The Luco Hybrid OSA Appliance is classified as a mandibular advancement type appliance as it holds the lower jaw in a forward positioning. This also moves the tongue forward, stabilizing the airway.
With sleep apnea, the tongue falls back and the throat muscles relax blocking the airway (Figure 1):
Mandibular advancement appliances all work by moving the lower jaw forward and holding it there. This prevents the tongue from blocking the airway.
The Luco Hybrid is FDA cleared for the treatment of sleep apnea and snoring. This is not a unique feature as all sleep apnea appliances work the same with this regard.
The patented forward bite of the Luco Hybrid – Significance
What does make the Luco Hybrid different is how it also treats sleep-related bruxism, associated tension/migraine headaches, and heart rate increase. This is how it accomplishes this:
The Luco Hybrid has a patented forward bite that affects a series of reflexes in the jaws.
This affects the body in 3 important ways:
1. Even Stress Distribution
When biting in the molar region there are very high-stress points located in the lower molars, lower jaw, ramus of the mandible, the condyle of the TMJ, under the eyes, and down the nasal septum. The following animation demonstrates these unfavorable stresses when biting in the molar region (Figure 2):
The Molar Bite
Figure 2 Stress Distribution Molar Bite
In this animation, you can see the high stress marked in red. The image of a conventional full coverage night guard demonstrates the molar bite. All conventional night guards, whether upper or lower contact in this manner.
The Luco Hybrid device does not use this type of bite at all. After years of research, the bite was shifted forward to the region of the eyetooth and 1st bicuspid. This provides a much more favorable stress distribution, as seen in the animation below (Figure 3):
The Cuspid Bite
As can be seen in this animation, the only area marked in red is the tip of the eyetooth, all other areas demonstrate lower stress. The bite in this area is evenly distributed up through the facial bones and over the skull. There is no stress distribution to the TMJ region. The Luco Hybrid is the only OSA/TMJ appliance with this patented bite.
Figure 4 The Luco Hybrid OSA Appliance’s Forward Bite
The Luco Hybrid’s forward bite is unique and patented (protected under US patent 9,545,332 B2). This forward bite reduces the bite force by preventing the sleep-related bruxism events via activation of the periodontal-masseter reflex of the cuspids. resulting in relaxation of the jaw muscles. Tension/migraine headaches are significantly reduced or eliminated.
The Luco Hybrid is the first FDA cleared treatment of sleep-related bruxism and associated tension/migraine headaches. To date, it is the only FDA cleared of slsleep-related bruxism of any kind.
2. Activation of the Periodontal-Masseter Reflex
This reflex is another protective reflex that is activated by sensory organs in the periodontal ligaments (Figure 5) that surround the roots of the teeth.
The periodontal ligaments contain sensory cells (around 120,000 per tooth) that relay pain and stretching to the brain. Some of the teeth also make up a very important protective reflex called the periodontal-masseter reflex (PMR). The PMR is activated by pressure on cuspids, first bicuspids and, to a lesser extent, the incisors (figure 6).
This reflex limits the biting force of the masseter and temporalis muscles to normal forces of 15-25lbs, similar to the masseter inhibitory reflex (MIR). Also unique to this reflex is that while the masseter muscle is being inhibited, the digastric muscle is being activated. The digastric muscle opens the jaw. The PMR is not affected by the HTR2a polymorphism as the MIR is.
The Luco Hybrid Device’s patented forward bite places pressure precisely on the first bicuspid and eyetooth resulting in activation of the PMR reflex during sleep.
3. Stabilization of the Trigeminal Cardiac Reflex
This reflex is best known for its effect on scuba divers. When the face is placed in cold water, heart rate, breathing, and blood pressure are reduced. This reflex is also seen in marine mammals like whales and dolphins. It is an oxygen conserving reflex and very helpful for marine mammals. It is activated in 6 regions of the face:
- The nasocardiac reflex (nasal mucosa, inside the nose)
- The oculocardiac reflex (pressure on the eyeball)
- The maxillomandibular reflex (upper and lower jaws, bicuspid teeth)
- The Gasserion ganglion reflex
- The central reflex (in the brainstem, trigeminal nucleus)
- The brainstem reflex (lower than the trigeminal nucleus)
Figure 7 Stimulation of the TCR at the Gasserion ganglion by sleep-related bruxism.
