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Dental Sleep Medicine:

Beyond Oral Appliance Therapy
by Drs. Richard Drake and Craig Schwimmer

leep disordered breathing continues to plague millions of fold increase in the number of dental devices
Americans. Our traditional way of managing patients has made in the US over the next 5 years.
But is OAT all we have to offer? As a den-
been inconvenient, intrusive, and ultimately offered solu- tist, what can you do for your patient who
tions most patients simply dont want (CPAP or surgery). Be- cant tolerate OAT? What about those who
tween the high cost and inconvenience of in-lab sleep studies, refuse to wear a dental device? Or those
patients for whom OAT offers partial, but
and the aversion that most people have to the idea of sleeping
incomplete relief? What else can we do for
with a CPAP device or having half their throat ripped out, these patients?
most people with sleep apnea have never even been diagnosed. The Pillar Procedure is another tool you
Perhaps more telling is the fact that most people who have been can use to better meet the needs of your
snoring and sleep apnea patients.
diagnosed currently go untreated! First approved by the FDA in 2002, the
Pillar Procedure has been used to treat
With real-world CPAP compliance rates over 50,000 patients with snoring and
as low as 35%, many patients simply need mild-to-moderate sleep apnea. The Pillar
better treatment options. Over the past 10 Procedure is a minimally invasive technique,
years, dental sleep medicine has played an performed chair-side, that works by inserting
increasingly vital role because Oral Appli- small woven sutures into the soft palate (see
ance Therapy (OAT) has proven efficacy and diagram). Performed under local anesthesia
is better tolerated than CPAP. More and more in about 10 minutes, it has been shown to
dentists are educated about what sleep ap- significantly reduce snoring (bed-partner sat-
nea is and help their patients with custom isfaction rates average around 80%),1,2 and
oral appliances. In fact, independent health- to effectively treat mild-to-moderate sleep
care business analysts Frost and Sullivan apnea (approximately 80% of patients expe-
recently reported that they anticipate a five- rience significant reduction in AHI).3,4 47

Stiffening the soft palate has been a pri- OK, but what does the Pillar Procedure
mary method of procedural sleep apnea have to do with dentistry? Simple, as a den-
treatment for over 40 years. The Uvulo- tist, you can perform the Pillar Procedure.
alato- haryngo- lasty ( ) as first in- While most Pillar Procedures performed to
troduced in the 1970s as a treatment for date have been done by ENT physicians, the
OSA, and remained the stan- FDA authorizes trained dentists to perform
dard surgical treatment for this procedure. Eager to offer their patients
It is a simple, essentially many years. Over the years, more than just OAT, an increasing number
painless chair-side procedure... the technique has been modi- of dentists are adding the Pillar Procedure
fied nu erous ti es but even to their practices. In the dental setting, the
now remains an extremely in- Pillar Procedure has been shown to augment
vasive and painful procedure. the efficacy of OAT reducing the a ount of
In contrast, the Pillar Procedure does not protrusion required to achieve a desired end
require the removal or destruction of any point. The theory is that the two techniques
soft tissue. The Pillar Procedure stiffens the work synergistically, because airway stabili-
soft palate by stimulating a foreign body re- zation is accomplished both retro-palatally
action. In response to the placement of the and retro-lingually. It also allows a dentist to
palatal i plants the patient s natural fibrot- help patients for whom OAT is not an option.
ic response stiffens the soft palate, thereby Performing the procedure: The patient is
decreasing palatal utter. o instead of an typically given ibuprofen 800 mg po, and
invasive, painful surgical procedure, it is a then asked to rinse with an antiseptic solu-
simple, essentially painless chair-side pro- tion immediately prior to the procedure. The
cedure that allows patients to immediately palate is anesthetized topically, and then in-
return to normal diet and activities. jected with approximately 3 cc of a short act-
ing local anesthetic (with epi). The implants
are then placed approximately 2 mm apart
and parallel ith the first i plant inserted
along the midline raphe. The entry point for
the delivery device is the junction of the hard
Dr. Craig Schwimmer is a practicing ENT from Dallas, TX, who has per-
and soft palate, allowing the implants to be
formed thousands of Pillar Procedures, and serves as Chief Medical Officer
placed as close to that junction as possible.
of Pillar Palatal, LLC. He can be reached at
The implants are placed 2mm apart and par-
Dr. Richard Drake is a practicing dentist in San Antonio, TX, and co-founder
allel (see illustration). Typically, 5 implants
of Dental Sleep Solutions and DS3 software. He routinely utilizes the Pillar are placed per patient.
Procedure in his dental office. Fifteen minutes later, the patient is driving
back to work. Post operatively, most patients
experience very little discomfort, typically

48 DSP | Summer 2016


managed with ibuprofen and cold liquids. of patients and is anaged by re oving
It takes several weeks for the scar tissue in the exposed implant.
the soft palate to form, and to integrate with Pillar Procedure courses are offered
the implant material. Therefore, patients are throughout the year and so eti es in con-
advised not to expect clinical improvement junction with Dental Sleep Solutions. You
for at least two weeks, and that maximal can get ore infor ation by calling illar s
improvement can take up to three months. anufacturer at - - or by visiting
ecreasing palatal utter in this ay can di-
rectly decrease snoring and apnea and (an-
ecdotally) it can also synergistically aug ent
1. ong-ter esults of alatal I plants for ri ary noring. aur-
the effect of OAT thereby providing the assist er JT, Verse T, Stuck BA, Hormann K, Hein G. Otolaryngol Head
that some dental devices need to get to the Neck Surg. 2005; 132: 125-132.
2. Patient Outcomes After Soft Palate Implant Placement for Treat-
end zone. Over 50,000 patients have been ent of noring. osenberg Alsaffar H andessa y T. ournal
treated with the Pillar Procedure, and not a of Otolaryngol Head Neck Surg. 2010; 39:323-328.
3. Extended Follow-up of Palatal Implants for OSA Treatment.
single significant co plication has been re- al er evine H Hopp reene . Otolaryngol Head
ported. The ost co only reported co - Neck Surg. 2007; 137:822-827.
4. One-year esults alatal I plants for the Treat ent of Obstruc-
plication is partial extrusion of one or more tive Sleep Apnea. Norgard S, Hein G, Stene BK, Skjostad KW,
of the implants. This occurs in between 1 and aurer T. Otolaryngol Head Neck Surg. 2007; 136: 818-822. 49