Dr. Paul Reaney is a dentist with a special interest in orthodontics who has successfully integrated a Dental Sleep Medicine clinic (Snoring SolutionsNI) into his general practice. He obtained accreditation through examination from the European Academy of Dental Sleep Medicine and currently serves as a committee member of the Irish Society of Dental Sleep Medicine. His innovative use of digital technologies in this field has been recognized with multiple prestigious awards between 2019 and 2020.

CAM/CAM technology typically offers practitioners a range of MAD design choices, presented as a menu of customization options. Panthera Dental also offers a BioMatch^TM optimization service where the CAD designers use AI-powered software to select customizations for optimal retention, usability, tolerability and side effect protection for an individual patient.

In challenging cases, practitioners can provide scans and case information and work with the lab to find completely bespoke design solutions. Dr Reaney presents a case series illustrating his decision-making process for appliance design and shows the outcomes of collaborations with the lab to create unique, co-designed solutions for atypical cases.

Dentist expert Miche De Meyer graduated in 1982 with a degree in dentistry from Ghent University and has since continued his training at home and abroad. Mainly in the medically oriented aspects of dentistry such as obstructive sleep apnea syndrome (OSAS) and temporomandibular dysfunctions (TMD), pain and movement disorders.

She worked for 23 years in the Dentistry department at Ghent University Hospital and (before that) also in the MKA services of several general hospitals. Dr. dent. De Meyer combines specific expertise in disorders within orofacial dysfunctions and pain with extensive experience in an interdisciplinary setting.

She is also active as a scientific collaborator at the University of Nijmegen (the Netherlands), UZ Brussel (lung diseases), VUB (dentistry), UGent (textile engineering) and at the University Medical Center/Center for Dentistry and Oral Care of U Groningen (the Netherlands).

Prof. Maria Clotilde graduated in Dentistry from the University of Parma in 2007 and obtained her PhD in Biomedical Sciences from the University of Montreal in 2012. She subsequently completed a three-year postgraduate program in Periodontology and Implant Dentistry at Paris Diderot University in 2015. She began her academic career in France, where she was appointed Assistant Professor in 2014, Associate Professor in 2017, and Full Professor in 2021, and she currently serves as Professor at the University of Ferrara. Her clinical work focuses on periodontology, implant dentistry, and dental sleep medicine, while her research has significantly contributed to understanding the links between periodontal diseases and cardiovascular conditions, as well as prevention and quality of life.

Triin Jagomägi graduated from the University of Tartu in 1993 and completed her orthodontic residency at the University of Kuopio in Finland in 1995. She obtained her doctoral degree from the University of Tartu in 2012. Since 1996, she has worked as an orthodontist at the Tartu Stomatology Polyclinic, and later served as a teaching physician at Tartu University Hospital, where she currently holds the position of senior teaching physician. Since 2000, she has been involved in teaching and research at the University of Tartu, where she has worked as an assistant in pediatric stomatology, a research fellow, and an associate professor, and has been Professor of Orthodontics since January 2025. Her research focuses on the genetic basis of cleft lip and palate, as well as the role of oral function in the development of dental anomalies.

Prof. Cibele Dal Fabbro is a dentist who earned a Master’s degree in Prosthodontics from the University of São Paulo (USP), Bauru School of Dentistry, and a PhD in Sleep Medicine from UNIFESP School of Medicine in Brazil. She also holds two specialty qualifications in Orofacial Pain and Acupuncture from the USP School of Medicine. Her scientific work focuses primarily on sleep apnea and sleep bruxism, and she has authored more than 50 scientific papers as well as three books, including the first Dental Sleep Medicine textbook in Portuguese. Since 2012, she has served as the Dental Sleep Medicine Program Coordinator at the Sleep Institute in São Paulo, and she is actively involved in several international professional organizations in leadership and committee roles. Currently, she divides her time between São Paulo and Montreal, where she is an Adjunct Professor at the Université de Montréal and also works as a research assistant in sleep medicine.

Gilles Lavigne is a dentist with specialized training in oral medicine, pain, and sleep medicine. He is internationally recognized for his research on sleep bruxism, sleep apnea, and the interactions between pain and sleep. Throughout his career, he has held several leading academic and administrative positions, including Vice-Dean for Research and Dean of the Faculty of Dental Medicine at the Université de Montréal, as well as President of the Canadian Sleep Society and the Canadian Pain Society. His extensive scientific output includes more than 290 peer-reviewed publications and four edited books, and his work has been honored with numerous prestigious awards, including the Order of Canada. Since June 2024, he has been a professor at the Faculty of Dental Medicine and Oral Health Sciences at McGill University, with an appointment in Neurology and Neurosurgery, while continuing his clinical and research activities.

