Effect of a Titrable Mandibular Advancement Appliance on Sleep Bruxism

Objectives: Assess the efficacy and safety of a reinforced titratable mandibular advancement appliance (MAA) on sleep bruxism (SB) activity in comparison to a mandibular occlusal splint (MOS), in order to offer an alternative to patients presenting concomitant SB and respiratory disorders during sleep.

Methods: Twelve subjects (mean age ± SEM: 26.0±1.5) with frequent SB participated in a short term (3 blocs of 2 weeks each) randomized crossover controlled study. Subjects were recorded in the sleep laboratory for 5 nights. After habituation and baseline nights, 3 more nights were spent with a MAA (Silencer Professional) either in a slightly (25%) or pronounced (75%) mandibular advancement positions, or with the control condition, the MOS. Patient self reports of pain intensity and oral appliance comfort were evaluated on 100 mm visual analogue scale (VAS). Appliance preference was also noted. Repeated measures ANOVA, Friedman and Wilcoxon signed rank tests were used for statistics.

Results: The mean number of SB episodes/hr was reduced by 39% and 47% from baseline values with the MAA at a protrusion of 25% and 75% respectively (p<0.04). No difference between the 2 MAA positions was noted. The MOS slightly reduced the number of SB episodes/hr without reaching statistical significance (34%, p=0.07). None of the SB subjects experienced any MAA breakage. With both types of oral appliance, transient tooth sensitivity to bite pressure was reported in the morning by half of the participants. All SB subjects preferred the MOS over the MAA and one subject was unable to tolerate the MAA at the 75% protrusion.

Conclusions: Short term use of MAA is associated with a significant reduction of SB motor activity without any appliance breakage in SB patients. Reinforced MAA design may be an alternative to patients with concomitant tooth grinding and snoring or apnea during sleep.