Use Of Mandibular Advancement Devices Research Articles

Evaluation of condylar and mandibular movements on the upper airway during the use of mandibular advancement device for obstructive sleep apnea treatment.

To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment. Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed. Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation. Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation. Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.

Treatment-emergent central sleep apnea (TECSA) with chronic use of mandibular advancement devices (MADs): Case series study

Treatment-emergent central sleep apnea (TECSA) with chronic use of mandibular advancement devices (MADs): Case series study

A new design of individual mandibular advancement device in the treatment of obstructive sleep apnea

Introduction. Mandibular advancement devices are used in the treatment of mild to moderate obstructive sleep apnea. We have created different types of devices over the years and come up with a design of an acrylic two-part adjustable device as the best one so far. New design of the mandibular advancement device. A 36-year-old male patient has been referred for polysomnography to the Sleep Medicine Center of the Institute of Pulmonary Diseases of Vojvodina due to primary problems in the form of drowsiness during the day, reduced concentration and witnessed cessation of breathing during sleep. By evaluating respiratory parameters, the patient was diagnosed with mild obstructive sleep apnea with an Apnea-Hypopnea Index of 10.3. Hygienicdietary regimen of life and the use of mandibular advancement device were prescribed to the patient. Control polysomnography was performed six months after the use of the mandibular advancement device. Evaluation of respiratory parameters has registered the apnea-hypopnea index of 6.2 with predominant hypopneas. The average oxygen blood saturation was 94.4%. Snoring was mild and rare. Patient did not have any long-term side effects of the device and he got used to it easily. Conclusion. Mandibular advancement device is an effective way to treat obstructive sleep apnea in clearly indicated cases. Dentists who indicate and make it must be well educated, informed and they must cooperate with the sleep medicine centers to monitor the effectiveness of the therapy.

Dental and Occlusal Changes during Mandibular Advancement Device Therapy in Japanese Patients with Obstructive Sleep Apnea: Four Years Follow-Up.

Dentoskeletal changes caused by the long-term use of mandibular advancement devices (MADs) for obstructive sleep apnea (OSA) have rarely been investigated in Japan. We assessed the long-term dentofacial morphological changes in 15 Japanese patients with OSA who used two-piece MADs for an average of 4 years. Lateral cephalography analyses were performed initially and 4 years later (T1). The dental assessment included overjet, overbite, upper anterior facial height, lower anterior facial height (LAFH), total anterior facial height (TAFH), and anterior facial height ratio. Dental casts were digitized and analyzed using a 3D scanner. Changes in the apnea hypopnea index (AHI) and other sleep-assessment indices were assessed using polysomnography and out-of-center sleep testing. Radiography revealed lingual inclination of the maxillary central incisors, labial inclination of the mandibular central incisors, clockwise rotation of the mandible, and an increase in the TAFH and LAFH at T1. In the dental cast analysis, the diameter width and palatal depth tended to decrease and increase, respectively. There was a significant decrease in the AHI and other sleep assessment indices after using the MADs for approximately 4 years. However, these findings do not provide a strong basis and should be interpreted cautiously. Future studies should have a larger sample size and should further investigate the long-term occlusal and dental changes caused by the original MADs in Japanese patients with OSA.

Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea.

Rationale: Mouth breathing increases upper airway collapsibility, leading to decreased efficacy of obstructive sleep apnea (OSA) treatments. We hypothesized that the use of mandibular advancement devices (MAD) increases mouth breathing, and thus, using an adhesive mouthpiece (AMT) to prevent mouth breathing in combination with MAD can improve the treatment efficacy. Objectives: To evaluate the efficacy of MAD + AMT in comparison with MAD alone. Methods: A prospective crossover pilot study was designed to test this hypothesis. Briefly, adult participants with an apnea-hypopnea index (AHI) between 10 and 50 events/h at the screening visit were randomized to no treatment (baseline), MAD treatment, AMT treatment, and MAD + AMT treatment. As a primary analysis, absolute AHI was compared between MAD and MAD + AMT arms. Secondary analyses included quantifying the percent change in AHI, percentage of complete (AHI < 5 events/h) and incomplete (5-10 events/h) responders, and the efficacy of AMT alone in comparison with other treatment arms. Results: A total of 21 participants were included (baseline AHI = 24.3 ± 9.9 events/h). The median AHI (interquartile range) in the MAD and MAD + AMT arms were 10.5 (5.4-19.6) events/h and 5.6 (2.2-11.7) events/h (P = 0.02), respectively. A total of 76% of individuals achieved an AHI of <10 events/h in the MAD + AMT arm versus 43% in the MAD arm (P < 0.01). Finally, the observed effect was similar in moderate to severe OSA (AHI ⩾ 15 events/h) in terms of absolute reduction and treatment responders, and AMT alone did not significantly reduce the AHI compared with baseline. Conclusions: A combination of an adhesive mouthpiece and MAD is a more effective therapy than MAD alone. These findings may help improve clinical decision making in sleep apnea.

Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea.

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

The use of mandibular advancement devices in adult patients affected by obstructive sleep apnea syndrome: our experience with Thornton Adjustable Positioner® splint.

Obstructive sleep apnea syndrome (OSAS) is a sleep-related disorder resulting in apneic and hypopneic episodes during sleep. The purpose of this article was to present and discuss our experience with the Thornton Adjustable Positioner® (TAP) Splint (Scheu-Dental GmbH, Iserlohn, Germany; Orthosystem, Milan, Italy) in a consecutive series of patients affected by OSAS. The data of all patients affected by OSAS and with indication to oral appliance (OA) treatment at the Department of Dentistry of the Hospital of Vercelli between January 1, 2019, and December 31, 2019, were collected. The following data were recorded for each patient: gender, age, smoke and/or alcohol assumption, BMI, comorbidities and current pharmacological therapy, initial AHI, OSAS category, eventual performed OSAS treatment options before OA treatment, indication to OA treatment, final AHI following OA treatment, complications and side effects. A total of 18 subjects (11 men, 7 women) with a mean age of 58.8 years were enrolled in this study with a mean AHI of 27.9 (range 5.884). Average BMI was 29. OA treatment reduced AHI in all patients (mean post treatment AHI: 5; range: 3.1-8). All patients were satisfied with the subjective improvement of OSAS symptoms. Our results confirm the usefulness of a specific type of mandibular advancement device that can be considered as a valuable therapeutic modality in OSAS patients. Side effects are limited, and they usually do not decrease the compliance of patients.

Does the Stomatognathic System Adapt to Changes in Occlusion? Best Evidence Consensus Statement.

The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature on the stomatognathic system's ability to adapt to occlusal changes. The search term stomatognathic system was not useful as it resulted in over 400,000 results nor was the search term temporomandibular joint adaptation with 738 results due to the large number of references not related to the topic. The terms stomatognathic system adaptation to occlusal changes (186 results), teeth flexion (139 results), muscle adaptation to dental occlusion (278 results), and occlusal changes and neuroplasticity (11 results) provided the best selection of articles related to the topic. Limiting the above searches to systematic reviews and randomized controlled clinical trials resulted in multiple publications that were related to the question.9-13 Other literature reviews, data-based publications, and expert opinion resources have been included due to their relationship to the question. From the extensive list of search results, 242 articles were determined to be potentially related to the focus question and were evaluated with 56 being included in this paper. It was determined that the stomatognathic system adapts to occlusal changes through the temporomandibular joint, muscles, teeth and bone. The dynamically modified periosteum on the articulator surfaces of the condyle and fossa has a unique load-bearing morphology with 3 subarticular layers of fibrocartilage that absorb and dissipate both peak (impact) and sustained loads. Adaptability of the TMJs and muscles can be documented through studies where artificially produced occlusal interferences were placed in patients and those study participants with normal temporomandibular joints (TMJs) adapted fairly well whereas those with a previous history of temporomandibular disorders (TMD) did not adapt as well. Available evidence indicates patients generally adapt to the occlusal change inherent in orthodontic treatment, mandibular advancement surgery, and the use of mandibular advancement devices. The head and neck muscles also adapt to occlusal changes in patients without a history of TMD. The dentition adapts to changes through the bone and periodontal ligaments as well as the ability of teeth to undergo slight flexion under masticatory loading. This article is protected by copyright. All rights reserved.

Há alterações dentoesqueléticas no tratamento a longo prazo da apneia obstrutiva do sono com aparelho para avanço mandibular?