Dr. Sara Camañes-Gonzalvo is a professor at the Faculty of Medicine and Dentistry, University of Valencia (UV), Spain. She graduated from the University of Valencia (UV), received her Ph.D. degree with an Extraordinary Award and a master’s degree in Orthodontics from the University of Valencia. She is also an expert in dental sleep medicine, certified by FESMES in 2020. In addition, she is a member of the Spanish Society of Dental Sleep Medicine (SEMDES), the Spanish Association of Orthodontists (AESOR and SEDO), and the European Academy of Dental Sleep Medicine (EADSM).

Dr. Patricia Fernández-Sanjuán is dedicated exclusively to private clinical practice in the field of Dental Sleep Medicine, with a focus on the treatment of snoring, sleep apnea, and temporomandibular disorders. She is specialized in the assessment of the upper airway during drug-induced sleep endoscopy (DISE or somnoscopia). She is the inventor of the “Mandibular Advancement Selector (SAM),” a device designed to identify suitable candidates for mandibular advancement devices in the treatment of snoring and sleep apnea. She is also leading an ongoing multicenter research study involving national and international hospitals aimed at optimizing mandibular advancement device therapy, which constitutes the main topic of her doctoral thesis. Her work has been recognized with several awards, including the Zaragoza Medical Association Award and the American Academy of Dental Sleep Medicine Clinical Research Award, and she actively participates in national and international conferences and specialized courses.

Sleep is a mixture of physiological and behavioral processes. Within the categorization of sleep disorders of the ICSD-3, TR (AADSM,2023) , the Sleep related Respiratory disorders are one of the most prevalent. The obstructed sleep related breathing encompasses Primary snoring (AHI < 5) and Obstructive Sleep Apnea (AHI ≥5). The non specified snore-signal is a prelude to a respiratory event during sleep, affecting 4 billion people from a world prevalence perspective. The state of the art will be presented, regarding the characteristics of the acoustics of snoring in function of it’s the medical information on Sleep Related Breathing Disorders e.g. Obstructive Sleep Apnea Syndrome (OSAS). Moreover, a spectrum of possibilities in evidence based therapy will be explored to facilitate a more effective and personalized approach for snoring along norms of 2026.

Smartphones and low-cost sensors, including accelerometers, are able to capture a wealth of data relevant to sleep disorders, including overnight recordings of sleep breathing sounds, measurements of body position during sleep, and image-based measures of facial structure. Could these readily obtainable data be used to predict the effectiveness of oral device therapy and thereby support clinical decision-making? This talk will review current capabilities in this area and present our recent work on acoustic markers of oral device efficacy, while considering how these approaches might be extended to other data streams available from low-cost sensors.

Guy Brown is a Professor of Computer Science at the University of Sheffield, UK. His main research interest is machine hearing, which aims to develop AI systems that interpret sounds in a similar manner to human listeners. His current work applies machine hearing technology to applications

in healthcare, including acoustic screening techniques for sleep disorders. He has published more than 200 papers in journals and conferences and is co-editor of an influential text in the machine hearing field, Computational auditory scene analysis: Principles, algorithms and applications published by Wiley/IEEE Press.

According to international standards a mandibular advancement device (MAD) should be a custom-made, adjustable, bimaxillary retained, double-splint system, which is based on a three-dimensional registration of the so-called starting position. This position is usually to be found with bite gauges that demand certain requirements of both the three dimensions, and technical issues.

A closer look into international publications about the three-dimensional MAD-starting-position reveals a lack of clear standards or practical instructions. As an overall principle in dentistry, accuracy and precision of oral sleep-devices should not only be always maintained, but also continuously improved in order to sufficiently eliminate airway obstructions and reduce side effects.

In this lecture will be demonstrated how a common digital registration system (JMAoptic, Zebris) helps to better understand jaw movements, to easily and precisely find the best possible MAD-starting-position, and finally to guide the dentist safely when adjustment of the device is required. Besides these enormous practical advantages digital registrations of the MAD-starting-positions could also help to implement clear and reproducible standards for scientific studies concerning MAD-therapy.

As a conclusive consequence, it finally will be pointed out how crucial it is, to transfer this precision into design and production of professional devices.

Dr Joseph Ryan is a Specialist in Oral Medicine with extensive experience across both public and private healthcare.

He graduated from the University of Sydney with a Bachelor of Medical Science in 2009, followed by a Bachelor of Dental Science from Charles Sturt University in 2014. During his dental studies, he was the only student in his class to complete a two-year honours research program in facial pain, graduating with First Class Honours in 2016.

