ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Remotely Controlled Mandibular Positioner (RCMP) Device Predicts Treatment Outcome and Effective Target Protrusive Position (ETPP) for Obstructive Sleep Apnea (OSA) Treatment with an Oral Appliance
Clinical Question Do remotely controlled mandibular advancement (RCMA) devices predict effective target protrusive position (ETPP) for oral appliances (OA) used to treat obstructive sleep apnea (OSA)?
Clinical Bottom Line RCMP devices, such as the MATRx, can be a useful predictor in dental practice for prescribing the appropriate amount of mandibular advancement necessary for treatment of OSA with an OA. The device reduces chair time needed to titrate devices to a therapeutic effect and may require less protrusion than is currently advocated (60% - 70% of protrusive range).
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24082311Remmers/2013N=67, 21-80 years, AHI >10/h, BMI <40 kg/m2Prospective/Blinded
Key resultsThe study demonstrated standard predictive measures at the final protrusion position accurately in 83% - 94% of the 61 patients (P < 0.05). Six patients did not have adequate PSG data to be included. The study then demonstrated in the predicted success group that ETPP position was accurate in 87% of 27 subjects with mandibular repositioning appliance (MRA) therapy (P <0.05). Protrusion necessary for therapeutic outcomes ranged from 0.5-10 mm from the patient’s “habitual bite."
#2) 26773412Okuno/201517 articles predicting OA treatment outcomesSystematic review of non-randomized trials
Key resultsThe study reviewed various methods for predicting treatment outcomes of OSA treated with an OA. RCMP was found to have high predictive accuracy based on results from sensitivity, specificity, positive predictive value, and negative predictive value. However, RCMP data was considered to have high risk of bias due to a reference standard of a level III monitor versus a PSG. It was also deemed “complex, costly, and laborious”.
#3) 27568892Kastoer/2016 N=254 OSA, from 4 full articles and 5 conference abstractsSystematic review of non-randomized trials
Key resultsWhile the studies selected had differences in population based on baseline apnea-hypopnea indexes (AHI), the therapeutic success achieved with mandibular protrusion devices was predicted by ETPP generated by RCMP titration during sleep. “A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OA on polysomnographic or portable sleep monitoring evaluation (p<0.05).” This study determined that RCMP was a useful tool for determining mandibular advancement needed for treatment of OSA by a mandibular advancement appliance.
Evidence Search Remotely[All Fields] AND controlled[All Fields] AND ("mandible"[MeSH Terms] OR "mandible"[All Fields] OR "mandibular"[All Fields]) AND positioner[All Fields]
Comments on
The Evidence
Validity: The RCMP device had high accuracy for predicting not only if an OA would be successful in treating OSA, but also predicting a target protrusive value with which to fabricate a mandibular advancement appliance. There is currently no Gold Standard testing device available on which to base the amount of mandibular protrusion necessary to achieve therapeutic effects. The current recommendation is a starting value of 70% of the patient’s maximum protrusion followed by titration to effect based on feedback from the patient regarding comfort and sleep quality, and should be followed with a PSG. Perspective: Use of RCMP, or MATRx, provides coordination between the patients sleep team by using measurable data from the effects of mandibular protrusion during a sleep study to assist the dentist to achieve a therapeutic device in less time. It is advantageous to the patient that fewer appointments may be required at the dental office. The goal of the device is to streamline workflow for sleep labs and dental professionals and expedite care. It is noteworthy that the inventor of the MATRx, Dr. John Remmers, was among the first researchers to discuss the pathology of sleep apnea. He is a co-founder and shareholder of Zephyr Sleep Technologies, which manufactures the MATRx.
Applicability The device is applicable for use in sleep labs. Dental professionals treating OSA patients would need to establish a referral network with physicians and sleep labs utilizing the MATRx device in order to receive an ETPP.
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Mandibular protrusion, OSA
ID# 3106
Date of submission: 11/09/2016spacer
E-mail Jessamyjae@gmail.com
Author Jessamy Thornton, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ronald Verrett, DDS, MS
Faculty mentor/Co-author e-mail Verrett@uthscsa.edu
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