WO2018096295A1

WO2018096295A1 - Oral-dental apparatus for improving the pulmonary ventilation of a subject, and production process

Info

Publication number: WO2018096295A1
Application number: PCT/FR2017/053252
Authority: WO
Inventors: Charles BOTBOL
Original assignee: Botbol Charles
Priority date: 2016-11-25
Filing date: 2017-11-24
Publication date: 2018-05-31
Also published as: FR3059226A1

Abstract

The invention relates to an oral-dental apparatus (1) for improving the pulmonary ventilation of a subject. The apparatus consists of a block of material approximately in the form of an arc and comprising three parts in continuity: a median part (2) and two lateral parts (3G, 3D), the median part (2) being arranged between the two lateral parts (3G, 3D) and being configured so as to be arranged behind the incisors and canines of the mandible, each lateral part (3G, 3D) comprising a lower mouthpiece (4G, 4D) for teeth of the mandible and at least one upper external wing (5G, 5D) to lie against the outer face of the upper dental arch, the apparatus (1) being configured such that, once in place in the mouth, the mandible is blocked in a protruding position relative to the maxilla. A process for manufacturing the apparatus completes the invention.

Description

Oral appliance for improving pulmonary ventilation of a subject and method of performing

TECHNICAL FIELD TO WHICH THE INVENTION REFERS

The present invention relates generally to the field of oral appliances. It relates more particularly to an oral appliance for improving pulmonary ventilation of a subject and essentially night ventilation. It also relates to a method of producing such an apparatus.

BACKGROUND

Nocturnal breathing difficulties or genes, such as snoring or sleep apnea, are common problems. Many techniques are proposed to remove or reduce them. For the most serious, mask systems with assisted ventilation are implemented and this represents a significant cost in health costs. For snoring, it is proposed articulated oral devices that are in practice difficult to support because little anatomical.

Document US-2015/03601 15A1 is also known concerning a mouthguard that "respects physiology". It is made of shock-absorbing material and does not interfere with speech and other activities. It therefore can not, in practice, block the dental arches between them and no protrusion of the mandible is provided. The document US-2009 / 0272387A1 relates to a dental appliance having complete gutters at the level of the molars and thus includes descending returns and internal uprights both up and down which can cause discomfort. The document US-2013 / 0333707A1 relates to a dental appliance with complete aligners on all the two dental arches and is therefore a bulky apparatus particularly uncomfortable. The document US-2012/0199141 A1 concerns a mouthguard and it is not planned to immobilize the dental arches between them because it does not interfere with speaking.

The present invention provides an apparatus which is intended to facilitate ventilation and which is anatomical in that it is adapted to the shape of the dental arches of the subject carrying it and is held in place because of this adaptation.

OBJECT OF THE INVENTION

The present invention therefore provides a dental device for improving the pulmonary ventilation of a subject having a lower dental arch or mandible and an upper or maxillary dental arch, the dental arches having teeth from the rear to the front with teeth. molars, canine premolars and incisors, the dental arches having an external face to the cheeks, lips and mouth of the subject and, on the opposite side, an inner side of the oral cavity and tongue of the subject, the apparatus comprising dental gutters.

According to the invention, the apparatus consists of a block of material approximately in the shape of an arc and having three parts in continuity: a middle part and two side portions, the medial portion being disposed between the two side portions and being configured to be disposed at least behind the incisors and canines of the mandible, each side portion having a lower gutter for teeth of the mandible and at least one outer fin upper to come against the outer face of the upper dental arch, the apparatus being configured so that once in place in the mouth the mandible is blocked in protrusion relative to the maxillary.

