Mandibular Advancement Splint Use Research Articles

Preferences and experiences regarding the treatment of obstructive sleep apnea with mandibular advancement splints - a cross-sectional pilot survey

ABSTRACT Objective To obtain a current overview of the use of mandibular advancement splints (MAS) as a therapeutic option for obstructive sleep apnea (OSA) in the dental profession in Northern Germany. Methods A questionnaire was mailed to 2431 dental professionals, and 8.3% responded. Descriptive data analysis was performed on each question separately. Results Most of the surveyed dentists (51.7%) estimated the success rate of MAS therapy to be higher than 75%. Analysis of the relationship between the number of splints prescribed annually and the dental specialization (p = 0.22), work experience (p = 0.14), estimated success rate of MAS therapy (p = 0.96), and discontinuation of MAS therapy (p = 0.57) revealed no significant correlations. Conclusion Mandibular advancement splints seem to be a safe and successful therapy for OSA. There seems to be a lack of information on the patient side and a lack of education on the dentist side.

Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review.

ABSTRACTIntroduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

Nasoendoscopic evaluation in adult OSA to predict outcomes in mandibular advancement splint use

Nasoendoscopic evaluation in adult OSA to predict outcomes in mandibular advancement splint use

The long-term effects of mandibular advancement splint on cardiovascular fitness and psychomotor performance in patients with mild to moderate obstructive sleep apnea: a prospective study.

Obstructive sleep apnea (OSA) manifests as a reduction or complete cessation of airflow despite an ongoing inspiratory effort, leading to hypoxemia and hypercapnia. The inability to maintain normal breathing reduces the oxygen saturation in blood leading to a cycle of various systemic implications. Hence, a prospective single arm study was planned to evaluate the long-term (2years) effect of oral appliance on cardiovascular fitness and psychomotor performance in patients with mild to moderate obstructive sleep apnea. Thirty dentulous OSA patients (25 males; 5 females; age 41±4years; BMI 22±5; AHI 5-30) were included in the study. All the patients were assessed for systolic blood pressure (SBP), diastolic blood pressure (DBP), apnea/hypopnea index (AHI), lipid peroxidation, and psychomotor vigilance test at baseline, 6months, 1year, and 2years after wearing mandibular advancement splint (MAS). A significant reduction in AHI, blood pressure, and lipid peroxidation was observed following MAS use. Psychomotor vigilance test showed marked improvement in response time with almost 0 count of lapses after 2years of MAS use. The present study suggested that MAS can be helpful in improving cardiovascular fitness and cognitive response in patients with mild to moderate OSA.

Craniofacial characteristics of successful responders to mandibular advancement splint therapy: a pilot study

Cephalometric variables that can be used to identify patients with obstructive sleep apnoea who are suitable for mandibular advancement splints and surgical maxillomandibular advancement are lacking. The aim of this pilot study was to describe the craniofacial characteristics of patients whose symptoms of obstructive sleep apnoea were successfully treated with mandibular advancement splints and who were subsequently considered for maxillomandibular advancement. We retrospectively compared the craniofacial characteristics of our patients with data from 2 previously published studies. There were significant differences between the 2 groups for ANB (p<0.000), overjet (p<0.0001), Go–Me (p<0.0002), and ANS–PNS (p<0.0009). Patients, whose symptoms improve with the use of mandibular advancement splints and are potential candidates for maxillomandibular advancement, may have unique craniofacial features consisting of bimaxillary retrusion characterised by a shorter maxilla and mandible, and a greater class II skeletal tendency. The results of this study should be viewed as a pilot. Further research is required.

Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

CPAP is used as the first-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP. Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months. Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m² completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased significantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no significant differences in SAQLI between MAS and CPAP treatment, while ESS decreased significantly on MAS. MAS self-reported usage was correlated with treatment efficacy (r = 0.52; p < 0.05). Seventy-five percent of the patients reported being sufficiently satisfied with MAS to continue to use it as an alternative short-term therapy. MAS partially or completely reduced sleep disordered breathing in the majority of selected, successfully CPAP-treated severe OSA patients. Many patients can probably effectively use MAS as a short-term treatment alternative to CPAP.

Complexity and Efficacy of Mandibular Advancement Splints: Understanding their Mode of Action

Complexity and Efficacy of Mandibular Advancement Splints: Understanding their Mode of Action

Surgical procedures and non‐surgical devices for the management of non‐apnoeic snoring: a systematic review of clinical effects and associated treatment costs

