Originally Posted by
gibsones300
Any mandibular repositioning device is going to move your mandibular condyles anteriorly. That's precisely how they work. But, more importantly, your comment suggests that moving your mandibular condyles anteriorly is a bad thing. I have seen no evidence that there are any long-term negative effects from this. There is a temporary influx of fluid in the temporomandibular joint space that causes a sense of bite change in the morning. But this will go away fairly quickly and tends to dissipate with long-term use.
Now, my problem with the Narval and similar appliances is that there are what we call two "points of contact" between the maxilla and mandible. We have two bands on either side of the appliance. One pulls the left side forward and one pulls the right side forward. This can be a problem for your TMJ because unequal amounts of tension between the sides can provoke some serious TMD symptoms.
I think a better appliance is the DreamTAP. It has one point of contact, allows for quite a range of lateral motion, and can be very precisely titrated. There is a reason why the DreamTAP is one of the few dental sleep appliances that is medicare approved.
I agree with the overall sentiment of your post though. As you said, we really shouldn't disregard the effectiveness of dental sleep appliances at treating OSA.