COMPARISONS
Oral appliance vs CPAP for sleep apnea
CPAP remains the gold standard for severe OSA (AHI 30+) and the higher-pressure cases your sleep physician needs to titrate. Custom oral appliances win on adherence for mild-to-moderate OSA, snoring, and the patient who cannot tolerate a mask.
THE BOTTOM LINE
CPAP remains the gold standard for severe OSA (AHI 30+) and the higher-pressure cases your sleep physician needs to titrate. Custom oral appliances win on adherence for mild-to-moderate OSA, snoring, and the patient who cannot tolerate a mask. The right answer is rarely either-or: it is the device the patient will actually wear, ordered after a sleep study and physician sign-off.
SIDE BY SIDE
Custom oral appliance (MAD) vs CPAP therapy
| Consideration | Custom oral appliance (MAD) | CPAP therapy |
|---|---|---|
| Best fit by OSA severity | Mild to moderate (AHI 5-29), simple snoring | Moderate to severe (AHI 15+), all severe cases |
| Patient adherence at 1 year | Published ranges 70-85% | Published ranges 30-60% |
| Requires sleep study + physician Rx | true | true |
| Fabrication path | Intraoral scan or impression, dental lab fabricates, dentist titrates | DME provider dispenses, sleep physician titrates pressure |
| Typical turnaround from scan to delivery | 2-3 weeks at Dani Dental for SomnoDent, EMA, Herbst | Days to weeks depending on DME and insurance auth |
| Travel friendly | Pocket-sized, no power | Requires power, hose, mask, humidifier |
| Common side effects | TMJ soreness, bite changes over years, dry mouth | Mask leak, skin irritation, aerophagia, claustrophobia |
| Medical insurance coverage | Often covered under medical with E0486 code, varies | Broadly covered as durable medical equipment |
| Who titrates after delivery | Restorative dentist or dental sleep specialist | Sleep physician or DME respiratory therapist |
THE TRADE-OFFS
Where each one earns its place
<p>The decision is not which device is better in the abstract. It is which device this patient will wear seven nights a week. A perfectly titrated CPAP sitting in a closet does nothing for the AHI.</p><p>Recommend a custom oral appliance when the patient has mild-to-moderate OSA confirmed by sleep study, has already failed CPAP adherence, or presents for primary snoring without significant desaturation. Choose CPAP when the AHI is 30 or higher, when central apneas are present, or when the sleep physician documents oxygen desaturation that needs positive pressure to resolve. Go with a combination protocol when the patient tolerates CPAP at lower pressures but the mandibular advancement device lets the physician dial pressure down to a level the patient can actually sleep through.</p><p>For the referring dentist: the workflow starts with a sleep study and physician diagnosis. Dani Dental fabricates SomnoDent, EMA, and Herbst appliances from an intraoral scan or PVS impression, with 2-3 week turnaround and the technician's direct line for titration questions.</p>
<p>Dani Dental fabricates oral appliances. We do not dispense CPAP, and we will tell you when CPAP is the right call. If your patient has severe OSA with an AHI north of 30, or the sleep physician has flagged central apneas, CPAP is genuinely the better clinical answer and we would rather you refer them back to the sleep doc than push an appliance that underperforms.</p><p>Where we earn the case: the mild-to-moderate patient, the CPAP-intolerant patient, and the combination-therapy patient. SomnoDent, EMA, and Herbst on a 2-3 week turnaround, intraoral scan or impression intake, named technician on the case, and direct-line titration support after delivery. Part of our Sleep & Appliances pillar.</p>
IN PRACTICE
How it plays out on real cases
Worked case examples for this comparison are coming. Send us your case and we will show you exactly how each option would play out.
GO DEEPER
Read the full guide on all procedures
This comparison sits inside a larger procedure. The pillar page covers materials, turnaround, and how we build it to your spec.
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