Other nonlimiting and advantageous features of the apparatus according to the invention, taken individually or in any technically possible combination, are as follows:

the medial portion further extends forwardly covering at least a portion of the incisors of the mandible, said medial portion forming on at least part of a downwardly open groove,

the apparatus comprises a continuous gutter on teeth of the mandible between the two lateral parts, passing through the middle part,

the block of material is substantially rigid,

the gutters and fins are configured to extend over at least a portion of the corresponding lower and upper teeth located behind the canines, said lower gutters being configured so that said at least a portion of the lower teeth located behind the canines of the mandible can engage in said lower gutters, said upper outer fins being configured to be disposed on the outer face of the upper dental arch, said upper outer fins being configured so that the outer, so-called buccal, faces of said teeth at least a portion of the upper teeth located behind the maxillary canines can be applied against the upper outer fin, and the apparatus is configured so that when the subject has said at least a portion of the lower teeth behind the canines blocked in the lower gutters and the fins ex dermal upper blocked against the outer faces of the teeth of said at least a portion of the upper teeth back of the canines that the subject bites said apparatus, the mandible is blocked in protrusion relative to the maxillary because the upper outer fins blocked prevent backward movement of the apparatus and the mandible,

the apparatus is substantially symmetrical with respect to an anteroposterior vertical median plane,

the protrusion is between 1 mm and 5 mm,

the external fins are made by taking an impression on the subject,

the apparatus comprises at the foot of each of said upper external fins an upper support surface intended to receive the occlusal faces of the corresponding upper teeth, the upper bearing surface at the foot of each upper external fin has imprints of the occlusal faces of the corresponding upper teeth, the upper bearing surface being made by taking an impression on the subject,

when the subject bites the device to block the mandible in protrusion, the occlusal faces of the corresponding teeth respectively apply to the upper bearing surfaces and the bottom of the lower channels,

the lateral parts of the apparatus further comprise upper internal fins, said upper internal fins being configured to be arranged on the inner side of the upper dental arch, said upper internal fins forming with the upper external fins upper gutters, said upper gutters being configured so that said at least a portion of the upper teeth located behind the maxillary canines can engage in said upper gutters and hang thereon,

- In the case of the presence of an upper inner fin, the support surface greater than the foot of the upper outer fin forms the bottom of the upper gutter,

the gutters and fins are further extended in the front to the level of the canines,

the gutters and fins are further extended at the back on all the molars,

the gutters and fins are extended at least on the premolars,

the gutters and fins are extended at least on the premolars and the first molar behind the premolars,

the upper gutters or the upper external fins are extended at least on the upper teeth No 14 to 16 and No 24 to 26, the lower gutters being extended on the corresponding lower teeth,

- Each gutter, lower and possibly upper, has a bottom on which the occlusal faces of the corresponding teeth may come into play, the gutters having been made from taking impressions on the subject,

the gutters are made directly from impressions taken on the subject,

- Gutters are made indirectly from taking impressions on the subject, hard models of the mandible and maxillary being made and used,

the apparatus comprises at the foot of each of said upper external fins an upper support face intended to receive the occlusal faces of the corresponding upper teeth and each lower gutter comprises a lower base on which the occlusal faces of the corresponding lower teeth may come; apply, and the lower bottom and the upper bearing face of each side portion are separated by a given height of material so that when the mandible is blocked in protrusion that the subject bites said apparatus, the upper and lower incisors are separated by a defined non-zero opening height allowing the passage of respiratory gases,

- the opening height is between 5 mm and 10 mm, preferably, the opening height is between 6 mm and 9 mm,

the width of the opening allowing the passage of respiratory gases extends substantially between the teeth No. 13 and 23,

the lower gutters each comprise a lower outer fin and a lower inner fin forming external and internal lateral walls of said lower gutters and for each lateral part of the apparatus, the upper and lower outer and outer fins are substantially in vertical continuity and determined thickness of between 3 mm and 10 mm in order to cause the cheeks to be spaced apart from the dental arches and to tension said cheeks,

the apparatus is in a material which is a plastic material chosen from dental polyacetates, FLEXITE®, VALPLAST®, dental acrylic resins, dental thermoformable plastics, ERKOFLEX®,

the material is substantially transparent or translucent,

- the material is colored in the mass.