Objectives To review the evidence on the clinical effects and associated treatment costs of surgical procedures and non-surgical devices for the management of non-apnoeic snoring. Data sources Major electronic databases were searched for relevant studies published between 1980 and 2007. All treatment costs were estimated based on data from NHS reference costs, device manufacturers and clinical opinion. Review methods Studies were screened, data extracted and quality assessed according to standard methods. Results were broadly grouped according to the intervention and comparator when applicable, and further subgrouped according to the specific intervention type and study design. Results were combined using a narrative synthesis with relevant quantitative results tabulated. Differences between studies assessing the same intervention were explored narratively by examining differences in the intervention, study duration and study quality. Results The systematic review included 27 studies (three randomised controlled trials, two controlled clinical trials and 22 pre-post studies) reported in 30 publications assessing uvulopalatopharyngoplasty (UP3) versus laser-assisted uvulopalatoplasty (LAUP), UP3 alone, LAUP alone, palatal stiffening techniques (Pillar implants and injection snoreplasty), radiofrequency ablation (RFA) of the soft palate or tongue base, continuous positive airway pressure (CPAP) devices and mandibular advancement splints (MAS). Studies were generally of a low methodological quality with small sample sizes. A total of 1191 patients was included. Both UP3 and LAUP reduced the number of snores per hour and produced a modest reduction in snoring loudness. UP3 was effective in reducing a number of subjectively reported snoring indices, but results on objective measures were equivocal. Limited evidence indicates that subjectively assessed snoring is improved after LAUP; no objective measures were assessed. RFA was associated with a reduction in partner-assessed snoring intensity, though evidence for an objective reduction in snoring sound levels was mixed. Pillar implants were moderately effective at reducing partner-rated snoring intensity, but had no effect on objective snoring indices. Use of CPAP reduced the number of snores per hour; no subjective measures were evaluated. Use of MAS improved objective snoring outcomes, including the maximal snoring sound volume, the mean snoring sound volume and the percentage of time spent in loud snoring; no subjective measures were evaluated. The cost for UP3 ranges from approximately 1230 pounds to approximately 1550 pounds. For LAUP the cost varies from 790 pounds to 2070 pounds depending on the number of stages of the procedure. The treatment costs associated with the use of Pillar implants range from 1110 pounds to 1160 pounds. The approximate annual treatment costs associated with the use of a CPAP machine and MAS are 220 pounds and 130 pounds respectively. Conclusions This study highlighted the paucity and poor quality of the evidence available on the effects of both surgical procedures and non-surgical devices for the management of primary snoring. Any conclusions to be drawn from the results are therefore somewhat tentative. There was no procedure that was clearly the least-cost option. Further research should focus on standardising methods of measuring outcomes and reporting, undertaking active controlled trials, and investigating the longer-term effects of treatments.

Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment costs

To review the evidence on the clinical effects and associated treatment costs of surgical procedures and non-surgical devices for the management of non-apnoeic snoring. Major electronic databases were searched for relevant studies published between 1980 and 2007. All treatment costs were estimated based on data from NHS reference costs, device manufacturers and clinical opinion. Studies were screened, data extracted and quality assessed according to standard methods. Results were broadly grouped according to the intervention and comparator when applicable, and further subgrouped according to the specific intervention type and study design. Results were combined using a narrative synthesis with relevant quantitative results tabulated. Differences between studies assessing the same intervention were explored narratively by examining differences in the intervention, study duration and study quality. The systematic review included 27 studies (three randomised controlled trials, two controlled clinical trials and 22 pre-post studies) reported in 30 publications assessing uvulopalatopharyngoplasty (UP3) versus laser-assisted uvulopalatoplasty (LAUP), UP3 alone, LAUP alone, palatal stiffening techniques (Pillar implants and injection snoreplasty), radiofrequency ablation (RFA) of the soft palate or tongue base, continuous positive airway pressure (CPAP) devices and mandibular advancement splints (MAS). Studies were generally of a low methodological quality with small sample sizes. A total of 1191 patients was included. Both UP3 and LAUP reduced the number of snores per hour and produced a modest reduction in snoring loudness. UP3 was effective in reducing a number of subjectively reported snoring indices, but results on objective measures were equivocal. Limited evidence indicates that subjectively assessed snoring is improved after LAUP; no objective measures were assessed. RFA was associated with a reduction in partner-assessed snoring intensity, though evidence for an objective reduction in snoring sound levels was mixed. Pillar implants were moderately effective at reducing partner-rated snoring intensity, but had no effect on objective snoring indices. Use of CPAP reduced the number of snores per hour; no subjective measures were evaluated. Use of MAS improved objective snoring outcomes, including the maximal snoring sound volume, the mean snoring sound volume and the percentage of time spent in loud snoring; no subjective measures were evaluated. The cost for UP3 ranges from approximately 1230 pounds to approximately 1550 pounds. For LAUP the cost varies from 790 pounds to 2070 pounds depending on the number of stages of the procedure. The treatment costs associated with the use of Pillar implants range from 1110 pounds to 1160 pounds. The approximate annual treatment costs associated with the use of a CPAP machine and MAS are 220 pounds and 130 pounds respectively. This study highlighted the paucity and poor quality of the evidence available on the effects of both surgical procedures and non-surgical devices for the management of primary snoring. Any conclusions to be drawn from the results are therefore somewhat tentative. There was no procedure that was clearly the least-cost option. Further research should focus on standardising methods of measuring outcomes and reporting, undertaking active controlled trials, and investigating the longer-term effects of treatments.

