Comparing the Effectiveness of Custom and Prefabricated Mandibular Advancement Appliances for Obstructive Sleep Apnea

Objectives: A meta-analysis and systematic review were performed to assess the effectiveness of custom and prefabricated mandibular advancement appliances for obstructive sleep apnea.
Methods: An electronic search of five databases (Google Scholar, PubMed, Scopus, Web of Science and Cochrane Library) without applying language restrictions was conducted. Randomized controlled trials (RCTs) published between years 2006-2021 were included in the search. Descriptive cross-sectional studies, case-series, case reports, conference abstracts and opinion-based articles were excluded. The references of the included papers were screened. A total of six RCTs were included in the study. A meta-analysis was conducted to determine the effectiveness through factors including patient compliance and preference, daytime sleepiness, treatment response, and apnea-hypoapnea index.
Results: The comparison of custom mandibular advancement appliances with prefabricated mandibular advancement appliances reported a higher rate of compliance (P= 0.05) in favour of the custom appliance. Patients also reported a preference (P = 0.002) for the custom appliance. Furthermore, factors such as daytime sleepiness (P = 0.04), sleep questionnaire scores (P = 0.03), and the apnea-hypoapnea index (P = 0.005) all had a mean significant difference.
Conclusions: There are clear advantages of using custom mandibular advancement appliances. It has been demonstrated to be more effective than prefabricated mandibular advancement appliances in terms of patient compliance and preference, daytime sleepiness, and treatment response.