Investigation of Oral Appliances (OA) Using Modeling in ArtiSynth

Investigators

Dr. John Fleetham, Dept. of Respiratory Medicine
Dr. Fernanda Almeidas, School of Dentistry
Dr. Sidney Fels, Department of Electrical and Computer Engineering
Dr. Rafeef Abugharbieh, Department of Electrical and Computer Engineering
Ian Stavness, Ph.D. candidate, Department of Electrical and Computer Engineering

Objectives.

1. To validate the ArtiSynth model as an accurate representation of the upper airway of patients with OSAH.
2. To utilize ArtiSynth to predict the mechanism of action of OA treatment and help identify which patients with OSAH are more likely to have a good response with OA treatment.

This project is funded by the Vancouver Coastal Health Research Institute (VCHRI). The UBC MR Imaging Centre and the School of Dentistry have contributed scanning time to this project.

Approach

Ten patients with OSAH to be treated with an OA will undergo an upper airway MRI which will include the anatomy from the top of the nasopharynx to the vocal cords. The data obtained from the upper airway MRI will then be put into the ArtiSynth model to develop a 3-dimensional simulation of their upper airway. The patients will then be treated with a mandibular advancement OA and the degree of mandibular advancement progressively increased until complete resolution of the OSAH or development of side effects. The patients will then undergo repeat overnight polysomnography and a repeat upper airway MRI with a plastic version of the OA which duplicates the degree of mandibular advancement. The baseline ArtiSynth model will then be adapted to take into account the degree of mandibular advancement, and the validity of this model will then be checked against the anatomical changes determined by the upper airway MRI performed with the OA in place.

Hypotheses

1. Upper airway computer simulation using ArtiSynth provides an accurate representation of the upper airway of patients with OSAH and will increase our understanding of the pathogenesis of OSAH.
2. Oral appliances relieve OSAH by increasing upper airway size.
3. Upper airway computer simulation using ArtiSynth will help determine which patients and what degree of mandibular advancement is necessary for OA to be effective in the treatment of OSAH.

Acknowledgements

We gratefully acknowledge the generous contributions from Dr. Alex Mackay, Dr. Alan Lowe and the staff at the UBC MRI Research Centre for their assistance.