The invention also proposes a method for producing a pulmonary ventilation improvement device for a subject, the apparatus being according to the invention and in which process:

- hard models of the mandible and maxillary of the subject are made,

on the hard model of the mandible, a block of wax is carved so as to produce an approximately arcuate shape and having three portions in continuity: a medial portion and two lateral portions, the medial portion being disposed between the two lateral portions and being arranged at least behind the incisors and canines of the model of the mandible, each lateral portion having a lower groove molded around at least a portion of the lower teeth located behind the canines, said gutter being delimited upwards, above occlusal faces of the corresponding teeth, by a wax thickness in which there is a rigid wedge of determined thickness,

in an articulator modelizing the oral articulation, the maxillary model is modeled on the mandible comprising the wax block in order to perform a physical representation of the jaw of the subject and in which at least one protrusion of the mandible relative to the maxillary is present while the teeth of the models tighten the calluses of the two lateral portions of the block of wax,

on the physical representation obtained, on each lateral portion, wax is added on the external, so-called vestibular, surfaces of the teeth of the said at least part of the upper teeth situated behind the canines of the maxillary model, the said wax addition being intended to form upper outer fins,

the wax block is extracted from the physical representation and the said wax block extracted is molded to obtain a mold of the apparatus, and

- A material is molded to form a block of material in the mold of the apparatus and then extracted from said mold the oral device made. Other nonlimiting and advantageous features of the process according to the invention, taken individually or in any technically possible combination, are as follows:

the median portion is arranged in a gutter at least over the incisors of the model of the mandible,

to produce the hard models of the mandible and maxillary of the subject, pre-established standard models are used from a representative population of individuals,

to perform the hard models of the mandible and jaw of the subject, fingerprints made on pre-established lower and upper standard models from a representative population of individuals are used, and for this purpose, the standard lower and lower models are used. upper respectively selected a lower impression of the lower dental arch or mandible and an upper impression of the upper or maxillary dental arch, said indentations for molding said models hard,

- To perform the hard models of the mandible and maxillary of the subject is used impressions made on the subject and for this purpose is made on the subject a lower impression of the lower dental arch or mandible and an upper impression of the upper or maxillary dental arch, said indentations making it possible to mold said models hard,

the imprints on the subject are made with alginates,

- wax is an occlusion wax,

the wedge is intended to prevent the occlusion / complete closure of the model of the mandible against the model of the maxillary and said wedge has a determined thickness such that the upper and lower incisors of the models in the physical representation are separated from a height defined non-zero opening,

the wedge is disposed at the occlusal surfaces of the premolars,

the addition of the wax on the external, so-called vestibular surfaces, of the teeth of the said at least part of the upper teeth situated behind the canines of the maxillary model is performed with a determined thickness of wax of between 3 mm and 10 mm .

DETAILED DESCRIPTION OF AN EXEMPLARY EMBODIMENT

The following description with reference to the accompanying drawings, given as non-limiting examples, will make it clear what the invention consists of and how it can be achieved.

In the attached drawing:

FIG. 1 represents a oral appliance in a perspective view from the rear and from above,

FIG. 2 represents the apparatus of FIG. 1, in perspective view from the front and from above,

FIG. 3 represents a front and partial view of the apparatus of FIG. 1 in relation to functional model with models of the mandible and maxillary of a subject, and - Figures 4 and 5 represent in two orientations, a partially carved wax block arranged on a mandible model of the subject, the block of wax once completely carved making a 1/1 scale model of the camera.

Device

The proposed oral appliance is simple, original and lightweight. In particular, it has no articulation and is related to a minimum of anatomical structures of the subject. It acts through three main actions to improve ventilation, especially night ventilation, and / or reduce or even suppress snoring, These actions are:

1 °) mandibular protrusion,

2 °) the elevation of the occlusion from 6 to 9 mm,

3 °) the improvement of the tissue tonicity at the level of the cheeks and the lips by the swelling of the two vestibular parts of the subject.

If the combination of these actions makes it possible to obtain particularly interesting results, each of these actions or combinations of two of them also makes it possible to obtain useful results.

With regard to the mandibular protrusion allowed by the apparatus of the present invention, it should be noted that it is obtained in a much simpler and more elegant way than in the existing apparatus where the high and low gutters are connected by hinges which force the mandible to close in a certain position. These existing devices are not very comfortable for the patient because of pain caused in the temporomandibular joints, causing awakenings several times at night and causing congestion of the airways.

The oral appliance 1 visible in FIGS. 1 to 3 consists of a block of material approximately in the form of an arc and comprising three parts in continuity: a middle part 2 and two lateral parts, a left lateral part 3G and a part 3D right side. The middle part 2 is arranged in continuity between the two lateral parts 3G, 3D. In this example, the medial portion 2 is configured to be disposed behind the incisors and canines of the mandible. The middle part 2 may, alternatively, be formed of a gutter enclosing the anterior teeth of the mandible in order to better maintain the apparatus 1 in the mouth.

