apart, in either the ABB or BAA sequence. Complete response (CR) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index (AHI) to , 5/h, and partial response (PR) as a > 50% reduction in AHI, but remaining > 5/h. Twenty-four patients (19 men, 5 women) completed the protocol. Subjective improvements with the MAS were reported by the majority of patients (96%). There were significant improvements in AHI (30 6 2/h versus 14 6 2/h, p , 0.0001), MinSa O 2 (87 6 1% versus 91 6 1%, p , 0.0001), and arousal index (41 6 2/h versus 27 6 2/h, p , 0.0001) with MAS, compared with the control. The control plate had no significant effect on AHI and MinSa O 2 . CR (n 5 9) or PR (n 5 6) was achieved in 62.5% of patients. The MAS is an effective treatment in some patients with OSA, including those patients with moderate or severe OSA. Obstructive sleep apnea (OSA) is a very common disorder, affecting approximately 4% of men and 2% of women in the middle-aged workforce (1). It is characterized by repetitive, complete or partial closure of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation (2). Continuous positive airway pressure (CPAP) applied to the upper airway via a nose mask during sleep, first reported in 1981 (3), remains the accepted treatment of choice. Although it is an extremely effective treatment, its cumbersome nature makes tolerance and compliance less than optimal (4‐6). During the last decade, a number of studies have reported successful treatment of OSA by various oral Appliances. Although they are thought to primarily act by advancing the mandible during sleep (7), other potential mechanisms such as stimulation of neuromuscular reflex pathways in the oral cavity and alteration of the bite relationship have not been explored to any great extent. They have potential advantages over nasal CPAP, in that they are far less obtrusive, more portable, make no noise, and are generally less costly. However, a number of methodologic deficiencies in previous studies of these Appliances, including small sample sizes, weak study Designs, and liberal definitions of treatment success, leave considerable doubt as to the role of these Appliances in the routine management of OSA (7, 8). Furthermore, questions relating to Appliance Design and prediction of treatment outcome remain unresolved. Hence, the primary aim of this study was to assess the efficacy of a newly Designed oral Appliance for OSA in a controlled fashion. In addition, we aimed to examine the potential of anthropomorphic, polysomnographic, and radiographic parameters to predict treatment outcome. METHODS Study Population Twenty-eight adult patients (22 men and six women) were recruited from a multidisciplinary Sleep Disorders Clinic in a university teaching hospital. Inclusion criteria were the presence of at least two symptoms of OSA (snoring, fragmented sleep, witnessed apneas, daytime sleepiness), and evidence of OSA on polysomnography, with an apnea/hypopnea Index (AHI) > 10/h. Patients were excluded if there was evidence of periodontal disease, edentulism, an exaggerated gag reflex, or regular use of sedatives. The study was approved by the institutional ethics committee, and written informed consent was obtained from all patients. Oral Appliance Each mandibular advancement splint (MAS) was custom-made from dental impressions. A wax interocclusal record was taken with the mandible in the most protrusive position that the patient could comfortably maintain. The Design features of the MAS (Figures 1 and 2) included the following: ( 1 ) Upper and lower removable clear acrylic plates with full occlusal coverage that fitted onto both dental arches. The average thickness of each upper and lower Appliance was between 1.5 and 2.0 mm. ( 2 ) Two acrylic flanges, one on either side of the palatal aspect of the molars of the upper plate. These flanges fitted into slots cut into the acrylic on the lingual sides of the lower plate in the molar region. This unique coupling mechanism prevents posterior movement of the mandible, while permitting free opening of the mouth. ( 3 ) Two 10-mm screws to enable incremental anterior advancement of the lower plate. In an attempt to control for some other potential effects of the MAS on upper airway function and, hence, apneic activity, such as stimulation of neuromuscular reflex pathways in the oral cavity and alteration of the bite relationship, we used the lower dental plate alone as a control. This had no protrusive effect on the mandible. Study Design
Steve Gill - One of the best experts on this subject based on the ideXlab platform.
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Designing a Design tool working with industry to create an information Appliance Design methodology
J. of Design Research, 2008Co-Authors: Steve Gill, Gareth Loudon, Darren WalkerAbstract:This paper details collaboration between the Programme for Advanced Interactive Prototype Research (PAIPR) based at the National Centre for Product Design and Development Research (PDR) and three key collaborators: Sony Ericsson, Samsung and Alloy Total Product Design (a UK top-five Design consultancy). These partners have been involved in trialling a Design method centred on a deliberately 'low-tech' hardware product called an IE Unit developed to tackle the problems that Designers face when Designing information Appliances without having the skills to produce working three-dimensional prototypes. The paper uses the IE System's deployment as a vehicle to draw out lessons that will be of use to a range of research groups tackling similar and overlapping issues.
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developing information Appliance Design tools for Designers
Ubiquitous Computing, 2003Co-Authors: Steve GillAbstract:As more products become computer-embedded, Designers need to consider both the hardware and interface. Traditional Design processes and Design tools focus on hardware aspects, and so new methods and techniques must be investigated and developed. The aim of this study is to investigate new Design models for Designing computer-embedded products. In particular, it focuses on ways by which Designers can be assisted in problem identification, exploration and evaluation of Design solutions by using a rapid interface prototyping technique. The technique is based on a widely used general presentation software application. It can be used to develop fully functional prototypes of computer embedded products without electronic engineering skills.