All regions except the Gasserion gangion result in the slowing of heart rate and breathing and lowering of the blood pressure. When stimulated at the Gasserion ganglion (Figure 7), there is the opposite effect: an increase of heart rate, breathing and raising of the blood pressure. Sleep bruxism affects the TCR at this level. An increase in heart rate is a hallmark sign of sleep-related bruxism!
By definition, tachycardia is a heart rate in excess of 90 beats per minute. The sleep tracing in Figure 8 demonstrates a patient with sleep-related bruxism. You can see that breathing is disturbed and the heart rate increased from 62 bpm to 111 bpm, an increase of 79%! This meets the medically accepted criteria of a 20% change in heart rate required to make a diagnosis of TCR activation. It also indicates that sleep-related bruxism has a profound effect on the TCR as it far exceeds this 20% threshold. There is actually a hyper-stimulation of the TCR with sleep-related bruxism.
The tracing in Figure 9 is the same patient wearing the Luco Hybrid device:
Re-Activation of the Trigeminal Cardiac Reflex
Notice the difference between Figures 8 and 9? In figure 9 there are no sleep-related bruxism events, breathing is steady and normal and the heart rate is steady between 72 and 75 bpm (4% increase). This demonstrates very clearly how the Luco Hybrid device treats sleep-related bruxism and prevents activation of the TCR. Heart rate is reduced to normal levels reducing stress on the heart. The Luco Hybrid returns heart rate well below the 20% threshold, indicating it is preventing activation of the TCR.
But how does it lower heart rate and blood pressure?
Recent studies have shown that conventional root canal of the eye teeth and 1st bicuspids activates the trigeminal cardiac reflex by suppression resulting in lower of heart rate, blood pressure, cranial pressure, breathing and gastric motility.
The patented forward bite activates the TCR outside of the brainstem through stimulation of the trigeminal nerve through sensory nerves in only the 1st bicuspid and eye teeth. Other teeth are not connected to the TCR this way.
With the patented forward bite placed over the 1st bicuspids and eye teeth, there is stimulation of these teeth (by pressure) resulting in the opposite effect that sleep-related bruxism has on the TCR. This suppression of the TCR neutralizes the increase seen in sleep-related bruxism resulting in no effect on the TCR.
This is, by far, the most significant feature of the Luco Hybrid as it significantly reduces the stress on the heart caused by sleep-related bruxism.
The Luco Hybrid OSA Appliance
This is what makes the Luco Hybrid truly unique in mandibular advancement therapy. This beneficial effect is seen in patients suffering from sleep apnea, snoring, sleep-related bruxism and tension/migraine headaches or any combination of these conditions.
The patented forward bite is a very significant feature of this device as is instrumental in providing even stress distribution as well as decreasing or eliminating the sleep-related bruxism events and the associated activation of the TCR.
It is the only OSA appliance that may be safely used on patients suffering from sleep apnea/snoring who also suffer from sleep-related bruxism. It is also the only OSA appliance that safely reduces the muscle pain associated with TMD more than a few months.
With the way this advanced medical/dental devices works, it restores deep, restorative sleep within the first few nights. The stabilization of the airway and tongue promote effortless airflow allowing the patient to drop into a deep sleep.
The Luco Hybrid device reduces considerably the number and intensity of the sleep-related bruxism events resulting in the restoration of deep restorative sleep, usually in the first night or two. Within a few weeks, the sleep-related bruxism is well controlled and, as long as the device is worn during sleep, the condition is controlled.
Our slogan, “Sleeping in Complete Comfort” is accurate as this advanced treatment prevents sleep arousals associated with sleep apnea, snoring and sleep-related bruxism, ensuring the best sleep possible while preventing activation of the TCR and an increase in blood pressure and heart rate during sleep.