Dr Ryan has been recognised for his research and academic excellence, winning the International Association of Dental Research (IADR) Western Region competition in both 2015 and 2016. He went on to complete a Masters of Pain Medicine at the University of Sydney in 2019 and a Doctorate of Clinical Dentistry in Oral Medicine at the University of Melbourne. His doctoral research focused on Photobiomodulation Therapy in the Management and Prevention of Oral Mucositis at the Sydney Adventist Hospital, earning him both the University of Melbourne Postgraduate Research Prize and the Sydney Adventist Hospital Prize for Innovation in Research.

Alongside his clinical practice, Dr Ryan is the Head of Discipline in Oral Medicine and Oral Pathology at Charles Sturt University, where he is actively engaged in teaching and mentoring the next generation of dental professionals.

In private practice, Dr Ryan provides specialist care to patients across Canberra and the surrounding regions, with a strong focus on delivering evidence-based, compassionate treatment.

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder associated with significant cardiovascular morbidity. Mandibular advancement devices (MADs) are recommended as an alternative treatment, particularly in patients with mild to moderate OSA or in those intolerant to continuous positive airway pressure (CPAP).

OBJECTIVE:

To evaluate the effectiveness of the Orthoapnea NOA® mandibular advancement device in the management of obstructive sleep apnea in adult patients.

METHODS:

A prospective observational cohort study was conducted in 2025-26, including adult patients diagnosed with OSA according to American Academy of Sleep Medicine (AASM) criteria and with an indication for treatment using the Orthoapnea NOA® device. Outcomes included apnea–hypopnea index (AHI), cumulative time with oxygen saturation below 90% (CT90), mean oxygen saturation (SpO₂), and Epworth Sleepiness Scale (ESS), assessed before and after treatment.

RESULTS:

A total of 68 patients were included (45 men, 23 women). Post-treatment data were available for 56 patients. At baseline, mean (SD) values were: AHI 21.8 (12.8), CT90 6.44% (12.5), SpO₂ 92.8% (1.72), and ESS 8.14 (4.51). Following treatment, values improved to: AHI 9.50 (5.85), CT90 2.16% (4.11), SpO₂ 93.15% (1.45), and ESS 6.18 (3.94). The mean mandibular advancement required to achieve these outcomes was 65.57%.

CONCLUSION:

The Orthoapnea NOA® mandibular advancement device appears to be an effective treatment option for adult patients with OSA. Clinically meaningful improvements were observed across respiratory and symptomatic outcomes. Therapeutic goals were achieved with a relatively moderate degree of mandibular advancement, which may contribute to reduced adverse effects and improved patient tolerance and adherence.

• Dentist (DDS), Universidad de los Andes
• Master in Temporomandibular Disorders and Orofacial Pain, International University of Catalunya
• Master in Clinical Research Applied to Health Sciences (MSc), Universitat Autònoma de Barcelona
• Assistant Professor, TMD and Orofacial Pain Program, Universidad Andrés Bello
• Academic and Scientific Director, Craniomandibular Institute

Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous disorder affecting nearly one billion people worldwide and is associated with substantial cardiovascular, metabolic, and neurocognitive morbidity. Although adenotonsillectomy is considered first-line treatment for pediatric OSA, up to 40% of children continue to exhibit residual disease, highlighting the limitations of treatment-centred approaches alone. Despite increasing awareness of early risk factors, most patients are still diagnosed late, when preventive opportunities related to growth and development have already been missed.

Dentistry and orthodontics occupy a unique position in the multidisciplinary management of OSA, as dentists encounter patients early, repeatedly, and during critical developmental periods. However, current dental and orthodontic care remains predominantly treatment-centred rather than prevention-centred. Preventive strategies are difficult to implement and sustain due to delayed and less visible outcomes, high demands on patient adherence, poorly structured long-term care pathways, and limited management frameworks. Furthermore, evidence for preventive interventions remains fragmented, heterogeneous, and challenging to translate into routine clinical practice.

This lecture explores OSA through a phenotype-based framework, focusing on oral and craniofacial contributors that are particularly relevant to dentistry, including tongue-related phenotypes, adenotonsillar obstruction, dysfunctional swallowing patterns, maxillary constriction, and craniofacial growth anomalies. Evidence from population-based studies demonstrates that orofacial myofunctional anomalies—such as restricted tongue mobility, reduced lip and tongue strength, altered oral posture, and abnormal breathing patterns—are already present in children with sleep-disordered breathing symptoms in the general population. These findings support the concept that airway vulnerability often develops early, long before formal OSA diagnosis.

Finally, the lecture addresses a major systemic barrier to prevention: the persistent separation of medical and dental education. Sleep medicine, airway physiology, oral function, and craniofacial development are still taught in parallel rather than in an integrated manner. As a result, interdisciplinary care is expected in clinical practice but not adequately supported during training. Building truly preventive and interdisciplinary approaches to OSA will require substantial effort within and between curricula, as well as political will and financial investment. Without integrated education, integrated care will remain the exception rather than the norm.