S K Derwent - One of the best experts on this subject based on the ideXlab platform.
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mandibular incisal edge demineralization and caries associated with twin block Appliance Design
Journal of Orthodontics, 2005Co-Authors: M Dixon, Y Jones, I E Mackie, S K DerwentAbstract:Demineralization and caries are well documented and unwanted complications of orthodontic therapy. These are most commonly reported in relation to fixed Appliance therapy. Five cases are presented of patients undergoing Twin Block Appliance therapy with the Appliances incorporating lower labial segment capping, illustrating a pattern of demineralization and caries of the incisal tips of the mandibular labial segment, influenced by the incisal capping and the frequent intake of carbonated soft drinks.
Barry H Grayson - One of the best experts on this subject based on the ideXlab platform.
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2012 american board of pediatric dentistry college of diplomates annual meeting the role of pediatric dentists in the presurgical treatment of infants with cleft lip cleft palate utilizing nasoalveolar molding
Pediatric Dentistry, 2012Co-Authors: Mohammad M Ahmed, Lawrence E Brecht, Court B Cutting, Barry H GraysonAbstract:The pediatric dentist plays a crucial role in the treatment and management of infants born with cleft deformities of the lip, alveolus, and palate. At New York University Langone Medical Center in New York City, 70% of infants with cleft lip/cleft palate (CLCP) are detected on prenatal ultrasound analysis. Thus, the role of the pediatric dentist can start as early as prenatal counseling. Nasoalveolar molding (NAM) is delivered during the first 3 to 5 months of life. During this stage of treatment, the pediatric dentist establishes the foundation of the “cleft dental” home and initiates the first stage of anticipatory guidance. Consequently, parents are educated and motivated to initiate oral hygiene care upon eruption of the first primary teeth. The purpose of this paper was to describe the role of the pediatric dentist in performing nasoalveolar molding and also describe its indications, Appliance Design, fabrication, biomechanics, complications, and patient management.
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presurgical nasoalveolar moulding treatment in cleft lip and palate patients
Indian Journal of Plastic Surgery, 2009Co-Authors: Barry H Grayson, Pradip R ShetyeAbstract:Presurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with bilateral cleft. The nasolaveolar molding (NAM) technique a new approach to presurgical infant orthopedics developed by Grayson reduces the severity of the initial cleft alveolar and nasal deformity. This enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This paper will discuss the Appliance Design, clinical management and biomechanical principles of nasolaveolar molding therapy. Long term studies on NAM therapy indicate better lip and nasal form, reduced oronasal fistula and labial deformities, 60 % reduction in the need for secondary alveolar bone grafting. No effect on growth of midface in sagittal and vertical plane has been recorded up to the age of 18 yrs. With proper training and clinical skills NAM has demonstrated tremendous benefit to the cleft patients as well as to the surgeon performing the repair.
Urban Hagg - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of the efficacy of oral Appliance Design in the management of obstructive sleep apnoea
European Journal of Orthodontics, 2011Co-Authors: Anika Ahrens, Colman Mcgrath, Urban HaggAbstract:Oral Appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different Design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control Appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive Appliances (six studies) or other types of MADs with different Design features. Compared with inactive Appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial Design feature of OA therapy for OSA. The evidence shows that there is no one MAD Design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD Designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which Design of OAs may be the most effective in the treatment of OSA.
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subjective efficacy of oral Appliance Design features in the management of obstructive sleep apnea a systematic review
American Journal of Orthodontics and Dentofacial Orthopedics, 2010Co-Authors: Anika Ahrens, Colman Mcgrath, Urban HaggAbstract:Introduction The purpose of this study was to review available evidence on the efficacy of various oral Appliances on subjectively perceived symptoms of obstructive sleep apnea syndrome. Methods A search of 4 databases was carried out. Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The finally selected articles were methodologically evaluated. Results Of an initial 1475 references, 14 studies were randomized controlled trials, which formed the basis of this review. Mandibular advancement devices (MADs) were compared with either inactive Appliances (6 studies) or MADs with different Design features (8 studies). In comparison with inactive Appliances, the majority of studies showed improved subjective outcomes with MADs, suggesting that mandibular advancement is a crucial Design feature of oral Appliance therapy for obstructive sleep apnea syndrome. Conclusions There is no 1 MAD Design that most effectively influences subjectively perceived treatment efficacy, but efficacy depends on many factors including materials and method used for fabrication, type of MAD (monoblock or Twin-block), and the degree of protrusion (sagittal and vertical). This review highlights the absence of universally agreed subjective assessment tools and health-related quality of life outcomes in the literature today. Future trials of MAD Designs need to assess subjective efficacy with agreed standardized tools and health-related quality of life measures to guide clinical practicitioners about which Design might be most effective in the treatment of obstructive sleep apnea syndrome with oral Appliances.