Each side portion 3G, 3D comprises at least one upper outer fin 5G, 5D and a lower gutter 4G, 4D not directly visible in the figures and therefore marked by a dashed arrow, this lower gutter 4G, 4D fitting on at least some of the premolars and molars of the mandible. The upper outer fin 5G, 5D is intended to come against the outer face of the upper dental arch / maxillary. In the apparatus 1, the lower gutters 4G, 4D and the fins External upper 5G, 5D are configured so that once in place in the mouth of a patient the mandible is blocked in protrusion relative to the maxillary.

In fact, the lower 4G, 4D gutters are similar to two downwardly open channels receiving the rear teeth of the mandible, laterally lined channels of internal lower fins 8G, 8D (tongue side) and external 7G, 7D (side). play). The outer upper fins 5G, 5D are in continuity, vertically, the outer lower fins 7G, 7D and together they respectively form two outer left and right outer thicknesses of material intended to spread the cheeks of the jaw and thus stretch the cheeks.

At the upper part of the apparatus 1 shown, there is no gutter proper for the rear teeth of the maxilla, the apparatus is maintained on these teeth by the outer upper fins 5G, 5D. However, in variants not shown, it is also possible to make gutters at the top for the rear teeth of the maxillary and in this case there are upper inner fins which are then in vertical continuity of the inner lower fins 8G, 8D of the lower gutter 4G, 4D.

In order to have the best possible adaptation of the device 1 to the patient's jaw, the bottom of the lower gutters 4G, 4D and the upper faces of the lateral parts 3G, 3D or possible upper gutters which are opposite the occlusal faces teeth have impressions corresponding to these occlusal faces. Likewise, the parts of the fins directed towards the teeth have imprints corresponding to these teeth. In other generic device modalities, there is no imprint and it is the general shapes of the different parts of the apparatus that make it possible to obtain the expected result of at least maintaining protrusion of the mandible .

Alternatively, the areas of the device in contact with the teeth are covered with a substantially flexible or elastic material to allow better maintenance / adaptation especially in the case of a generic device. In other embodiments, this substantially flexible or elastic material may be porous and provision is made to introduce a substance having beneficial properties on the teeth. For example, it can be left in the day, after a possible washing, the device in a solution comprising a bleaching or antibacterial or fluorinated substance which will be incorporated in the porous material and which will be released at night on the teeth during the use of the device set up in the mouth.

As can be understood, in the apparatus of the present invention, there is no hinge and the bottom gutter is light and is surmounted by fins at the level of the premolars and first molars to prevent a beginning of closure mandibulo -axillary in a position other than the mandibular protrusion position. For this, we use the anatomy of the dental arches which are wider behind and narrower on the front. As a reminder, the upper dental arch, called maxillary, overlooks the lower dental arch, called mandible. The upper or maxillary arch that is part of the cranio facial assembly is fixed and the lower arch or mandible is articulated and movable.

The fins are applied to the vestibular surfaces of the upper teeth, No

14 to 16 and 24 to 26, in the desired occlusion ratio in protrusion and these fins force the mandible to go forward, hence protrusion, to begin to close the jaws. In normal occlusion, the fins are found on the occlusal surfaces of the upper teeth and the subject can not close the jaws. On the other hand, by projecting the mandible forward, the latter finds a width of the maxilla weaker given the anatomy of the arches which are narrow in front and the subject can begin to close the jaws.

By a quick and easy learning, the subject ends up memorizing the closed position in protrusion and this becomes almost a reflex with the device in the mouth.

As regards the elevation of the protrusion occlusion, an elevation of 6 to 9 mm is provided depending on the case. This elevation of 6 to 9 mm from the protrusion occlusion makes it possible to create an air path / air passage at the front of the jaws, especially between the teeth No 13 and 23.

It is therefore created an important opening that will overcome the lack of nasal ventilation due to inflammation of the nasal mucosa due to multiple causes: air pollution, smoking, nasal septum bypass, allergy and other problems.