Various comorbidities have been studied in patients with obstructive sleep apnoea (OSA), and interest in the relationship between sleep disorders and cancer has increased significantly over the past 10 years. According to numerous studies, there appears to be a bidirectional relationship between fragmented sleep and oxyhaemoglobin desaturation, and cancer. Key studies have highlighted various parameters, primarily inflammatory ones, that are part of the OSA context in response to sleep fragmentation and hypoxia. These parameters are also central to cancer research. This consequently leads to cancer progression, manifesting as carcinogenesis, tumour invasion and metastasis, among other factors. Chronic sleep fragmentation has several consequences that may explain this relationship. These include the formation of a pro-tumour inflammatory environment, involvement of the hypothalamic–pituitary–adrenal (HPA) axis and autonomic nervous system, metabolic changes, and breakdown of the blood–brain barrier. Conversely, patients with head and neck cancer have a higher incidence of OSA, particularly following treatment involving surgery or radiation therapy. This lecture aims to review the scientific literature on this subject and demonstrate how sleep dentistry clinicians can assist in the management of OSA for these patients.

Dental sleep medicine emerged over 30 years ago in our practice. Our most frequently used therapeutics tool includes oral appliances for obstructive sleep apnea (OSA), sleep bruxism and orofacial pain-temporomandibular pain. Recently new medications have been added to our armamentarium. Although these are mainly in the medical domain, they offer an additive value

to our approaches for some individuals. Insomnia is frequently associated to orofacial pain. Although the gold standard treatment is cognitive and behavioral therapy, medication is among first line therapy. New orexin-related medication offers an alternative to most addictive benzodiazepine sleep pills but evidence are yet low for concomitant orofacial pain and insomnia. OSA is usually managed by CPAP or mandibular advancement devices up to surgeries, weight control, myotherapy and hypoglossal nerve stimulation. Recent advances using: i) glucagon-like peptide-1 receptor agonist (GLP- 1RA; FDA approved such as tirzapetide) are know to improved OSA variables in individuals with obesity and predominant anatomical airways collapse, ii) combination therapy using noradrenergic and muscarinic agents or cannabinoids (ongoing Phase 3 trial) targeting upper airway muscle tone shows promising effects if tolerability is not a problem, iii) in presence of

OSA low respiratory arousal thresholds frequently contribute to poor sleep quality and use of

hypnotic-Z pills or the off-label trazodone seem to help some individuals; yet use of new orexin

dual antagonists only offer marginal benefit on OSA variables. For sleep bruxism, several agents

seem to have some benefit that has to be balanced with risk of side effects; these include the

cardiac-related medication clonidine, gastro-oesophageal reflux medication and botulinum toxin

for otherwise non responsive cases.

This lecture will address the variability in patient response to mandibular advancement device (MAD) therapy in obstructive sleep apnea (OSA). It will focus on how phenotypes and endotypes can contribute to a better understanding of treatment outcomes.

Clinical phenotypes, such as craniofacial features, body mass index, age, and positional dependency, will be reviewed in relation to their potential role in identifying suitable candidates for MAD therapy. However, since these factors alone do not fully explain treatment response, the lecture will also explore relevant endotypes, including upper airway collapsibility, loop gain, arousal threshold, and muscle responsiveness.

By integrating both phenotypic and endotypic perspectives, this lecture will outline how a more individualized approach to patient selection may improve the effectiveness of MAD therapy in OSA management.

Mandibular advancement devices (MADs) are an established treatment for obstructive sleep apnea (OSA), yet variability in therapeutic response remains a major clinical challenge. Drug-induced sleep endoscopy (DISE) has emerged as a valuable tool to characterize upper airway behavior under sleep-like conditions, offering the potential to refine patient selection and optimize treatment strategies.

This presentation outlines a structured DISE-based protocol for the evaluation and optimization of MAD therapy.

Key findings regarding upper airway responses to mandibular advancement will be discussed, highlighting differential effects across anatomical levels. Particular focus will be placed on patterns of collapse resolution or persistence at the velopharyngeal, oropharyngeal, tongue base, and epiglottic levels, and how these findings inform treatment decisions. The interpretation of DISE findings is framed within a functional perspective, recognizing that DISE visualizes anatomical and dynamic changes rather than directly measuring physiological outcomes.

A classification-based approach to treatment personalization will be presented, integrating observed airway responses into clinically meaningful categories that guide therapeutic decisions, including MAD as a standalone therapy or in combination with adjunctive treatments such as positional therapy or upper airway surgery.

Finally, the predictive value of DISE in the context of MAD therapy will be examined.

This approach supports a move toward precision medicine in dental sleep medicine, leveraging DISE not only as a diagnostic tool but as a dynamic platform for individualized treatment planning.