The Use of Finite Element Analysis to Study Stress Distribution on Temporo-Mandibular Joints and Teeth Using Mandibular Advancement Devices for Obstructive Sleep Apnea Treatment

Obstructive sleep apnea syndrome (OSA) is a frequent pathological condition. The patient is characterized by an upper airway obstruction during sleep that can be total of partial. The gold standard of disease treatment is CPAP (Continuous Positive Airway Pressure). A therapeutic alternative is represented by Mandibular Advancement Devices (MADs). The MAD aims to generate a mandibular protrusion that induces a tensioning of the soft tissues in the retro-palatal and retro-lingual area. However, this kind of treatment present long-term side events that may affect the dentition and temporo-mandibular joints (TMJ). The application of forces on the dento-alveoloar structures and TMJ present a compressing/stretching modality that activate bone remodeling. Application of a compressive force induces absorption of alveolar bone. On the other side, tensile stress determines the formation of new alveolar bone. Finite Element Method (FEM) is an innovative and non-invasive method to evaluate the biomechanical effects of an oral appliance. The treatment results depend on several factors such as thickness, material construction property, degree of retention, dental coverage and mandibular advancement, individual mandibular motion, and titration type. FEM provides useful information that doctors and dentist can use for treating patients suffering from OSA. The main goal is to increase treatment efficacy, efficiency, patient compliance and reducing the side effects of this life-long treatment. Designing and fabricating optimized and customized MADs is a crucial aspect for this goal.