With regard to the swelling of the vestibular parts from 3 to 6 mm by the lower external fins 7G, 7D and 5G, 5D, this makes it possible to overcome the mucosal relaxation and to avoid closure of the oral route. This technique, which is similar to the false gum in the toothless, will help support the cheeks and improve the tone of the whole cheek-lips. It may be noted in this connection that the collapse of the mucous membranes is one of the causes of snoring.

Process

Although it is possible to make a generic device that can adapt to groups of subjects having certain characteristics in common (including dimensions of the oral organs), in the preferred embodiment, the apparatus is adapted to a subject in question. particular.

Thus, the apparatus of the invention can be manufactured in several ways. In particular, it can be considered that the manufacture can be made on generic bases, the apparatus being adapted to groups of individuals having common characteristics concerning their jaws, but it is also possible to manufacture the "customized" apparatus for each subject. In addition, in the very steps of the manufacturing process, these may differ depending on the techniques used. For example, in the case of "made to measure", dental impressions can be taken on the subject or one can use 3D measurement means and 3D reconstruction, including 3D printer, not requiring to intervene in a significant way in the mouth of the subject.

We will therefore present manufacturing processes as examples in the following.

In a conventional procedure with impression taking, two impressions in high alginate (maxillary) and low (mandible) are made in the subject's mouth. Once these two prints obtained, two hard models of the mandible 10 and maxillary 1 1 of the subject are made. For this purpose the alginate impressions are "poured" in the laboratory with for example plaster or another product to achieve these models 10, 1 1 hard.

An occlusion wax is then used to produce a scale model 1/1 wax of the device on these two models hard mandible and maxillary. This occlusion wax 20 is sculpted in an approximately arcuate shape and has three portions in continuity: a middle portion 22 and two lateral portions 23G, 23D. The median portion 22, corresponding to the middle part 2 of the future apparatus, is disposed between the two lateral portions 23G, 23D which correspond to the two lateral parts 3G, 3D of the future apparatus. Each side portion 23G, 23D comprises a lower groove 24G, 24D molded around at least a portion of the lower teeth located behind the canines. The lower 24G, 24D gutters are lined on the tongue side by the internal lower fins 28G, 28D.

The carving of the wax block consists of several actions: casting of the wax on the hard models and addition or manual removal of wax according to the needs, especially if one wishes or not to realize gutters at the top / superior or to be satisfied with the external fins superior for the maxillary.

This occlusion wax 20 comprises in particular a shim 12 of resin of 4 to 5 mm is disposed at the occlusal faces of premolars, on each side, right, left, so that the elevation / opening of the jaws is obtained. In Figure 4 this shim 12 is only visible and referenced left side in the wax block 20 partially carved in the side portion 23G, although such a calle is also present in the right side portion 23D.

This occlusion wax will be able to record at least the occlusion with the centrally protruded mandible and an opening 6 to 9 mm high at the level of the canines No 13 to 23. To this end, the two hard models are placed in an articulator modeling the oral articulation and allowing to place the two models in hard in the indicated relations of protrusion and opening.

Typically, the registration of the occlusion is done by trying the occlusion wax in the mouth, the mouth of the subject, or on hard models in the articulator. The wax bead is heated and the bead is bitten into the centered protrusion position. The resin wedge, the thickness of which can be reduced or increased depending on the case, will prevent total embedment in the wax and will achieve the expected elevation / opening.

It is also possible and preferably, by inflating the vestibular parts, external fins occlusion wax performed, to promote a tone in the lips and cheeks and avoid snoring with the device that will ultimately be obtained . In FIG. 4, only the lower outer fin 27G of the wax block 20 is visible and referenced and the wax block is not yet completely sculpted since its upper part comprises 13G, 13D wax masses which do not have still received the imprints of the hard model of the maxillary 1 1, which will be done once the hard model of the mandible 10 with the block of wax placed in the articulator with the hard model of the maxilla 1 1 and in a relation of protrusion.

The wax model thus produced is fixed in a muffle, according to the usual techniques of dental prosthesis. After taking the plaster introduced into the muffle, the two plaster parts made are scalded to remove any trace of wax. Preferably, the shims will have been removed beforehand and the spaces thus created by wax filled. Then fill the space left empty by the removal of the wax in the two plaster parts with resin, for example acrylic, having taken care to make vents for removal of excess, the resin once taken forming the oral appliance of the invention.

