General Dentistry · Sleep Dentistry · Last reviewed May 2026
Sleep Apnea Appliance: Custom-Fitted MAD
For Diagnosed OSA.
Picasso Dental fits a custom mandibular advancement device (MAD) for adults with a diagnosed mild-to-moderate case of obstructive sleep apnea (OSA) who cannot tolerate or do not need CPAP. We work alongside your sleep physician. We do not diagnose sleep apnea. A confirmed diagnosis from a sleep physician, via polysomnography or a home sleep apnea test, is required before we fabricate a device.
Diagnosis is Medical. Treatment is Dental.
Obstructive sleep apnea is a medical condition. It is diagnosed by a sleep physician using a polysomnography (overnight in-lab sleep study) or a home sleep apnea test. Picasso Dental does NOT diagnose sleep apnea. What we do is fit oral appliances for adults whose physician has confirmed mild-to-moderate OSA and recommended a dental device, or who cannot tolerate CPAP. We work alongside your sleep physician, share device titration findings, and refer back to them if the appliance is not enough.
What is a Mandibular Advancement Device?
A MAD is a custom-fitted oral device worn during sleep that holds the lower jaw slightly forward, opening the airway and reducing collapse of the soft tissue at the back of the throat. Best evidence (AASM 2015 clinical practice guidelines) supports oral appliance therapy for mild-to-moderate OSA, and as an alternative for patients who cannot tolerate CPAP. A MAD does not cure OSA; it manages it for as long as the device is worn.
Why Picasso for MADs
Custom-Fitted, Not Boil-and-Bite
Every device is custom-made from an iTero scan and a precise bite registration in slight protrusion. Boil-and-bite pharmacy mouthpieces are not equivalent and we do not fit them.
Titratable Design
Our preferred devices are titratable, meaning the amount of forward jaw advancement can be adjusted in small increments after fitting. We titrate over 6 weeks to find the position that controls symptoms with the least TMJ load.
iTero Scan + Bite Registration
Digital impression of the upper and lower arches, plus a calibrated protrusive bite record. The lab fabricates the device to digital tolerances. No putty trays.
Follow-Up Titration Visits
Fitting is the start, not the end. Adjustment appointments during the titration period and a 6-month review are part of the standard pathway.
Co-Management With Your Sleep Physician
We share device findings with you, and with your physician on request. We recommend a follow-up sleep study at 6 months to confirm efficacy. We do not stop CPAP without your physician''s input.
Honest Escalation
If the MAD is not controlling your apnea, we say so and refer back. Not every patient is a MAD responder, and we are not interested in keeping you in a device that is not working.
When a Dental Appliance Is Right (and When It Isn''t)
The honest version, decided together with your sleep physician.
A MAD May Be Right If
You have a confirmed diagnosis of mild-to-moderate obstructive sleep apnea from a sleep physician.
You have been prescribed CPAP but cannot tolerate it (mask discomfort, claustrophobia, travel impracticality).
You have primary snoring and your physician has ruled out OSA.
You need a supplemental device for travel while continuing CPAP at home.
You have enough healthy teeth in both arches to retain the device, and a TMJ that tolerates a small amount of forward posture overnight.
A MAD Is Not Right If
You have severe OSA. CPAP is first-line per AASM 2015 guidelines. We will not fit a MAD as a primary device for severe OSA.
You do not have a confirmed diagnosis. Get a sleep study first.
You have central sleep apnea, an entirely different mechanism that an oral appliance cannot address.
You have insufficient teeth to retain the device, or are wearing dentures that cannot anchor it.
You have a severe TMJ disorder, where forward posture overnight would worsen joint pain.
MAD Pricing
Final price depends on the device type chosen and the titration period your case needs. All prices include the consultation, scan, fitting and the titration appointments listed below.
| Service | Price | Notes |
|---|---|---|
| Custom MAD (titratable) | 5,000,000 – 10,000,000 | Depending on device type |
| Initial consultation + iTero scan + bite | 200,000 exam + 2,000,000 iTero | |
| Adjustment visit during titration | Each, over 6 weeks | |
| Follow-up review at 6 months | Recommended | |
| Replacement after wear (3–5 years) | 5,000,000 – 10,000,000 | Same as new |
Sleep study (polysomnography or home sleep apnea test) is performed by a sleep physician, not by us, and is billed separately by the sleep medicine unit.
