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Özköylü G, Saraç D, Sasany R, Umurca DG. Comparison of monoblock and twinblock mandibular advancement devices in patiens with obstructive sleep apnea and temporomandibular disorder: effects on airway volume, polysomnography parameters, and sleepiness scale scores. BMC Oral Health 2024; 24:1026. [PMID: 39215302 PMCID: PMC11365127 DOI: 10.1186/s12903-024-04653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE This study aimed to compare the effects of two different mandibular advancement devices on the upper airway volume, polysomnographic parameters, and sleepiness scale scores in patients with obstructive sleep apnea and Temporomandibular disorders (TMD). MATERIALS AND METHODS Monoblock and twinblock mandibular advancement devices were applied to patients with obstructive sleep apnea syndrome for 3 months separated by a wash-out period of 2 weeks. Research Diagnostic Criteria for TMD (RDC/TMD), Polysomnographic parameters and cone-beam computed tomography findings were recorded before and after the use of the mandibular advancement devices. A three-dimensional analysis of the airway was then performed. RESULTS The use of the monoblock device significantly increased the upper airway volume compared with the use of the twinblock device (p = 0.032). The polysomnographic parameters similarly improved with the use of the twin-block and monoblock devices. The significant reduction in TMD symptoms was observed. CONCLUSION The use of the monoblock device increased the retropalatal airway volume. This volume increase may be attributed to the fact that the design of the monoblock device allows less mandibular movement than does that of the twinblock device. Indicates the potential benefits of MADS treatment in alleviating TMD-related issues. CLINICAL SIGNIFICANCE Monoblock MADs have improved effects on respiratory parameters and upper airway dimensions in patients with OSA and mild to moderate TMD.
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Affiliation(s)
| | - Duygu Saraç
- Department of Prosthodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Rafat Sasany
- Department of Prosthodontics, Faculty of Dentistry, İstanbul Biruni University, İstanbul, Turkey.
| | - Dilara Gülhan Umurca
- Department of Othodontics, Faculty of Dentistry, İstanbul Biruni University, İstanbul, Turkey
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Wang W, Pang J, Zhang YX, Mo YM, Zhang J, Wei ZH. Clinical Effect of Personalized Adjustable Mandibular Advancement Device on Obstructive Sleep Apnea. Br J Hosp Med (Lond) 2024; 85:1-17. [PMID: 39212566 DOI: 10.12968/hmed.2024.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Aims/Background: Mandibular advancement devices are effective in treating mild or moderate obstructive sleep apnea (OSA), but such devices that are commonly used in clinical settings require further improvement. In this study, we evaluated the clinical effects of personalized adjustable mandibular advancement devices on mild or moderate OSA. Methods: Forty patients with mild or moderate OSA were randomly divided into experimental (personalized adjustable device) and control (traditional device) groups. Side effects, including increased salivation, dry mouth, muscle aches, and temporomandibular joint discomfort, were assessed. Respiratory markers during sleep, including the apnea-hypopnea index, mean blood oxygen saturation, lowest blood oxygen saturation and maximum apnea time, were evaluated using polysomnography. The upper airway cross-sectional area and temporomandibular joint morphology and motion trajectory were evaluated using cone beam computed tomography. Results: Side effects were significantly lower in the experimental group than in the control group. Respiratory marker levels were significantly restored post-treatment. Soft palate- and tongue-pharyngeal cross-sectional areas were significantly increased in both groups, but temporomandibular joint morphology or motion trajectory remained unchanged. Conclusion: The personalized adjustable mandibular advancement devices may reduce side effects and are effective in treating patients with OSA. Clinical Trial Registration: The study was registered and approved by the Chinese Clinical Trial Registry (ChiCTR2400080306). https://www.chictr.org.cn/showproj.html?proj=206538.