A síndrome da apneia obstrutiva do sono caracteriza-se por repetidos episódios de parada momentânea da respiração, durante o sono, resultando em severas alterações sistêmicas. Há diferentes abordagens para a terapia desta síndrome, dependentes da severidade da mesma. Nas de grau suave ou moderada pode-se indicar uma terapia com aparelhos para avanços mandibulares, associados ou não às máscaras de bombeamento positivo e contínuo de ar nas vias aéreas. Há relatos na literatura indicando o surgimento de mordida cruzada na região dos pré-molares e diminuição do overjet e do overbite, devido à lingualização dos incisivos superiores e vestibularização dos incisivos inferiores, principalmente se o período de utilização do aparelho para avanço mandibular for maior que 3 anos. Este trabalho relata as alterações dentoesqueléticas promovidas pela utilização durante 5 anos de um aparelho intrabucal para avanço mandibular, em um paciente adulto, com quadro de ronco noturno. Pelas análises cefalométricas realizadas ao início do tratamento e após o tempo apresentado, observa-se que as alterações ocorridas não apresentaram relevância clínica. Assim, pode-se esperar que a utilização de aparelhos para avanço mandibular no tratamento da apneia obstrutiva do sono não promove alterações dentoesqueléticas significativas.

The effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnoea in adults: a methodological quality assessment of systematic reviews.

There is growing interest in the use of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnoea (OSA). Many systematic reviews (SRs) have investigated their effectiveness, but the applicability of SR results is affected by their methodological quality. This study critically appraises the methodological quality of SRs on this topic using a more detailed and updated version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR). The literature was searched for SRs on MAD effectiveness in adults (≥18 years of age) for OSA treatment as compared with other non-surgical or surgical interventions or no intervention. Any objective or subjective measures of treatment outcome were considered eligible. AMSTAR2 was used to assess methodological quality. The literature search yielded 64 potential reports; 10 met the eligibility criteria. All SRs had more than one critical flaw in AMSTAR2, so their methodological quality was rated as critically low. The most common issues included non-registration of study protocol, absence of list of excluded studies, no acknowledgment of fundings of included studies, no impact of risk of bias on SR results or interpretation and discussion of results, and data extraction not in duplicate. If a SR was not clearly identified by title or abstract as a SR or meta-analysis, it may have been missed during the screening process. The methodological quality of SRs was suboptimal and warrants further improvement in order to provide strong evidence of MAD effectiveness and increase applicability of SR results for clinical decision-making.

The use of mandibular advancement devices in obstructive sleep apnea: a proven and effective therapy

The use of mandibular advancement devices in obstructive sleep apnea: a proven and effective therapy

Long-term use of mandibular advancement devices for the treatment of obstructive sleep apnea: A systematic review of craniofacial changes

Objective: The aim of this study is to identify the craniofacial changes of long term use of Mandibular Advancement Devices (MAD) for Obstructive Sleep Apnea (OSA) treatment trough a systematic review of the literature.&#x0D; Materials and methods: A systematic review was performed assessing the following electronic databases: PubMed, EBSCOhost, The Cochrane Library and EMBASE,between January 2000 and May 2014, human studies and english language. Inclusion and exclusion criteria were applied to the results. Selected articles were evaluated with the use of an international check list related to the type of the study (CONSORT). A classification of the level of evidence and the degree of recommendation were performed trough the SORT strategy.&#x0D; Results: 1383 articles were identified after the initial search. After applying the criteria selection and complete the check list selected (CONSORT) only 1 study fulfilled the inclusion criteria. A classification of the level of evidence and grade of recommendation were performed by using the SORT strategy to the selected article.&#x0D; Conclusions: No enough body of evidence were found in this study to identify the craniofacial changes with the long term use of Mandibular Advancement Devices for the treatment of Obstructive Sleep Apnea.

Effect of mandibular advancement device on sleep bruxism score and sleep quality

Statement of problemThe use of mandibular advancement devices (MADs) in the treatment of sleep bruxism is gaining widespread importance. However, the effects of MADs on sleep bruxism scores, sleep quality, and occlusal force are not clear. PurposeThe purpose of this clinical study was to analyze the effect of MADs on sleep bruxism scores, sleep quality, and occlusal force. Material and methodsThis uncontrolled before and after study enrolled 30 participants with sleep bruxism. Outcomes assessed were sleep quality, sleep bruxism scores (sleep bruxism bursts and sleep bruxism episodes/hour), and occlusal force before and after 15 and 30 days of using a MAD. Sleep bruxism scores were assessed by ambulatory polysomnography and sleep quality by using the Pittsburgh sleep quality index (PSQI). Occlusal force was recorded by using a digital gnathodynamometer in the first molar region on both sides. Statistical analysis was done by 1-factor repeated measures ANOVA (α=.05). ResultsStatistically significant reductions in sleep bruxism bursts/h, sleep bruxism episodes/h, and PSQI scores were found after 15 and 30 days of using a MAD (P<.001). Statistically significant reduction in occlusal force on both sides was found only after 15 days (P<.001) but not after 30 days of using a MAD (P=.292 on left side, and P=.575 on the right side). ConclusionsThe study showed a short-term improvement in sleep bruxism scores, sleep quality, and reduction in occlusal force in sleep bruxism participants after using MADs.

Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: A pilot study.

BackgroundThe current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Aim: the objective of the present study was to evaluate MAAs in children with OSA.Material and MethodsChildren presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children’s maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup.ResultsThere was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups.ConclusionsThere was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices. Key words:Mandibular advancement appliance, obstructive sleep apnea.

Non-CPAP therapies in obstructive sleep apnoea

In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

Position paper on the use of mandibular advancement devices in adults with sleep-related breathing disorders. A position paper of the German Society of Dental Sleep Medicine (Deutsche Gesellschaft Zahnaerztliche Schlafmedizin, DGZS).

Custom-made mandibular advancement devices are an effective treatment option for snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). Evidence-based data indicates their efficacy, and international sleep societies recommend oral appliance (OA) therapy for patients with sleep-related breathing disorders. The following position paper by the German Society of Dental Sleep Medicine (DGZS) is to guide the interdisciplinary team (sleep physician and sleep disorder dentist) in detail when to prescribe oral appliances. This position paper supports the responsible use of OA as an effective treatment option for patients with sleep-related breathing disorders. The paper advises of proper indication regarding OSA severity, body mass index (BMI), and dentition. It emphasizes the interdisciplinary approach of oral appliance therapy and suggests treatment under the guidance of dentists trained in dental sleep medicine.

Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea

Orthodontic side effects can complicate the long-term use of mandibular advancement devices (MADs) in the treatment of patients with snoring and obstructive sleep apnea. The aim of this study was to find predictors of dental side effects from monoblock MADs. Four hundred fifty patients, who consecutively received treatment with either soft elastomeric or hard acrylic devices, were followed up after 5.4 +/- 0.8 years (mean +/- SD). The continuing patients responded to questionnaires and had dental examinations and plaster casts made. Twenty-seven patients had moved or died during the follow-up period. Two hundred thirty-six of the remaining 423 patients (56%) continued treatment, and 187 of them reported compliance rates of > or = 50% at night. A small reduction in overjet of < 1 mm was associated with a deepbite with an overbite of > 3 mm and an overjet of < or = 3 mm (odds ratio [OR] = 7.5; P = .015), nasal congestion (OR = 2.9; P = .005), or the use of a soft elastomeric device (OR = 2.7; P = .014) controlled for age, sex, treatment time, and mandibular displacement. A small reduction in overbite of < 1 mm was related to a small opening of the mandible of < 11 mm (OR = 2.5; P = .008). Orthodontic side effects might be predictable on the basis of initial characteristics in dental occlusion and the design of MADs.

Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea.

The aims of this study were to investigate possible orthodontic side-effects following the use of mandibular advancement devices (MAD) in adults with snoring and sleep apnoea. A second objective was to analyse the effect of the appliance design. Seventy-five patients treated with MAD and 17 reference patients were studied at follow-up after 2.5 +/- 0.5 years. In the test group, 47 patients were provided with soft elastomeric devices, while the remaining 28 patients received hard acrylic devices. The treatment induced a change in overjet of -0.4 +/- 0.8 mm (mean +/- SD) and a change in overbite of -0.4 +/- 0.7 mm (mean +/- SD). These changes were larger than those found in the reference group (P < 0.01). The odds ratio (OR) for the largest quartile of reduction in overjet was 3.8 in patients using hard acrylic devices compared with those using soft elastomeric devices (P < 0.05). A large reduction in overjet in patients using the hard acrylic devices was unrelated to the degree of mandibular protrusion by the device. The OR for a large reduction in overjet in patients using the soft elastomeric devices with a protrusion of 6 mm or above was 6.8 compared with smaller mandibular protrusions (P < 0.05). The results indicate that the orthodontic side-effects are small during the treatment of adult subjects with MAD for snoring and sleep apnoea, especially in patients using soft elastomeric devices with mandibular protrusions of less than 6 mm. The follow-up of patients treated with MAD is recommended, as individual patients may experience marked orthodontic side-effects.

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.