A follow-up study of dental and skeletal changes associated with mandibular advancement splint use in obstructive sleep apnea

Mandibular advancement splints (MAS) are a recognized therapeutic option in the treatment of obstructive sleep apnea (OSA). This study aimed to investigate side effects and possible changes in the dentofacial complex associated with long term use of MAS. The sample included 64 patients with OSA who had been using MAS on average for 25.1 +/- 11.8 months (range, 10.7-64.5 months). A specifically designed questionnaire was used to investigate the patients' self-assessment of the side effects of wearing MAS; cephalometric analyses and dental cast measurements were conducted to identify objectively dental and skeletal changes caused by MAS over time. The most commonly reported side effects were jaw discomfort, tooth tenderness, excessive salivation, and dry mouth. Subjectively, snoring improved in 56 patients (88%), and daytime sleepiness (Epworth sleepiness scale) scores significantly decreased from pretreatment to follow-up (11.4-7.1, P <.001). Small subjective occlusal changes were experienced by 8 patients (12.5%). Reductions in overbite (-0.3 +/- 0.08 mm, P <.01) and overjet (-0.2 +/- 0.06 mm, P <.05) were found, and cephalometric analysis showed statistically significant but clinically insignificant changes limited to anterior movement of the mandibular incisors (0.5 +/- 0.12 mm, P <.001). Side effects of MAS use over long periods are common but mild and well tolerated by most patients, and dentofacial changes are negligible.

Dental side‐effects of mandibular advancement splint wear in patients who snore

(a) To evaluate the longer term orthodontic side-effects of a Herbst mandibular advancement splint (MAS) in subjects with sleep disordered breathing. (b) To determine whether these are related to dental occlusion, degree of mandibular advancement or duration of appliance wear. Retrospective, cohort study. Teaching hospital dental school. Subjects with sleep disordered breathing who had been wearing an MAS regularly (a minimum of 5 h per night, six nights a week) for at least 2 years. Of 192 subjects who were identified, 30 fulfilled the inclusion criteria and were prepared to attend for review. Dental casts were obtained and BMI and Epworth Sleepiness Scale scores recorded. These data were compared with those collected when the subject was first referred. A questionnaire was completed concerning MAS use, side-effects and any problems associated with the device. Changes in incisor tooth position. Median duration of MAS wear was 3.64 years. Small, statistically significant reductions in both vertical (-0.4 mm) and horizontal (-0.5 mm) overlap of the incisor teeth were found. This correlated with the degree of vertical opening of the MAS but was not related to the amount of mandibular protrusion or the duration of appliance wear. Patients who are considered suitable for MAS should be warned that dental changes may occur. Thus referring surgeons should also be aware of this possibility.

Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey.

A mandibular advancement splint (MAS) may be an alternative treatment for snoring and obstructive sleep apnoea (OSA). However, there is little subjective or objective information concerning long-term effectiveness, compliance and side effects. A retrospective questionnaire was used to survey these issues plus patient satisfaction and maintenance requirements in 166 patients who could have worn a mandibular advancement splint for over a year. One-hundred and twenty-six (76%) subjects returned the questionnaire, (84 with OSA, 42 snorers), of whom 69 (55%) reported still using the splint regularly, 47 (37%) every night. The most common reported reasons for stopping use were discomfort (29/ 57; 52%) of nonusers), and poor perceived efficacy (12 subjects). Users reported more daytime symptoms, and they and their partners were more likely to observe improvements with splint use. Side effects were reported by 49 subjects, more commonly in nonusers. Sixty-five of 67 current users and 23 of 41 nonusers reported less snoring with splint use (p = < 0.001). Long-term mandibular advancement splint usage appeared less satisfactory than previously reported, however, splints were considered effective by 97% of current users and even by over half of those who had stopped use. Reasons for stopping use included side effects, social circumstances, dental treatment, as well as lack of perceived efficacy.

An investigation into the changes in airway dimension and the efficacy of mandibular advancement appliances in subjects with obstructive sleep apnoea.

This prospective clinical study evaluates a group of 37 male Caucasians with obstructive sleep apnoea for changes in airway dimension and the efficacy associated with the use of mandibular advancement splints. Lateral skull radiographs were obtained with the subjects--upright in occlusion, supine in occlusion, and supine in protrusion. Each radiograph was traced and digitized, and changes in mandibular position, airway dimensions, and hyoid were examined. Subjects were invited to complete pre- and post-treatment questionnaires, and interviewed following fitting of a removable Herbst mandibular advancement splint. Significant changes were recorded in the airway dimensions in response to both a change in position, from upright to supine, and in response to mandibular advancement. A compliance rate of 76 per cent was achieved with no reported serious complications associated with the use of mandibular advancement devices.