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Affiliation(s)
- Wei Wang
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Jian Pang
- Department of Respiratory, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Yi-Xue Zhang
- Department of Respiratory, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Yi-Meng Mo
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Jiao Zhang
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Zhen-Hui Wei
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
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Ciavarella D, Lorusso M, Fanelli C, Ferrara D, Esposito R, Laurenziello M, Esperouz F, Lo Russo L, Tepedino M. The Efficacy of the RME II System Compared with a Herbst Appliance in the Treatment of Class II Skeletal Malocclusion in Growing Patients: A Retrospective Study. Dent J (Basel) 2024; 12:254. [PMID: 39195098 DOI: 10.3390/dj12080254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
(1) Background: The objective of this study was to evaluate the efficacy of the Rapid Maxillary Expander (RME) II System compared to a Herbst appliance and a control group in the treatment of class II skeletal malocclusions in growing patients. (2) Methods: A total of 30 class II patients treated using the RME II System (group R) were compared with 30 patients treated with a Herbst appliance (group H) and 30 untreated class II children (group C). Cephalograms were compared at the start (T0) and after 24 months (T1). Nine cephalometric parameters were analyzed: SN-MP, SN-PO, ANB, AR-GO-ME, AR-GO-N, N-GO-ME, SN-PP, LFH, CO-GN, 1+SN, IMPA, OVERJET, and OVERBITE. Since the variables failed the normality test, a Wilcoxon test was performed for a pairwise comparison of the cephalometric measurements taken at T0 (pre-treatment) and at T1 (post-treatment). ANOVA with Tukey post hoc correction was used to evaluate the differences among the groups. (3) Results: ANOVA showed a statistically significant difference for all analyzed variables except for AR-GO-ME, AR-GO-N, and N-GO-ME. Post hoc Tukey's HSD test showed the following difference: the SN-PO angle in group H was 3.59° greater than in group R; the LFH in group H was 4.13 mm greater than in group R. The mandibular length (CO-GN) in group H was 3.94 mm greater than in group R; IMPA in group H was 6.4° greater than in group R; and the ANB angle in group H was 1.47° greater than in group R. (4) Conclusions: The RME II System is an effective therapeutic device for class II skeletal malocclusion treatment in growing patients.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Carlotta Fanelli
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Donatella Ferrara
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Rosa Esposito
- Department of Biotechnological and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, 67100 L'Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Fariba Esperouz
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, 71122 Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, 67100 L'Aquila, Italy
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Pak S, Bous RM, Acosta Lenis C, Kumar AR, Valiathan M. A 3-Dimensional Evaluation of the Effects of Unilateral Vertical Mandibular Distraction Osteogenesis on Airway Volume Among Patients With Hemifacial Microsomia. Cleft Palate Craniofac J 2024; 61:1157-1163. [PMID: 36891580 DOI: 10.1177/10556656231158984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). DESIGN This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. RESULTS Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability (r > .86, P < .001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% (P = .043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 (P = .044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant (P > .05), but an increase in the mean values were observed. CONCLUSION Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD.
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Affiliation(s)
- Sarah Pak
- Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Rany M Bous
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Claudia Acosta Lenis
- Department of Craniofacial and Special Care Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Anand R Kumar
- Department of Plastic and Reconstructive Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Manish Valiathan
- Department of Craniofacial and Special Care Orthodontics, Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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Degraeve M, Beij T, Lammens I, Vagenende T, De Meyer M, Aps J, Jacquet W. A systematic review on 4D images of the upper airway in patients with OSA. Sleep Breath 2024; 28:597-606. [PMID: 38127191 DOI: 10.1007/s11325-023-02948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
AIM-BACKGROUND In the treatment of obstructive sleep apnoea (OSA), oral appliances are now being recognized as a valuable alternative to continuous positive airway pressure (CPAP). Various static imaging techniques of the upper airways allow for assessment of bone and soft tissue structures. However, static images do not capture dynamic airway characteristics. The aim of this paper was to review 4D imaging techniques in patients with OSA. METHODS PubMed/MEDLINE, Web of Science and Embase were systematically searched for studies published before June 2022. The review was compliant with the PRISMA guidelines. The quality of each eligible study was critically evaluated by all four authors independently. Four unique articles with qualitative analyses were retrieved. All included studies had a clear objective/aim, an appropriate endpoint and sufficiently described eligibility criteria. RESULTS With dynamic imaging (4D) evaluation of the upper airway, the incidence of upper airway collapsibility due to use of a mandibular advancement device (MAD) was reduced, extraluminal tissue pressure was decreased and the space in the upper airway was increased, notably in the retropalatal and retroglossal areas of the airway. These findings suggest that MADs may be effective for OSA regardless of whether or not the obstruction site is in the velopharynx or oropharynx. However, further investigation of dynamic changes in the upper airway is required to explain the efficacy of OSA treatment and the underlying mechanisms.
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Affiliation(s)
- Michiel Degraeve
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Ghent, Ghent, Belgium.
| | - Tessa Beij
- Department of Oral and Maxillofacial Surgery, RadboudUMC, Nijmegen, The Netherlands
| | - Inés Lammens
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Tim Vagenende
- Department of Oral and Maxillofacial Surgery, Jan Palfijn General Hospital, Ghent, Belgium
| | - Miche De Meyer
- Department of Adult Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Dentistry, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Aps
- Department of Dentistry, Groningen University Medical Center, Groningen, the Netherlands
- OpiniDent BV, Marke, Belgium
| | - Wolfgang Jacquet
- Department of Adult Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Fernández-Sanjuán P, Alcaraz M, Bosco G, Pérez-Martín N, Morato M, Lugo R, Arrieta JJ, Sanabria J, Ríos-Lago M, Plaza G. Modifications in Upper Airway Collapsibility during Sleep Endoscopy with a Mandibular Positioner: Study in Snorers and Obstructive Sleep Apnea Patients. J Clin Med 2024; 13:1184. [PMID: 38592035 PMCID: PMC10932289 DOI: 10.3390/jcm13051184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. METHODS This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. RESULTS In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. CONCLUSIONS The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition.