For this, the two parts of the muffle are assembled and pressed at high pressure in a hydraulic press. The muffle is closed and keyed with keys that hold it tight, and is then cooked in a pressure cooker. Another method is to inject the resin under pressure using an injection machine to obtain a more dense resin with less porosity.

The apparatus obtained at the outlet of the muffle is then deburred and polished.

Any type of resin can be used for the realization of the apparatus as long as it is compatible with the manufacture of dental or orthodontic appliances: FLEXITE, VALPLAST, and all types of pink gums or transparent dental poly-acetates, all types of colored or transparent dental acrylic resins, all thermoformable materials type ERKOFLEX + transparent transparent resin or colored.

In the end, it will be enough to unmold, deburr, and polish the resulting device.

In variants, it is possible to make the base of the model made of thermoformable materials type ERKOFLEX or any other removable material, for example calcinable, replacing the wax. We can predict that the intrados is flexible and the extrados is hard. It is possible for the model to achieve the wax fins and the occlusal portion in transparent resin with a silicone key or by setting muffle as described above.

In a method requiring less involvement of the subject, a method is used in the dental CAD / CAM computer to obtain the models, for example example from 3D snapshots of the jaws of the subject or "scanner" dental. These models can then be hard-coated by a 3D printer and the waxing method described above for obtaining the apparatus. However, it is preferred to continue to use the "CAD / CAM" method until the machine is produced in a machine which is then directly produced by a 3D printer. It is understood that part of the machine realization can be automated by a computer program in which the value of the protrusion, the opening and the thickness of the fins can be parameterized, the program using the 3D model of the jaw from subject. 3D printers can be 3D machiners.

It is also possible to start from a thin thermoplastic plate intended to form the framework of the oral appliance: the plate forming the middle part and being completed by adding material to form the two lateral parts 3G, 3D. This plate can play the role of the rigid wedge of determined thickness to obtain the raised / the planned opening of the jaw of the subject. In the middle part, the plate after shaping can remain confined to the rear part of the anterior teeth of the mandible or come to form a gutter. This formatting can be done easily on a hard model of the mandible.

Claims

1. Oral apparatus (1) for improving pulmonary ventilation of a subject having a lower dental arch or mandible and an upper or maxillary dental arch, the dental arches having teeth from the back to the front with molars, premolar canines and incisors, the dental arches having an external face towards the cheeks, lips and mouth of the subject and, on the opposite side, an internal face on the oral cavity and tongue of the subject, the apparatus comprising dental gutters,

characterized in that it consists of a block of material approximately arc-shaped and having three parts in continuity: a middle part (2) and two side parts (3G, 3D), the middle part (2) being disposed between the two lateral portions (3G, 3D) and being configured to be arranged at least behind the incisors and canines of the mandible, each lateral portion (3G, 3D) having a lower gutter (4G, 4D) for teeth of the mandible and at least one upper outer fin (5G, 5D) for coming against the outer face of the upper dental arch, the apparatus (1) being configured so that once in place in the mouth the mandible is blocked in protrusion relative to the maxillary, and in that the lower gutters (4G, 4D) each comprise a lower outer fin (7G, 7D) and a lower inner fin (8G, 8D) forming external and internal lateral walls of said lower gutters (4G). , 4D) and in that for each lateral part (3G, 3D) of the apparatus, the lower outer (7G, 7D) and upper outer (5G, 5D) vanes are substantially in vertical continuity and of predetermined thickness between 3 mm and 10 mm to cause a separation of the cheeks relative to the dental arches and to stretch said cheeks.

