Mandibular advancement devices used with morning occlusal guides for treating obstructive sleep apnea-changed incisor inclination and its associated factors.

Abstract

Mandibular advancement devices (MADs) effectively treat patients withobstructive sleep apnea (OSA). Although the use of morning occlusal guides (MOGs) along with MADs is recommended to prevent dental side effects, there is no evidence to support this. The aim of this study was to evaluate the change in incisor inclination in patients withOSA treated with MADs and MOGs, and to identify its predictive factors. Patients with OSA who received MAD and MOG therapy and had a reduction in their apnea-hypopnea index greater than 50% were analyzed. Cephalometric measurements were performed at baseline and at a 1-year follow-up or longerto assess the dentoskeletal side effects of MAD/MOG treatment. Multivariable linear regression analysis was used to assess the association between the change in incisor inclination and the independent variables that may cause the observed side effects. Among 23 patients enrolled in the study, there was significant upper incisor retroclination (U1-SN: 2.83° ± 2.68°, U1-PP: 2.86° ± 2.46°; P < 0.05) and significant lower incisor proclination (L1-SN: 3.04° ± 3.29°, L1-MP: 1.74° ± 3.13°; P < 0.05). However, no significant skeletal changes were observed. Multivariable linear regression revealed that advancement ≥ 95% of the patients' maximal mandibular protrusion was associated with greater upper incisor retroclination. Increased treatment duration was alsoassociated with increased upper incisor retroclination. No \measured variables were associated with the change in lower incisor inclination. Dental side effects occurred in patients who used MADs with MOGs. The amount of mandibular protrusion by MADs and treatment duration were predictive factors associated with upper incisor retroclination.