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Affiliation(s)
- Patricia Fernández-Sanjuán
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Universidad Rey Juan Carlos, 28002 Madrid, Spain
| | - Marta Alcaraz
- Department of Otolaryngology, Hospital Universitario La Moraleja, 28050 Madrid, Spain;
| | - Gabriela Bosco
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario La Zarzuela, 28023 Madrid, Spain
| | - Nuria Pérez-Martín
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario La Zarzuela, 28023 Madrid, Spain
| | - Marta Morato
- Department of Otolaryngology, Hospital Quirónsalud San José, 28002 Madrid, Spain;
| | - Rodolfo Lugo
- Department of Otolaryngology Head and Neck Surgery, Hospital San José, Monterrey 64718, Mexico;
| | - Juan José Arrieta
- Department of Stomatology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Jaime Sanabria
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Marcos Ríos-Lago
- Department of Basic Psychology II, Faculty of Psychology, UNED—Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain;
| | - Guillermo Plaza
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Universidad Rey Juan Carlos, 28002 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario La Zarzuela, 28023 Madrid, Spain
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Zreaqat M, Hassan R, Samsudin AR, Alforaidi S. Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study. Eur J Pediatr 2023; 182:5501-5510. [PMID: 37777602 DOI: 10.1007/s00431-023-05226-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
Twin-block appliance had been advocated as a potential treatment option in paediatric obstructive sleep apnoea (OSA) due to their favourable effect in enhancing upper airway parameters and improving OSA symptoms. The aim of this study was to evaluate the effect of twin-block appliance therapy on upper airway parameters/dimensions and the apnoea-hypopnea indexes (AHIs) in OSA children with class II mandibular retrognathic skeletal malocclusion using cone-beam computed tomography. This prospective longitudinal study comprised 34 polysomnography-proven OSA growing children with class II mandibular retrognathic skeletal malocclusion between the ages of 8 and 12 years who had completed myofunctional twin-block therapy and matched corresponding controls. The upper airway was segmented into the nasopharynx, oropharynx, and hypopharynx, and the effect of twin-bock treatment on upper airway parameters/dimensions was assessed pre- and posttreatment using CBCT analysis, while a second standard overnight PSG was performed to determine changes in the AHI. At the nasopharynx level, minimal (nonsignificant) increases in all variables were observed within the twin-block group and between the groups (P > 0.05). At the level of the oropharynx, all variables increased significantly in the treatment group and between groups (P < 0.001), but these increases were nonsignificant in the control group. At the level of the hypopharynx, only the minimum cross-sectional area (MCA) increased significantly in the treatment group (P = 0.003). The change in MCA was also significant between the groups (P = 0.041). In addition, the upper airway length increased significantly in the twin-block group (P = 0.0154), and the AHI decreased by 74.8% (P < 0.001). CONCLUSION Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters. WHAT IS KNOWN • CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures. • Twin block appliance may be an effective treatment modality in children with OSA. WHAT IS NEW • Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA. • Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.
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Affiliation(s)
- Maen Zreaqat
- Orthodontic Dep., School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Rozita Hassan
- Orthodontic Dep., School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
| | - A R Samsudin
- Maxillofacial Surgery Dep., College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sahal Alforaidi
- Pediatric and Orthodontic Dep. College of Dentistry, Taibah University, Medina, Saudi Arabia
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Huang W, Dong L, Yu S, Zheng Y, Wu H, Li C, Zhang Y, Zhang Q, Yan X, Lv T, Yuan X. Stress distribution of the modified clear twin-block aligner on the temporomandibular joint, alveolar bone and teeth: A finite element analysis. Int Orthod 2023; 21:100815. [PMID: 37839391 DOI: 10.1016/j.ortho.2023.100815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The modified clear twin-block aligner (CTBA) was developed to provide a mandibular advancement appliance for the treatment of mandibular retrognathia. The objective of this study was to analyse the stress distribution changes of CTBA with 45°, 60° and 70° bite blocks. MATERIAL AND METHODS A three-dimensional model of the craniomaxillofacial bones and teeth was generated from a spiral computed tomography (CT) scan. The models of the articular disc, capsule, periodontal ligament and CTBA were constructed mathematically. After assigning the appropriate material properties and the boundary condition using ABAQUS software, we simulated the CTBA with different bite blocks to analyse the mechanical effects. RESULTS In the temporomandibular joint (TMJ) region, the posterior aspect of the condyle and glenoid fossa experienced tensile stress that was approximately about 22 times greater at 70° than at 45°. The Von Mises stress distribution on the articular disc tended to be uniform. The strain direction of the condyle was backward. In the maxillary bone, the stress on the labial alveolar bone was about 5.83MPa at 70° and greater than that on the lingual side. The resulting displacement of the dentition revealed a tendency for the upper teeth to shift backward and the lower teeth to move forward by 0.46 to 0.49mm. The foregoing stress and displacement rose as the angle of the bite blocks increased. CONCLUSIONS CTBA with 70° bite blocks constituted an advantageous biomechanical setting for the treatment of mandibular retrognathia in teenagers and provided a superior therapeutic effect.
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Affiliation(s)
- Wenli Huang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Lirong Dong
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Shaoyang Yu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Yao Zheng
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Haoting Wu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Chenzhi Li
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Yingyue Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Qiang Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Xiao Yan
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Tao Lv
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, 250000 Jinan, China.
| | - Xiao Yuan
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China.
