Effect of an Adjustable Mandibular Advancement Appliance on Sleep Bruxism: A Crossover Sleep Laboratory Study

Purpose: The objective of this experimental study was to assess the efficacy and safety of a reinforced adjustable mandibular advancement appliance (MAA) on sleep bruxism (SB) activity compared to baseline and to a mandibular occlusal splint (MOS) in order to offer an alternative to patients with both tooth grinding and respiratory disorders during sleep. Materials and Methods: Twelve subjects (mean age: 26.0 +/- 1.5 years) with frequent SB participated in a short-term (three blocks of 2 weeks each) randomized crossover controlled study. Both brain and muscle activities were quantified based on polygraphic and audio/video recordings made over 5 nights in a sleep laboratory, After habituation and baseline nights, 3 more nights were spent with an MAA in either a slight (25%) or pronounced (75%) mandibular protrusion position or with an MOS (control). Analysis of variance and Friedman and Wilcoxon signed-rank tests were used for statistical analysis. Results: The mean number of SB episodes per hour was reduced by 39% and 47% from baseline with the MAA at a protrusion of 25% and 75%, respectively (P < .04). No difference between the two MAA positions was noted. The MOS slightly reduced the number of SB episodes per hour without reaching statistical significance (34%, P = .07). None of the SB subjects experienced any MAA breakage. Conclusion: Short-term use of an MAA is associated with a significant reduction in SB motor activity without any appliance breakage. A reinforced MAA design may be an alternative for patients with concomitant tooth grinding and snoring or apnea during sleep. Int J Prosthodont 2009;22:251-259.