2. Apparatus (1) according to claim 1, characterized in that the gutters (4G, 4D) and the fins (5G, 5D) are configured to extend over at least a portion of the corresponding lower and upper teeth located behind canines, said lower gutters (4G, 4D) being configured so that said at least a portion of the lower teeth behind the canines of the mandible can engage said lower gutters (4G, 4D), said upper outer fins ( 5G, 5D) being configured to be disposed on the outer side of the upper dental arch, said upper outer wings (5G, 5D) being configured so that the outer, so-called vestibular, faces of the teeth of said at least a portion of the upper teeth behind the maxillary canines can be applied against the upper outer fin (5G, 5D), and that the apparatus (1) is configured so that when the subject has said at least a portion of the lower teeth behind the canines blocked in the lower grooves (4G, 4D) and the upper outer wings (5G, 5D) locked against the outer faces of the teeth of said at least a portion of the teeth superior back of the canines because the subject bites said device (1), the mandible is locked in protrusion relative to the maxillary because the upper outer wings (5G, 5D) blocked prevent the rearward recoil of the apparatus (1) and the mandible.

3. Apparatus (1) according to claim 1 or claim 2, characterized in that the lateral parts (3G, 3D) of the apparatus further comprise upper internal fins, said upper internal fins being configured to be arranged on the front side. internal upper dental arch, said upper internal fins forming with the upper outer fins (5G, 5D) upper gutters, said upper gutters being configured so that said at least a portion of the upper teeth located behind the maxillary canines can engage in said upper gutters and get stuck.

4. Apparatus (1) according to any one of the preceding claims, characterized in that each gutter (4G, 4D) has a bottom on which the occlusal faces of the corresponding teeth can come into play, the gutters having been made from taking impressions on the subject.

5. Apparatus (1) according to any one of the preceding claims, characterized in that it comprises at the foot of each of said upper outer fins (5G, 5D) an upper bearing face (6G, 6D) for receiving the occlusal faces of the corresponding upper teeth and each lower gutter (4G, 4D) has a lower bottom on which the occlusal faces of the corresponding lower teeth may come to apply, and in that the lower bottom and the upper bearing face of each lateral part (3G, 3D) are separated from a given height of material so that when the mandible is blocked in protrusion because the subject bites said apparatus, the upper and lower incisors are separated by a non-zero opening height determined allowing the passage of respiratory gases.

6. Apparatus (1) according to claim 5, characterized by a predetermined height of material between the lower bottom and the upper bearing surface of each side portion such that when the mandible is blocked in protrusion that the subject bites said apparatus the upper and lower incisors are separated by an opening height of between 5 mm and 10 mm.

7. A method of producing a device (1) for improving pulmonary ventilation of a subject, the apparatus (1) being according to any one of the preceding claims and wherein the method: hard models of the mandible (10) and maxillary (1 1) of the subject are produced,

- on the hard model of the mandible (10) is carved a wax block (20) to achieve an approximately arcuate shape and having three portions in continuity: a middle portion (22) and two side portions (23G, 23D ), the medial portion (22) being disposed between the two lateral portions (23G, 23D) and being arranged at least behind the incisors and canines of the model of the mandible (1 1), each lateral portion (23G, 23D) comprising a lower groove (24G, 24D) molded around at least a portion of the lower teeth located behind the canines, said groove (24G, 24D) being delimited upwards, above the occlusal faces of the corresponding teeth, by a wax thickness in which there is a wedge (12) rigid of determined thickness,

the model of the maxillary (1 1) on the model of the mandible (10) comprising the wax block (20) is placed in an articulator modeling the oral articulation in order to make a physical representation of the jaw of the subject and in which at least one protrusion of the mandible with respect to the maxilla is present while the teeth of the models tighten the calluses of the two lateral portions of the wax block (20),

on the physical representation obtained, on each lateral portion (23G, 23D), wax is added on the external, so-called vestibular, faces of the teeth of said at least a portion of the upper teeth situated behind the canines of the maxillary model said waxing being intended to form upper outer fins,

- A material is molded to form a block of material in the mold of the apparatus and then extracted from said mold the device (1) performed oral.

8. Method according to claim 7, characterized in that the wedge (12) is intended to prevent the occlusion / complete closure of the model of the mandible against the model of the maxillary and said wedge has a determined thickness such that the upper incisors and lower models in the physical representation are separated from a determined non-zero aperture height.

9. The method of claim 7 or claim 8, characterized in that the addition of wax on the outer surfaces, said vestibular teeth of said at least a portion of the upper teeth located behind the canines of the maxillary model. is carried out with a determined thickness of wax of between 3 mm and 10 mm.