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Yue Z, Yi Z, Liu X, Chen M, Yin S, Liu Q, Chen X, Hu J. Comparison of invisalign mandibular advancement and twin-block on upper airway and hyoid bone position improvements for skeletal class II children: a retrospective study. BMC Oral Health 2023; 23:661. [PMID: 37705022 PMCID: PMC10500932 DOI: 10.1186/s12903-023-03295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND This study is to evaluate and compare the improvement of upper airway morphology and hyoid bone position in children with Class II mandibular retrusion treated with Invisalign mandibular advancement (MA) and Twin-Block (TB) appliances, utilizing cone beam computed tomography (CBCT). METHODS 32 children aged between 8 and 11.5 years old were included in this study, with an average age of 10.2 years old. These children were divided into two groups, MA and TB, with 16 children in each group. Changes in upper airway morphology and hyoid bone position before and after treatment were analyzed using CBCT. RESULTS (1) Changes in upper airway before and after treatment: the oropharynx volume (Or-V), the oropharynx minimum cross-sectional area (Or-mCSA), the hypopharynx volume (Hy-V), and the hypopharynx minimum cross-sectional area (Hy-mCSA) in both the MA and TB groups increased after treatment, and the differences were statistically significant (P < 0.05) compared to pre-treatment status. (2) Changes in hyoid bone position before and after treatment: The distances between H point and third cervical vertebra (H-C3), H point and pogonion (H-RGN), H point and mandibular plane (H-MP), H point and Frankfort horizontal plane (H-FH), H and S point (H-S), and H point and palatal plane (H-PP) in both the MA and TB groups increased after treatment, and the differences were statistically significant (P < 0.05). CONCLUSION Both MA and TB appliances effectively improved the structural narrowness of the upper airway and reduced respiratory resistance, thus improving breath quality. However, MA showed more effectiveness in improving the narrowest part of the hypopharynx compared to TB. Both appliances also promoted anterior downward movement of the hyoid bone, which opens the upper airway of the oropharynx and hypopharynx and helps the upper airway morphology return to normal range.
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Affiliation(s)
- Zheng Yue
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
- Department of Orthodontics, Lianbang Institute of Stomatological Technology and Hospital of Stomatology, Xi'an, 710032, Shaanxi, China
| | - Zian Yi
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Xinyi Liu
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Mengting Chen
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Shuhui Yin
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Qianqian Liu
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China
| | - Xuefeng Chen
- Xuefeng Dental Care, Huaian, 223000, Jiangsu, China.
| | - Jiangtian Hu
- Department of Orthodontics, Kunming Medical University School and Hospital of Stomatology, Kunming, 650031, Yunnan, China.
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10
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Ma Y, Yu M, Gao X. Role of craniofacial phenotypes in the response to oral appliance therapy for obstructive sleep apnea. J Oral Rehabil 2023; 50:308-317. [PMID: 36681880 DOI: 10.1111/joor.13418] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/23/2022] [Accepted: 01/13/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Mandibular advancement device (MAD) is a good alternative for patients with obstructive sleep apnea (OSA). However, the treatment response varies amongst individuals. OBJECTIVE This study aimed to explore the role of craniofacial features in the response to MADs to improve prognostication and patient selection. METHODS The retrospective trial contained 42 males aged 41.5 ± 9.0 years, and with an apnea-hypopnea index (AHI) of 21.5 ± 13.8 events/h. According to the mandibular plane angle, participants were divided into three groups: low angle (n = 13), average angle (n = 14) and high angle (n = 15). Under the monitoring of home sleep testing, adjustable MADs were used to titrate the mandible forward from 0 mm with an increment of 0.5 mm every day. The polysomnography outcomes, mandibular protrusion amounts, changes in upper airway MRI measurements and nasal resistance were compared amongst the three groups. RESULTS The normalisation rate (AHI <5 /h) was 92.3%, 57.1% and 46.7%, respectively, in the low-, average- and high-angle groups (p = .027). The effective protrusion where AHI was reduced by half was 20 (11.3 ~ 37.5) %, 31.3 (23.6 ~ 50) % and 50 (36.9 ~ 64.9) % of the maximal mandibular protrusion, in the low-, average- and high-angle groups (p = .004). Multivariate logistic regression revealed that increased gonion angle (OR = 0.878) and baseline AHI(OR = 0.868) can reduce the probability of normalisation. CONCLUSION The high mandibular plane angle might be an unfavourable factor to MAD treatment and more protrusion was needed to achieve a 50% reduction in AHI. Vertical craniofacial pattern (gonion angle) and baseline AHI constituted the model for predicting the effect of MADs.
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Affiliation(s)
- Yanyan Ma
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
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11
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Gurgel ML, Junior CC, Cevidanes LHS, de Barros Silva PG, Carvalho FSR, Kurita LM, Cunha TCA, Dal Fabbro C, Costa FWG. Methodological parameters for upper airway assessment by cone-beam computed tomography in adults with obstructive sleep apnea: a systematic review of the literature and meta-analysis. Sleep Breath 2023; 27:1-30. [PMID: 35190957 PMCID: PMC9392812 DOI: 10.1007/s11325-022-02582-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND A reliable method for analyzing the upper airway (UA) remains a challenge. This study aimed to report the methods for UA assessment using cone-beam computed tomography (CBCT) in adults with obstructive sleep apnea (OSA). METHODS We performed a systematic review (PROSPERO #CRD42021237490 and PRISMA checklist) that applied a search strategy to seven databases and grey literature. RESULTS In 29 studies with moderate-to-high risk of bias, investigators mostly reported the body position during CBCT (upright or supine) and hard tissue references, diverging in UA delimitation and terminologies. The meta-analysis showed two subgroups (upright and supine), and no statistical differences were identified (p = 0.18) considering the UA area. The volume in the OSA group was smaller than that in the control group (p < 0.003 and Cohen's d = - 0.81) in the upright position. Patients with OSA showed smaller anteroposterior dimensions than the control group and were not affected by the position during image acquisition (p = 0.02; Cohen's d = - 0.52). The lateral measurements were also lower in the OSA group (supine) (p = 0.002; Cohen's d = - 0.6). CONCLUSIONS Patients with OSA showed smaller UA measurements in the upright (volume) and supine (lateral dimension) positions. The anteroposterior dimension was also reduced in patients with OSA compared to the control group, regardless of the position during CBCT acquisition.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | - Cauby Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil.
