The main aim was to evaluate the influence on occlusal contact area (OCA), maximum bite force (MBF), center of occlusal load (COL), and tooth pain after the nocturnal use of different mandibular advance appliances (MAAs) for snoring. Subjects were consisted of ten adult volunteers with mild snoring in Hiroshima University Hospital. Recordings of occlusal function were performed six times for two hours, that is, immediately and 5, 15, 30, 60, and 120 minutes after the nocturnal use of MAA. The subjects continuously scored their pain intensity on a 10？cm visual analogue scale (VAS) when MBF was measured. Comparing two MAAs, OCA and MBF were significantly larger in two-piece MAA than in one-piece MAA five minutes after removing the appliance. Significant difference in COL and VAS score compared to baseline disappeared more quickly with two-piece MAA than with one-piece MAA. In conclusion, it is shown that two-piece MAA could be superior to the one-piece one in terms of the degree side effect on occlusal function. 1. Introduction Obstructive sleep apnea (OSA) is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation [1]. Excessive daytime sleepiness caused by nocturnal sleep fragmentation interferes with daytime activities, being a common complaint of patients with OSA. OSA is also associated with increased morbidity and mortality from cardiovascular, metabolic, and cognitive alterations in adults [2–7]. Mandibular advancement appliances (MAAs), aiming to enlarge the upper airway by repositioning the mandible forward, are known to be useful as a lifelong treatment tool for primary snoring and mild-to-moderate OSA [8–11]. MAAs are sometimes more preferable for moderate-to-severe OSA when the nasal continuous positive airway pressure (nCPAP) therapy is not indicated, although MAA therapy was less effective than nCPAP [12, 13]. Recently, several studies have focused on the side effects of MAAs related to temporomandibular joint (TMJ) discomfort and the masticatory muscles stiffness with difficulty in chewing immediately after the nocturnal use of MAAs [14–16]. George [17] reported that most OSA patients, after the use of MAA for a whole night, experience that the bite does not feel right upon awakening, but that it normalizes after breakfast. Ringqvist et al. [18] also demonstrated that some patients had problems in biting in the regular habitual intercuspal position during the first hour or so after using MAA for a whole night. The adverse event might be small
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