The 'lifespan' of mandibular repositioning appliances

  • A Correction to this article was published on 25 October 2019


Introduction Mandibular replacement appliances (MRAs) can be used in the treatment of snoring, mild to moderate obstructive sleep apnoea and as a second-line treatment where continuous positive airway pressure (CPAP) fails. There is currently a paucity of evidence as to how long these appliances last.

Aims Assess the replacement rate for MRAs using this as a proxy for lifespan; estimate the period prevalence of temporomandibular joint disorder (TMJD) and bruxism in the study population.

Methods Prospective observational study as part of service evaluation. Data from consecutive patients seeking a replacement MRA were collected over a three-month period, yielding a sample of 60. The mean time between the provision of appliances was calculated in months. Reasons for replacement were sought, collated and categorised. Patients were asked to report any TMJD symptoms and bruxing.

Results The mean replacement rate was 36.7 months. The main reasons for replacement were: device condition; fit and reduced effectiveness; and other minor reasons reported. Period prevalence of TMJD was 6.7%; bruxism was reported in 5% of patients.

Conclusions A 'lifespan' of ust over three years for thermoplastic MRAs is estimated. The main reasons for replacement were: condition, poor fit and reduced effectiveness. MRAs do not appear to increase the frequency of TMJD and bruxism.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2


  1. 1.

    Punjabi N M. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008; 5: 136-143.

  2. 2.

    Scottish Intercollegiate Guidelines Network. Management of obstructive sleep apnoea/hypopnoea syndrome in adults. 2015.

  3. 3.

    Robinson G, Stradling J, Davies R. Sleep 6: obstructive sleep apnoea/hypopnoea syndrome and hypertension. Thorax 2004; 59: 1089-1094.

  4. 4.

    Marin J M, Carrizo S J, Vicente E, Agusti A G. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-1053.

  5. 5.

    Lim J, Lasserson T J, Fleetham J, Wright J. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 2006; CD004435. DOI: 10.1002/14651858.CD004435.pub3.

  6. 6.

    National Institute for Health and Care Excellence. Obstructive sleep apnoea syndrome: Scenario: management of sleep apnoea. 2015. Available at!scenario (accessed August 2019).

  7. 7.

    British Snoring & Sleep Apnoea Asssociation. Somnowell. Available at (accessed August 2019).

  8. 8.

    NHS. Conditions: Snoring. 2017. Available at (accessed August 2019).

  9. 9.

    NHS. Conditions: Sleep Apnoea. 2019. Available at (accessed August 2019).

  10. 10.

    Durham J. Oral surgery: part 3. Temporomandibular disorders. Br Dent J 2013; 215: 331-337.

  11. 11.

    Ferguson K A, Cartwright R, Rogers R, Schmidt-Nowara W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 2006; 29: 244-262.

  12. 12.

    Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 2007; 11: 1-22.

  13. 13.

    Balasubramaniam R, Klasser G D, Cistulli P A, Lavigne G J. The link between sleep bruxism, sleep disordered breathing and temporomandibular disorders: an evidence-based review. J Dent Sleep Med 2014; 1: 27-37.

  14. 14.

    Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain 2013; 27: 99-110.

  15. 15.

    de Almeida F R, Lowe A A, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis. Am J Orthod Dentofacial Orthop 2006; 129: 205-213.

  16. 16.

    Quinnell T G, Bennett M, Jordan J et al. A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO). Thorax 2014; 69: 938-945.

  17. 17.

    Bloch K E, Iseli A, Zhang J N et al. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med 2000; 162: 246-251.

  18. 18.

    Basyuni, S, Barabas, M, Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. J Thorac Dis 2018; 10 (Spec Iss): S48-S56.

  19. 19.

    Perez C V, de Leeuw R, Okeson J P et al. The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 2013; 17: 323-332.

  20. 20.

    Sanders A E, Essick G K, Fillingim R et al. Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort. J Dent Res 2013; 92 (Spec Iss): S70-S77.

Download references


The authors gratefully acknowledge James Harrison (Lead Technician) and Lesley Spears (Clinical Photographer) for their assistance with the appliance images.

Author information



Corresponding author

Correspondence to John A. Ho-A-Yun.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ho-A-Yun, J., Sharma, P. The 'lifespan' of mandibular repositioning appliances. Br Dent J 227, 470–473 (2019).

Download citation