| | | | | | | | - Lúcio Mitsuo Kurita
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | | | - Cibele Dal Fabbro
- Faculty of Dental Medicine, Center for Advance Research in Sleep Medicine & Stomatology, Universite de Montreal & CIUSSS Nord Ile de Montreal, CHUM, Montreal, QC, Canada
| | - Fabio Wildson Gurgel Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
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12
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Waghchaure SS, Bhad WA, Chavan SJ, Mehta N, Baheti N. Effectiveness of Surgical Mandibular Advancement in Improving Airway Dimensions in Nongrowing Skeletal Class II Patients With Obstructive Sleep Apnea—A CBCT Study. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2022. [DOI: 10.1177/03015742221076914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Skeletal nongrowing class II patients with retrognathic mandible are often at risk of developing obstructive sleep apnea (OSA). This skeletal discrepancy, when severe enough, is often addressed by surgical mandibular advancement which not only achieves aesthetics, structural balance, and functional efficiency but also improves the airway function. Objective: The aim of the study was to evaluate the effectiveness of surgical mandibular advancement on airway dimensions, in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA. Materials and Methods: The sample consisted of 8 patients with skeletal class II due to retrognathic mandible associated with OSA. Screening was done with functional outcomes of sleep questionnaire (FOSQ) score and confirmed with polysomnography. Pretreatment and posttreatment airway dimensions/volume were assessed and calculated on cone beam computed tomography (CBCT). Three months post surgery, oxygen saturation was recorded. Results: A statistically significant improvement in mean oxygen saturation level was observed from 87.62 ± 7.70 to 97.75 ± 0.46 and mean increase in airway volume was from 48.60 ± 7.17 to 69.48 ± 26.22. The smallest cross section increased from 137 ± 74.37 to 253.75 ± 76.67. Anteroposterior dimensions increased significantly from 6.17 ± 1.78 to 9.33 ± 2.07 and transversed from 24.56 ± 6.41 to 30.14 ± 3.35. FOSQ score improved from 9.37 ± 2.61 to 15.25 ± 0.88. Conclusion: Surgical mandibular advancement is an effective treatment option in improving airway dimensions in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA.
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Affiliation(s)
- Saurabh S. Waghchaure
- Department of Orthodontics & Dentofacial Orthopaedics, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Wasundhara A. Bhad
- Department of Orthodontics & Dentofacial Orthopaedics, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Santosh J. Chavan
- Department of Orthodontics & Dentofacial Orthopaedics, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Niyati Mehta
- Department of Orthodontics & Dentofacial Orthopaedics, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Nikita Baheti
- Department of Orthodontics & Dentofacial Orthopaedics, Government Dental College & Hospital, Nagpur, Maharashtra, India
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13
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Camañes-Gonzalvo S, Marco-Pitarch R, Plaza-Espín A, Puertas-Cuesta J, Agustín-Panadero R, Fons-Font A, Fons-Badal C, García-Selva M. Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices. J Clin Med 2021; 10:5255. [PMID: 34830533 PMCID: PMC8621062 DOI: 10.3390/jcm10225255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. METHODS All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. RESULTS The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. CONCLUSIONS The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).
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Affiliation(s)
- Sara Camañes-Gonzalvo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Rocío Marco-Pitarch
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Andrés Plaza-Espín
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Javier Puertas-Cuesta
- Medical School of Medicine, Universidad Católica de Valencia, 46002 Valencia, Spain;
| | - Rubén Agustín-Panadero
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Antonio Fons-Font
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Carla Fons-Badal
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Marina García-Selva
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
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14
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Marco-Pitarch R, García-Selva M, Plaza-Espín A, Puertas-Cuesta J, Agustín-Panadero R, Fernández-Julián E, Marco-Algarra J, Fons-Font A. Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi- and three-dimensional evaluation. J Oral Rehabil 2021; 48:927-936. [PMID: 33977548 DOI: 10.1111/joor.13176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/21/2020] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The efficiency of the mandibular advancement device (MAD) in patients with obstructive sleep apnoea syndrome (OSAS) has been demonstrated. Nevertheless, the behaviour of the upper airway once MAD is placed and titrated, and its correlation with the apnoea-hypopnoea index (AHI) is still under discussion. OBJECTIVES To analyse the morphological changes of the upper airway through a bi- and three-dimensional study and correlate it with the polysomnographic variable, AHI. METHODS Patients were recruited from two different hospitals for the treatment of OSAS with a custom-made MAD. A cone-beam computer tomography and a polysomnography were performed at baseline and once the MAD was titrated. RESULTS A total of 41 patients completed the study. Treatment with MAD reduced the AHI from 22.5 ± 16.8 to 9.2 ± 11.6 (p ≤ .05). There was a significant increase of the total airway volume with MAD from 21.83 ± 7.05 cm3 to 24.19 ± 8.19 cm3 , at the expense of the oropharynx. Moreover, the correlation between the improvement of the AHI and the augmentation of the volume of the upper airway was not statistically significant. CONCLUSIONS The oral device used in this prospective study increased the mean upper pharyngeal airway volume and significantly reduced the AHI. Future studies that measure the muscular tone are needed to completely understand the association between the AHI and the physiological and anatomical response of the upper airway.
