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

Mandibular Advancement Devices in OSA Patients: Impact on Occlusal Dynamics and Tooth Alignment Modifications-A Pilot Prospective and Retrospective Study

Background: The widespread prevalence of obstructive sleep apnea (OSA) underscores the necessity for effective therapies. Mandibular advancement devices (MADs) have emerged as valid treatment for mild to moderate cases, despite the associated dental side effects. Methods: This study evaluates the nature, onset, and long-term manifestation of these side effects. In the prospective group (n = 12), dental impressions were taken pre-MAD-insertion and at intervals of three, six, nine, and twelve months post-insertion to monitor occlusal alterations. In the retrospective group, participants (n = 8) wearing MADs for 7 years at average underwent lateral cephalogram assessments to compare with pre-treatment X-rays. All participants completed a specific questionnaire. Statistical analysis was performed via t-test and with p < 0.05 as the significance level. Results: The majority of participants in both groups consistently used MADs and reported significant sleep quality improvements, rating common symptoms like jaw tension as negligible. In both the prospective group and the retrospective group, significant reductions in overjet were observed at multiple time points, with the prospective group showing reductions at six months (p = 0.001), nine months (p > 0.001), and twelve months (p = 0.019), while the retrospective group indicated a notable decrease between baseline and follow-up assessments after a mean of seven years of device wear (p = 0.004). A slight overbite increase of 0.2 mm was prospectively observed after one year, whereas a trend towards a minimal decrease over the long term was observed in the retrospective sample (p = 0.003). Noteworthy changes in angle class or lower incisor inclination were absent. Cephalograms revealed significant IOK-NL angle alterations with a mean of 98.2° before and 95.2° upon long-term treatment (p = 0.020). Conclusions: These findings suggest that MADs are effective in treating OSA with minor adverse effects. This study advocates for moderate mandibular protrusion to balance therapeutic efficacy with dental health considerations, crucial for optimizing treatment outcomes. Nonetheless, the limited sample size warrants caution when generalizing these results to the broader population.

Dentoskeletal changes of long-term oral appliance treatment in patients with obstructive sleep apnea: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to evaluate the dental and skeletal effects of the long-term oral appliance (OA) treatment in patients with obstructive sleep apnea (OSA) and provide insights for clinicians in treatment planning and decision-making for OSA patients undergoing OA treatment.

MATERIALS AND METHODS

A comprehensive literature search was conducted in major databases up to April 2024. Studies were included if they assessed long-term OA treatment (≥6 months) in adults with OSA using any type of mandibular advancement device (MADs) or tongue retaining device (TRD). Dental and skeletal changes, measured by dental cast and cephalometric analysis, were the primary outcomes.

RESULTS

A total of 42 studies were included in the systematic review, with 23 included in the meta-analysis. Long-term OA treatment was associated with a significant decrease in overbite (0.87 mm, 95% CI: 0.69-1.05) and overjet (0.86 mm, 95% CI: 0.69-1.03). Subgroup analyses showed the decrease of overbite and overjet progressively changed over the years intervals. There was a significant retroclination of the upper incisors (U1-SN, 2.58°, 95% CI: 1.07-4.08) and proclination of the lower incisors (L1-MP, -2.67° (95% CI: -3.78-1.56). Skeletal changes were not significant.

CONCLUSION

Overbite and overjet gradually decreased in the long-term OA treatment, which might predominantly result from the retroclination of the upper incisors and the proclination of the lower incisors. The skeletal patterns in the anteroposterior and vertical direction might remain relatively stable over time. There was a tendency for the clockwise rotation of the mandible.

Mandibular advancement devices decrease systolic pressure during the day and night in patients with obstructive sleep apnea: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients with obstructive sleep apnea (OSA) in relation to use time and if the device is used at night or day.

MATERIALS AND METHOD

A systematic review of the literature and meta-analysis was carried out in accordance with PRISMA guidelines. In the bibliographic search, a total of four databases were consulted: PubMed-Medline, Scopus, Web of Science, and Cochrane. Of the 622 articles initially revealed, 160 duplicates were eliminated. After applying the selection criteria, 17 articles were included for the qualitative analysis and 4 for the meta-analysis. The studies were combined using a random effects model with the inverse method of variance, determining the mean differences in systolic and diastolic pressure before and after treatment using the MAD splint as the effect size. Day/night circadian effect and treatment time were analyzed using meta-regression with a mixed-effects model.

RESULTS

MAD treatment was not found to affect diastolic pressure. By combining the four studies with the control group in a meta-analysis (I2 = 75%; z =  - 0.15; p-value = 0.882), the mean difference in diastolic pressure between the MAD group and the control group was estimated at - 0.06 (- 0.86; 0.74). The meta-regression also showed no significant effect of day/night (p = 0.560) or treatment time (p = 0.854) on diastolic pressure. When combining the four studies with the control group (I2 = 84%%; z =  - 1.47; p-value = 0.142), a non-significant mean difference in systolic pressure between the MAD group and the control group of - 0.99 (- 2.31; 0.33) was estimated in the meta-analysis. However, when assessing the effect of day/night or treatment time on systolic blood pressure using a meta-regression, the latter showed significant covariates that reduce systolic blood pressure values in the model at night (p < 0.001) and in relation to treatment time (p < 0.001).

CONCLUSIONS

Only systolic pressure appears to be affected by the use of the MAD in patients with OSA, and this decrease in systolic pressure is greater at night and when treatment time is longer.