If you’ve got sleep apnea, CPAP can be a literal life-saver.
Even so, many people hate it. They can’t tolerate the mask. They hate the inconvenience of always needing access to a power supply to sleep or having to tote the device with them any time they travel.
These are all non-issues with oral appliance therapy, which studies have shown can be at least as effective as CPAP. This is reason enough for folks to reach out to offices like ours. Some seek an alternative to their current treatment. Others look to appliance therapy as a first line treatment, even in severe cases of apnea.
But CPAP has other downsides that are often overlooked, such as the possibility of the constant airflow gradually creating gaps between teeth that were never there before. Now, a new case report in the Journal of Prosthodontics suggests another potential pitfall to be aware of: dental implant failure.
The patient was a 71-year old man who wanted to have his lower teeth restored. He ultimately had four implants surgically placed to support a full denture, which was placed immediately.
A day after his post-op visit, the patient reported no pain and little swelling. Ten days later, however, he reported increasing discomfort and minor swelling. An exam showed lots of exposed bone in the front of his jaw, even though the implants and denture were stable. The bone was cleaned, and a layer of necrotic (dead or dying) bone was removed. Some additional bone was removed to improve closure of the surgical sites.
Yet when the patient returned a month later to have his sutures removed, the flaps had opened again, exposing bone.
Once again, the bone was cleaned and necrotic tissue, removed. The surgeon also removed some bone at the flaps’ margins to improve the primary closure. The patient was told to return in four weeks for evaluation and removal of the sutures.
When he did, it appeared as though the flaps had reopened once more, exposing a considerable amount of bone. The denture came out easily, and the implants did, as well, with bits of bone attached to them. Once more, he surgeon removed the dead tissues from the jaw, and the site was irrigated and sutured.
It was only at this point that the patient told his dental team that he used CPAP diligently each night.
With the consent of the patient’s sleep doctor, the dentist told the patient to stop using the machine for three weeks. Instead, he was to control his apnea by sleeping with his head elevated.
During that time, the soft tissues healed, his bone was re-evaluated, and a new implant plan was designed for him. Ultimately, he was pleased with the results, while the saga as a whole, taught an important lesson, according to the case study authors:
This patient treatment has demonstrated that sleep apnea and subsequent CPAP machine usage as a new landmarked risk factor demonstrated in this patient contribut[ed] to primary implant failure.
There are a couple lessons here for patients, starting with being sure to let your dentist know if you use CPAP, especially if you’re considering getting dental implants but really with any type of dental surgery or treatment. Your medical history matters just as much as your dental history.
The other lesson is that CPAP is not a risk-free treatment. (No treatment is, really, in dentistry or medicine.) Even oral appliance therapy has its risks, although these can be greatly reduced by a skilled clinician – another thing that makes it an excellent alternative to CPAP.