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Affiliation(s)
- Rocío Marco-Pitarch
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Marina García-Selva
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Andrés Plaza-Espín
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - Rubén Agustín-Panadero
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - Jaime Marco-Algarra
- Department of Otorhinolaryngology, Medical School of Medicine and Dentistry, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Antonio Fons-Font
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
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15
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Haskell BS, Voor MJ, Roberts AM. A consideration of factors affecting palliative oral appliance effectiveness for obstructive sleep apnea: a scoping review. J Clin Sleep Med 2021; 17:833-848. [PMID: 33196434 PMCID: PMC8020709 DOI: 10.5664/jcsm.9018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This scoping review allows physicians, researchers, and others interested in obstructive sleep apnea to consider effectiveness of oral appliances (OAs). The intent is to improve understanding of OA effectiveness by considering morphologic interaction in patients with obstructive sleep apnea. METHODS Morphologic and biomechanical criteria for positional alterations of the mandible assessed success rates of OA appliances. Searches of databases (Medline, PubMed, The Cochrane Library, EBSCO) using terms: OA treatment effectiveness and positive and/or negative outcome predictors. Craniofacial predictors of OAs and obstructive sleep apnea biomechanical factors of anatomical traits associated with OA effectiveness were included. Databases searched radiographic cephalometric imaging for morphology/phenotypes and apnea-hypopnea index responses. Articles were excluded if title or abstract was not relevant or a case report. If the analysis did not report mean or standard deviation for apnea-hypoxia index, it was excluded. No language, age, or sex restrictions were applied. RESULTS Analysis of 135 articles included in searched literature indicated alterations in musculature and pharyngeal airway structure through OA use. These alterations were individually unpredictable with wide variability 61.81% ± 12.29 (apnea-hypoxia index mean ± standard deviation). Morphologic variations as predictors were typically weak and idiosyncratic. Biomechanical factors and wide variations in the metrics of appliance application were unclear, identifying gaps in knowledge and practice of OAs. CONCLUSIONS An integrated basis to identify morphologic and biomechanical elements of phenotypic expressions of sleep-disordered breathing in the design and application of OAs is needed. Current knowledge is heterogeneous and shows high variability. Identification of subgroups of patients with obstructive sleep apnea responding to OAs is needed.
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Affiliation(s)
- Bruce S. Haskell
- Division of Orthodontics, University of Kentucky College of Dentistry, Lexington Kentucky
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
- Comprehensive Dentistry, School of Dentistry, University of Louisville, Louisville, Kentucky
| | - Michael J. Voor
- Department of Orthopedics, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Biomedical Engineering, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Andrew M. Roberts
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
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16
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Pereira PKN, de Castro Rocha VÁ, Degan VV, Garib DG, Vedovello SAS, de Menezes CC. Upper airways after mandibular advancement orthognathic surgery: A 4-year follow-up. Am J Orthod Dentofacial Orthop 2021; 159:743-749. [PMID: 33795190 DOI: 10.1016/j.ajodo.2020.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the stability of changes in the upper airways 4 years after orthognathic surgery in patients with skeletal Class II malocclusion. METHODS A retrospective clinical study was conducted including 33 cone-beam computed tomography images from 11 patients (average age of 35.91 years) followed up longitudinally for 4 years. The airways were measured with the help of the Dolphin Imaging software (Dolphin Imaging and Management Systems, Chatsworth, Calif) at 3 points: T1 (preoperative), T2 (6 months after surgery), and T3 (4 years after surgery). The parameters assessed were surface area (SA), minimum axial area, and volume (VOL) of the pharyngeal airway space. The times were compared using analysis of variance and Tukey's test. Pearson's analysis was performed to assess the correlation with surgical changes and age (P <0.05). RESULTS Four years after operating on the airway spaces, the means of SA and VOL were significantly higher than those observed before the surgery (P <0.05). The means at 6 months were intermediate, with no significant difference before the surgery and 4 years after it (P >0.05). There was no significant correlation of the changes in SA, VOL, and minimum axial area with the amount of mandibular advancement, counterclockwise rotation of the occlusal plane, and age of the patient (P >0.05). CONCLUSIONS Four years after mandibular advancement surgery in patients with skeletal Class II malocclusion, the increases in the airways remained stable.
