A chrome cobalt mandibular advancement appliance for snoring and obstructive sleep apnoea used during active aligner orthodontic treatment

Adult orthodontics is now mainstream, made all the more acceptable by the advent of removable aligners. These patients may also coincidentally suffer from snoring and obstructive sleep apnoea (OSA), for which the indefinite wearing of a mandibular advancement device (MAD) during sleep may be required. Indefinite removable nocturnal orthodontic retention is now established practice. This case report describes a cast chrome cobalt MAD and its application in the management of a patient who, having very successfully managed his snoring and mild OSA with a removable cast chrome cobalt MAD, wished to continue this management while undergoing active orthodontic treatment using removable aligners. He also wished to wear a chrome cobalt MAD to incorporate orthodontic retention and inter occlusal splinting as part of his MAD on completion of his active orthodontic treatment.