Evolution of intraoral prosthesis
The use of oral prostheses for snoring and sleep apnea is not a new therapy and the use of intraoral appliances in the treatment of obstructive sleep disorders is very ancient. Pierre Robin described it in 1902 using a functional appliance "the monobloc", that moves the jaw forward preventing the tongue to fall backwards (glossoptosis) in patients with severe mandibular hypoplasia. Robin Earlys designs were applied in cases of mandibular micrognathia or mandibular hypoplasia in children.
In the 80's we generalize the use of these devices as an alternative to the monopoly of the CPAP and offering patients a new therapeutic side to subtract the inconvenience from one side of the irreversible and invasive surgery and the mechanisms of positive pressure ventilation ( CPAP), which is annoying and has low levels of acceptance. Since the advent of oral appliances in treatment for snoring and apnea, it has been designed many devices currently on the market. The apparatus includes intraoral mandibular advancement prosthesis, positioners of the tongue, uplift of the soft palate and uvula repositioning and oral positive pressure devices. The clinical trials of available oral appliances, show that the mechanisms of mandibular advancement (fixed and adjustable forward moving) are those, with a higher level of efficiency. Now there have been described more than three hundred devices aimed at solving the problem of snoring and sleep apnea. The American Association of Sleep Disorders defines intraoral devices such as those designed to change the mandibular propulsion of the UA by altering the position of the tongue and other secondary structures.
In a submission to SEPAR 1993, referred to alternatives to CPAP in these terms:
Clinical investigations in recent years detract value from this approach, that would describe our current experience as obsolute and not very successful, since it does not reflect the reality of patients with apnea. Clinical experience places the mandibular advancement prosthesis as the option of easy treatment, which causes the patient less pain and better levels of adaptation and acceptance by users, who get a less cumbersome, than the bulky masks. Continuous positive airway pressure (CPAP) has been for decades the treatment of choice, but its disadvantages, rejection and intolerance in patients hinder the optimal compliance with therapy and treatment has lost its hegemony over other available alternatives. This has led to the need to work on other solutions, which are equally effective, but more tolerable. Spearheading this new line therapy highlights there is a growing interest in the use of oral prostheses and more specifically mandibular advancement devices, which have in the apparatus Orthoapnea its fullest expression and novelty. These systems have suffered a great technological development in recent years and now it is constituted as one of the treatments of choice for people with snoring and sleep apnea.