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Affiliation(s)
| | | | | | - Daniela Gamba Garib
- Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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17
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Yıldırım E, Karaçay Ş. Volumetric Evaluation of Pharyngeal Airway after Functional Therapy. SCANNING 2021; 2021:6694992. [PMID: 33680278 PMCID: PMC7906813 DOI: 10.1155/2021/6694992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to evaluate three-dimensional (3D) effects of Twin-block functional appliance (TB) on the pharyngeal airway by using cone beam computed tomography (CBCT). A total of 30 patients (14 females, 16 males; mean age 12.50 ± 1.23 and 12.83 ± 1.17 years, respectively) with skeletal Class II malocclusion were included in this study and were treated with TB. On the pretreatment (T1) and posttreatment (T2) CBCT scans, volumetric changes in the pharyngeal airway; SNA, SNB, and ANB angles; and bilateral effective mandibular (Co-Gn) and midfacial length (Co-A) were also evaluated. The statistical differences were accessed by Wilcoxon signed-rank tests, and Mann-Whitney U tests were used to analyze the scores of male and female subjects. In this study, an increase was observed in SNB and Co-Gn (p < 0.01) while a decrease in ANB and SNA (p < 0.01 and p < 0.05, respectively) was found. However, increase in midfacial length was not statistically significant (p > 0.05). In the evaluation of volumetric pharyngeal airway changes, statistically significant increases (p < 0.01) in the upper and lower division and total airway volume were determined. Gender differences were insignificant for all measurements (p > 0.05). Volumetric changes in the pharyngeal airway after functional therapy can be successfully evaluated by CBCT images. The anterior repositioning of the mandible by TB increases the mandibular length and pharyngeal airway volume in patients with retrognathic mandible.
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Affiliation(s)
- Ersin Yıldırım
- Health Sciences University, Faculty of Dentistry, Department of Orthodontics, Istanbul, Turkey
| | - Şeniz Karaçay
- Health Sciences University, Faculty of Dentistry, Department of Orthodontics, Istanbul, Turkey
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18
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Premaraj TS, Stadiem J, Premaraj SA, Davies CR, Dennis M, Harrington JJ. Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study. Eur J Dent 2021; 16:749-755. [PMID: 33412609 PMCID: PMC9683874 DOI: 10.1055/s-0040-1719220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives
The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks.
Setting and Sample Population
Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study.
Materials and Methods
All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean
t
-test was performed to determine significance.
Results
The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (
p
= 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (
p
= 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference.
Conclusion
This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.
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Affiliation(s)
- Thyagaseely Sheela Premaraj
- Department of Orthodontics, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States
| | - Jacob Stadiem
- Department of Orthodontics, University of Nebraska Medical Center, Lincoln, Nebraska, United States
| | - Shyamaly Arya Premaraj
- College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States
| | - Charles R Davies
- Carle Neuroscience Institute, Carle Physician Group, University of Illinois at Urbana, Illinois, United States
| | - Matthew Dennis
- Division of Pediatric Pulmonology & Sleep Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska, United States
| | - John J Harrington
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
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19
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Aziz R, Somaiah S, Kalha AS, Reddy G, Muddaiah S, Shetty B. Comparative assessment of changes in pharyngeal airway space in cases of obstructive sleep apnoea with a customized mandibular repositioning appliance - a clinical study. Sleep Sci 2021; 14:16-24. [PMID: 34917269 PMCID: PMC8663729 DOI: 10.5935/1984-0063.20200072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives The present study aims at evaluating the effects of a customized mandibular repositioning appliance on the pharyngeal airway, nocturnal sleep patterns, daytime discomfort and occlusal changes in established cases of adult obstructive sleep apnoea. Material and Methods Ten consecutive patients with a complaint of snoring and disturbed sleep were included in the study. The primary diagnosis was established by the Epworth sleepiness scale, clinical examination, history and subsequently the diagnosis was substantiated through assessment of the pharyngeal airway space on a lateral cephalogram and polysomnography. A customized mandibular repositioning appliance was used to advance the mandible sequentially every 6 months, using 4 sets of the appliance. Pre and post-treatment evaluations were performed to establish, effects and changes in the outcome of obstructive sleep apnoea. Results The study revealed significant increase in the mean pharyngeal widths of upper airway and velum dimension with antero-superior repositioning of hyoid bone. Epworth sleepiness scale score improved significantly from baseline with clinically evident change in daytime discomforts. Significant decline in the mean apnoea/hypopnea index, oxygen desaturation index, respiratory disturbance index, heart rate, snoring and a significant increase in mean oxygen saturation of arterial blood was observed. No evident change noticed in occlusion except lower incisor inclination. Conclusion The customized mandibular repositioning appliances are effective in the management of adult obstructive sleep apnoea with a significant improvement observed in the airway patency and polysomnography parameters with clinically non-significant effects on dental occlusion..