How MAD Treatment Works
Five steps from confirmed diagnosis to a titrated, fitted device.
1. Confirmation of Diagnosis
You bring the sleep study report from your sleep physician. We confirm the diagnosis (mild-to-moderate OSA, or primary snoring with OSA ruled out) and the recommendation for an oral appliance. Without this report, we do not proceed.
2. Clinical Assessment
Your dentist examines your teeth, gums and TMJ. We confirm you have enough sound teeth to retain the device, that your gums are healthy, and that your jaw joint can tolerate a small amount of forward posture overnight.
3. iTero Scan + Bite Registration
We capture digital impressions of both arches and a precise bite record in slight protrusion. The starting protrusive position is calculated to balance airway opening against jaw comfort.
4. Laboratory Fabrication
The lab fabricates the titratable device from your digital records. Manufacturing typically takes 3 weeks.
5. Fitting + Titration (4–6 Weeks)
We fit the device, check retention and bite, and start titration. Over 6 weeks, in small increments at each adjustment visit, we advance the device until symptoms are controlled with the least amount of forward posture. Your physician then orders a follow-up sleep study at 6 months to confirm efficacy.
Aftercare
Clean daily, dry storage, monitor for tooth or bite changes, return for adjustment if discomfort develops. Replacement is typically needed every 5 years with regular use.
What MADs Can and Cannot Do
The honest version. We would rather under-promise and have you sleep better than over-promise and have you back in our chair frustrated.
What a MAD Can Do
Reduce the apnea-hypopnea index (AHI) for many mild-to-moderate OSA patients. Studies typically report mean AHI reductions of around 50%, though individual response varies widely.
Reduce or eliminate snoring in many patients.
Improve sleep quality, daytime alertness and bed partner sleep when the patient responds well.
Serve as an alternative when CPAP is not tolerated, or as a travel device alongside home CPAP.
What a MAD Cannot Do
Replace CPAP for severe OSA. CPAP remains first-line per AASM 2015 guidelines for moderate-to-severe disease.
Cure underlying causes of OSA. Obesity, airway anatomy, alcohol and sleep position all matter and a device does not address them.
Work for patients with insufficient teeth to retain the device.
Prevent the medical complications of severe untreated sleep apnea (cardiovascular, metabolic, daytime accident risk). For severe cases, please follow your physician''s guidance on CPAP.
Co-Management With Your Sleep Physician
An oral appliance is one part of an OSA care plan, not a standalone solution. We share device titration data and clinical findings with you and, on request, with your sleep physician. We recommend a follow-up sleep study at 6 months after titration to confirm whether the device is controlling your apnea. If it is not, we refer back. We do not start, stop or replace CPAP without physician input. This is not our specialty and we do not pretend it is.
Aftercare
Daily Cleaning
Brush the device with cool water and a soft toothbrush after each use. Avoid hot water, which can warp the acrylic. No toothpaste, which can scratch the surface.
Storage
Store dry in the supplied case during the day. A wet sealed case grows bacteria and odour quickly.
Monitor for Bite Changes
Small tooth movement or bite changes are uncommon with quality titratable devices but possible over years of nightly use. Mention any change at your follow-up visits.
Return for Adjustment
If the device feels loose, sore on the gums, or your jaw aches in the morning beyond the first two weeks, come in for adjustment rather than abandoning the device.
Risks & Honest Tradeoffs
Oral appliance therapy is well-established for mild-to-moderate OSA but it is not free of side effects. Here is the honest list, the things to expect and the things to watch for.
TMJ Discomfort During Titration
Mild jaw soreness in the first 2 weeks of wear and after each titration step is common and usually settles. Persistent or sharp TMJ pain is not normal, come in.
Tooth Movement Over Years
Long-term nightly wear can cause minor tooth movement. Quality custom titratable devices minimise this risk. We monitor at follow-up visits.
Bite Changes
Small bite changes (occasional, typically minor) can develop with years of use. Most are clinically insignificant; some patients need bite re-establishment after several years of wear.
Drooling and Dry Mouth
Excess saliva or dry mouth in the first week is common as you adapt. Both usually settle. Persistent dry mouth can affect dental health and should be mentioned.
Daytime Fatigue if Device Dislodged
If the device falls out at night, the apnea returns for the rest of that night. Persistent dislodgement means the retention is wrong, come in for adjustment.
