Mandibular advancement device: who is this treatment for?

When can an oral appliance be considered?

A MAD holds the lower jaw forward during sleep to reduce obstruction of the airway. It may be discussed in particular for mild to moderate obstructive sleep apnea, depending on the assessment and your preferences.

It may also be considered when CPAP (continuous positive airway pressure) is difficult to use. The doctor then reviews the difficulties and the options suited to your situation. 1 3

For snoring, the assessment looks for possible sleep apnea before a treatment is chosen.

What about severe sleep apnea?

CPAP remains the preferred treatment for severe sleep apnea. Severe sleep apnea does not, however, automatically rule out an oral appliance.

The Panthera instructions for use provide for second-line use after refusal, failure or intolerance of CPAP, in line with applicable national recommendations. The decision requires an individual medical assessment and a check of the result. 1

What needs to be checked before starting?

The sleep test and medical assessment establish the type of sleep apnea, its consequences and the treatments to discuss. The dental examination then assesses the condition of the teeth and gums, their ability to support the appliance and how the jaw functions. 2

The Panthera instructions for use exclude use under the age of 18, with loose teeth, advanced periodontal disease, central sleep apnea or severe respiratory disorders other than obstructive sleep apnea. Your medical history and other health problems are also taken into account.

This assessment makes it possible to choose a suitable treatment and plan its follow-up.

Why do the choice of appliance and follow-up matter?

A custom appliance must fit your mouth and then be adjusted gradually. Comfort, dental health and breathing effectiveness are monitored together. 2

At Shalvina, Dr Chira Riahi-Boukhris carries out the dental assessment and provides Panthera oral appliance therapy in Netanya. The choice between the Classic and X3 models depends on your situation.

The result is not judged only on reduced snoring: a sleep test with the appliance in place checks whether sleep apnea is controlled. 1

How to prepare for your assessment

Bring your sleep test, the letter from your doctor recommending mandibular advancement device therapy and documents about the treatments you have already tried. Existing dental assessments and panoramic X-rays are useful if available.

If your doctor has already referred you for a MAD, you can go directly to the dental assessment. If the choice of treatment is still open, a medical assessment can help review your situation.

Discover Panthera oral appliance therapy at Shalvina, from assessment to adjustments and follow-up of the result.

About Panthera oral appliance therapy

Scientific references

1. Ramar K, Dort LC, Katz SG, et al. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015. Joint clinical guideline of the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM). Journal of Dental Sleep Medicine. 2015;2(3):71–125. doi:10.15331/jdsm.4868. Official AASM/AADSM text on the AADSM website.

2. Levine M, Cantwell M, Postol K, Schwartz D. Dental Sleep Medicine Standards for Screening, Treatment, and Management of Sleep-Related Breathing Disorders in Adults Using Oral Appliance Therapy: An Update. Journal of Dental Sleep Medicine. 2025;12(2). doi:10.15331/jdsm.7384. AADSM professional standards.

3. Department of Veterans Affairs / Department of Defense. Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea. Version 3.0, 2025. Full professional guideline.

Device instructions for use

Patient selection for Panthera also follows the manufacturer’s instructions for use for D-SAD Classic / D-SAD X3, edition L-001_V11_ROW_2026-10. These instructions are device documentation, separate from the scientific recommendations above.