No. The splinting material is applied to the back of the tooth. This results in the splint being completely hidden from view. You are able to head to dinner immediately after your appointment with total confidence.
Anterior splinting for sleep apnea is a clinical procedure that joins the lower teeth together with thin composite resin. This stabilization is required for patients who have stage II periodontitis to safely distribute the mechanical pressure of sleep apnea appliances across more tooth roots. Our team at Enamel Dentistry The Domain helps to solve your sleep apnea without risking the health of your natural teeth.
Stage II periodontitis is a phase of gum disease that occurs when the infection has moved from the gums and begun dissolving the alveolar bone. Clinically, this usually indicates the periodontal pockets are greater than 4mm in depth. Since there is less bone to hold the tooth in place, the lower incisors can become slightly mobile. Clinical studies demonstrate that long-term MAD therapy has clinically significant effects on occlusion [1] (Rana et al., 2023). When Mandibular advancement devices (MAD) are utilized, the appliances transmit forces to the lower teeth to pull the jaw forward and keep the airway open. For healthy patients, the bone absorbs these forces easily. However, with stage II bone loss, that constant pressure can accidentally push the teeth out of alignment. Before sleep apnea can be treated, the bone structure must be stable.
Medical literature supports that anterior repositioning splints exhibit efficacy in alleviating TMJ popping and improving mandibular movement [2] (Wang et al., 2025). Anterior splinting is utilized to make sleep therapy safe for patients with lower bone support. Instead of one or two vulnerable teeth bearing the weight of jaw advancement, the overlying teeth are bonded together to act as a stronger unit. Medical studies indicate that periodontally compromised splinted teeth show a high-survival rate [3] (Sonnenschein et al., 2017). The procedure is quite simple and non-invasive. High-strength, composite resin is applied to the lingual side of the teeth. Microscopic fiber ribbons are used to reinforce the bond. This creates a rigid block that can withstand the mechanical load of the sleep appliance. By distributing the force across six roots instead of two, the teeth can be prevented from shifting and protect the remaining bone from trauma.
If a patient with stage II periodontitis skips the splinting process, they can face several biomechanical risks. The MAD exerts large amounts of pressure. Every night for 7-8 hours, the lower teeth are being pulled forward. Without the stabilization of a splint, the pressure slowly moves the teeth. Over several months, you may notice the lower teeth beginning to flare forward and gaps forming where there were none previously. In addition to being a cosmetic issue, it also accelerates bone loss by creating traumatic occlusion. By investing in the $350 splint, you are protecting yourself from expensive dental implants or bone grafting surgery later.
When budgeting for sleep apnea care in the Domain, it is important to view the whole picture. Many patients are interested in the price point of mail-order mouthguards. However, for patients with periodontitis, these can be dangerous. Generic kits apply uneven pressure, which can accelerate bone loss in under 30 days. Below, our team has summarized mail-order mouthguards against MAD appliances, anterior splitting, and periodontal maintenance.
Service Component | Cost | Purpose | Durability |
MAD Appliance | ~$2,000 | Opens the airway | 3-5 years |
Anterior splinting | ~$350 | Stabilizes the teeth | 2-4 years |
Periodontal maintenance | ~$200 | Prevent bone loss | Quarterly |
Generic Mouthguards | ~$50 | Temporary snoring relief | High risk for perio patients |
At Enamel dentistry, we are transparent about the clinical necessities because we want your treatment to last and be successful. Most PPO insurance recognizes the medical necessity for sleep apnea therapy. While dental insurance covers the splints, we coordinate with the medical insurance providers to offset the cost of MAD appliances, often including the appropriate billing code D4321. To make the remaining balance affordable for you, we offer financing options to make small monthly payments.
No. The splinting material is applied to the back of the tooth. This results in the splint being completely hidden from view. You are able to head to dinner immediately after your appointment with total confidence.
The process is non-invasive and does not hurt. There is no drilling into the tooth or numbing required. The tooth is primed, and the resin is bonded. This process is similar to a dental filling without the use of a needle.
Yes, but your oral routine may change. Since the teeth are joined together, the floss cannot be pulled through the top. Instead, a floss threader should be used or an interdental brush to clean the space near the gumline under the splint.
Dr. Hardik Chodavadia, DDS, provides comprehensive general and cosmetic dentistry at Enamel Dentistry in Austin, TX. With extensive clinical experience, he specializes in preventive care, gum health, restorative dentistry, and minimally invasive aesthetic treatments. He is committed to delivering safe, evidence-based solutions that keep patients comfortable and informed at every step.
[1] Rana A, Raut A, Mathur A. The Occlusal Side Effects of Mandibular Advancement Device Therapy in Adult Sleep Apnea Patients: A Systematic Review. Cureus. 2023;15(11):e48682. Published 2023 Nov 12. doi:10.7759/cureus.48682
[2] Wang L, Zhang Y, Chen H, et al. The efficacy of anterior repositioning splints in the management of temporomandibular disc displacement: a systematic review and meta-analysis. BMC Oral Health. 2025;25(1):1267. Published 2025 Jul 28. doi:10.1186/s12903-025-06379-3
[3] Sonnenschein, S. K., Betzler, C., Rütters, M. A., Krisam, J., Saure, D., & Kim, T.-S. (2017). Long-term stability of splinted anterior mandibular teeth during supportive periodontal therapy. Acta Odontologica Scandinavica, 75(7), 475–482.
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