Non-Response
Not every patient is a MAD responder. The follow-up sleep study at 6 months tells your physician whether the device is working. If it is not, we refer back to discuss CPAP or other options.
Your Picasso Sleep Dentistry Team
Our general dentists fit and titrate MADs in close coordination with your sleep physician. Picasso Dental does not have a sleep physician on staff, the medical diagnosis must come from a sleep medicine unit.
Dr. Thao Tran
General Dentist. Fits and titrates oral appliances for diagnosed mild-to-moderate OSA in coordination with the patient''s sleep physician.
Dr. Nhung Duong
General Dentist. Co-manages oral appliance therapy and follow-up titration appointments.
Dr. Emily Nguyen
Founding Clinical Director. Sets the case selection and co-management protocol that governs our oral appliance pathway group-wide.
Common Questions
Does Picasso Dental diagnose sleep apnea?
No. Sleep apnea is a medical condition that must be diagnosed by a sleep physician using polysomnography or a home sleep apnea test. We fit oral appliances for adults whose physician has confirmed mild-to-moderate OSA and recommended a dental device. We do not interpret sleep studies and we do not start, stop or replace CPAP without physician input.
Do I still need CPAP if I get a MAD?
It depends on the severity of your OSA and your sleep physician''s recommendation. CPAP is the first-line treatment for moderate-to-severe OSA per AASM 2015 guidelines. A MAD is supported for mild-to-moderate OSA, and as an alternative when CPAP is not tolerated. Some patients use a MAD as a primary device, others as a CPAP travel alternative. Your physician decides.
Will a MAD cure my sleep apnea?
No. A MAD manages OSA while it is in your mouth at night. It does not cure the underlying anatomy or weight factors that cause OSA. If you stop wearing the device, your apnea returns.
What is the success rate of a MAD?
AASM 2015 guidelines support oral appliance therapy for mild-to-moderate OSA and as a CPAP alternative. Clinical studies typically report mean AHI reductions of around 50%, with substantial variation between patients. A follow-up sleep study at 6 months is the only way to confirm how well the device is working for you.
Can I just treat snoring without a sleep study?
Loud snoring is one of the most common signs of undiagnosed OSA, and treating snoring without ruling out OSA risks masking a serious medical condition. Picasso Dental will not fit a custom MAD without a sleep physician''s assessment. If you snore, we recommend a sleep study first.
Will my insurance cover a dental MAD?
Coverage varies. Some international and Vietnamese health insurance plans cover oral appliance therapy when prescribed by a sleep physician for diagnosed OSA, others classify it as dental and exclude it. We provide an itemised quote and the device documentation; you submit the claim through your insurer.
Can I travel with a MAD?
Yes. The device fits in a small case, requires no power, and has no consumable supplies. Many CPAP-using patients keep a MAD specifically as a travel device, with their physician''s knowledge.
Will a MAD move my teeth?
Long-term oral appliance use can cause minor tooth movement and small bite changes in some patients over years of nightly wear. Quality custom titratable devices minimise this risk compared with cheaper boil-and-bite appliances. We monitor for movement at follow-up visits.
What about anti-snore mouthpieces from a pharmacy?
Boil-and-bite anti-snore devices are not equivalent to a custom titratable MAD. They are bulky, often poorly retentive, cannot be precisely titrated, and have a higher rate of TMJ discomfort and tooth movement. They also do not require a diagnosis, which means they may mask undiagnosed OSA. We do not recommend them as a substitute for a custom device prescribed for a diagnosed condition.
How do I find a sleep physician in Vietnam?
Several private hospitals in Hanoi and Ho Chi Minh City have sleep medicine units that perform polysomnography or home sleep tests, including Vinmec, FV Hospital and Hong Ngoc. We can refer you, but we do not have a sleep physician on staff at Picasso. If you live abroad, get the sleep study and diagnosis at home and bring the report to us.
Start Here
Have a Sleep Study?
Bring It In, We''ll Take It From There.
If you have a confirmed diagnosis of mild-to-moderate obstructive sleep apnea from a sleep physician, book a MAD consultation and bring the sleep study report. We will assess your teeth and TMJ, scan, and quote you in writing before any device is fabricated. If you do not yet have a sleep study, please book one with a sleep physician first.