Abstract
Patients：A 65-year-old female. The patient’s main complaints were improvement of the existing prosthesis and full mouth treatment. During a medical
interview, the patient reported that she was undergoing treatment for reflux esophagitis and that she snored during sleep. A questionnaire survey and
sleep evaluation device revealed that the patient had mild obstructive sleep apnea. Intraoral examination revealed that all existing prostheses were
inadequate, and there was dentin exposure due to acid erosion, gingival recession and loss of cervical dentition around the entire circumference of the
tooth. The upper and lower dental arches were stenotic, narrowing the lingual tufts. To reduce airway obstruction by the tongue, we proposed full
orthodontic treatment to enlarge the dentition, but the patient did not give consent. So we performed a prosthetic mouth rehabilitation. The crowns of
the upper and lower molars were tilted buccally from the original tooth axis in the form of a prosthetic appliance, and the dentition was enlarged.
Comparison of lateral cephalometric radiographs taken before and after the prosthetic treatment showed that the anteroposterior diameter of the air-
way was enlarged. Sleep evaluation device examination revealed moderate obstructive sleep apnea. An oral appliance with a mandibular forward
movement of 6 mm was fabricated, and a re-evaluation after the patient started using the appliance showed improvement of obstructive sleep apnea
symptoms. After completion of treatment, the patient continues to be monitored for occlusion and sleep status.
Discussion：The anterior-posterior diameter of the upper airway was enlarged by correction of the mandibular position, which resulted in an anterior
traction of the hyoid bone by the suprahyoid muscles attached to the mandible, and the construction of a dentition that did not obstruct the lingual
tuft. Oral appliance is a symptomatic treatment with the risk of occlusal changes. The effectiveness of the treatment is affected by a combination of fac-
tors, including weight fluctuations and hormonal effects on the activity of the upper airway opening striae. Unlike conventional prosthetic treatment,
more careful follow-up is important because many items are subject to postoperative reevaluation.
Conclusion：Pre- and posttreatment comparisons confirmed that the prosthetic device enlarged the dentition and the anterior-posterior diameter of
the upper airway, but mouth rehabilitation alone did not solve all the problems. The fabricated oral appliance improved obstructive sleep apnea, but
careful follow-up is necessary to avoid occlusal changes.