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Affiliation(s)
- Rezeen Aziz
- Coorg Institute of Dental Sciences, Orthodontics and Dentofacial Orthopedics - Virajpet - Karnataka - India
| | - Sanju Somaiah
- Coorg Institute of Dental Sciences, Orthodontics and Dentofacial Orthopedics - Virajpet - Karnataka - India
| | - Anmol S Kalha
- Coorg Institute of Dental Sciences, Orthodontics and Dentofacial Orthopedics - Virajpet - Karnataka - India
| | - Goutham Reddy
- Coorg Institute of Dental Sciences, Orthodontics and Dentofacial Orthopedics - Virajpet - Karnataka - India
| | - Sunil Muddaiah
- Coorg Institute of Dental Sciences, Orthodontics and Dentofacial Orthopedics - Virajpet - Karnataka - India
| | - Balakrishna Shetty
- Coorg Institute of Dental Sciences, Orthodontics and Dentofacial Orthopedics - Virajpet - Karnataka - India
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Orthopedic Treatment for Class II Malocclusion with Functional Appliances and Its Effect on Upper Airways: A Systematic Review with Meta-Analysis. J Clin Med 2020; 9:jcm9123806. [PMID: 33255537 PMCID: PMC7759817 DOI: 10.3390/jcm9123806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Aim of this systematic review was to assess the effects of orthopedic treatment for Class II malocclusion with Functional Appliances (FAs) on the dimensions of the upper airways. Eight databases were searched up to October 2020 for randomized or nonrandomized clinical studies on FA treatment of Class II patients with untreated control groups. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane guidelines, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses and assessment of the quality of evidence. A total of 20 nonrandomized clinical studies (4 prospective/16 retrospective) including 969 patients (47.9% male; mean age 10.9 years) were identified. Orthopedic treatment with FAs was associated with increased oropharynx volume (MD = 2356.14 mm3; 95% CI = 1276.36 to 3435.92 mm3; p < 0.001) compared to natural growth. Additionally, significant increases in nasopharynx volume, minimal constricted axial area of pharyngeal airway, and airway were seen, while removable FAs showed considerably greater effects than fixed FAs (p = 0.04). Finally, patient age and treatment duration had a significant influence in the effect of FAs on airways, as had baseline matching and sample size adequacy. Clinical evidence on orthopedic Class II treatment with FAs is associated with increased upper airway dimensions. However, the quality of evidence is very low due to methodological issues of existing studies, while the clinical relevance of increases in airway dimensions remains unclear.
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Schultz Martins R, Girouard P, Elliott E, Mekary S. Physiological Responses of a Jaw-Repositioning Custom-Made Mouthguard on Airway and Their Effects on Athletic Performance. J Strength Cond Res 2020; 34:422-429. [PMID: 29927893 DOI: 10.1519/jsc.0000000000002679] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Martins, RS, Girouard, P, Elliott, E, and Mekary, S. Physiological responses of a jaw repositioning custom-made mouthguard on airway and their effects on athletic performance. J Strength Cond Res 34(2): 422-429, 2020-Advanced dental techniques such as jaw-repositioning have shown to increase lower body muscular power such as vertical jump, but its effects on acceleration and speed have not been studied. Similarly, jaw repositioning is commonly used to increase airways volume and ventilation in a special population (i.e., obstructive sleep apnea); however, its ergogenic effects on aerobic performance have yet not been studied. The purpose of the cross-over study was to investigate the effects of a jaw-repositioning custom-made mouthguard (JCM) on volumetric changes in airway and jaw position and determine the effects this may have on aerobic and anaerobic performance. Results indicated that jaw-repositioning custom-made mouthguard may have an ergogenic effect on performance. The JCM condition showed an increase of 13% in upper airway volume (p = 0.04), 10% in upper airway width (p = 0.004), 7% in ventilation (p = 0.006), 5% in maximal aerobic power (p = 0.003), 4% in time to exhaustion (p = 0.03), 3% in vertical jump (p = 0.03), 2% in broad jump (p = 0.009), and a decrease of 4% in 20-m (p = 0.04) and 2% in 40-m (p = 0.001) sprint times. This is the first study to demonstrate a significant link between jaw repositioning, airway volumetric change, and performance enhancement in both aerobic and anaerobic performances. The results of this study may lead to a change in culture for the use of mouthguards in different sports applications, from high orofacial injury risk sports to other sports, specifically for ergogenic enhancement.
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Al-Jewair T, Kurtzner K, Giangreco T, Warunek S, Lagravère-Vich M. Effects of clear aligner therapy for Class II malocclusion on upper airway morphology and daytime sleepiness in adults: A case series. Int Orthod 2019; 18:154-164. [PMID: 31879193 DOI: 10.1016/j.ortho.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To evaluate the effects of clear aligner therapy (CAT) on the upper airway dimensions and on daytime sleepiness in adults with dentoskeletal Class II malocclusion. METHODS This study was conducted from August 2017 to February 2019. Inclusion criteria were healthy adults≥18years old, Angle Class II division 1 malocclusion, first-molar relationship of end-to-end or greater, overjet<10mm, and presenting for multi-arch comprehensive orthodontic treatment with aligners. Treatment mechanics included mandibular dentoalveolar advancement with Class II elastics without maxillary sequential distalization programmed into aligners. Post-treatment changes in dentoskeletal and upper airway dimensions were assessed using CBCT images. The treatment effect on daytime sleepiness was evaluated using an Epworth Sleepiness Scale (ESS). RESULTS Eight subjects were included in this pilot study (mean age at treatment initiation=44.6years [SD=15.3]). The mean treatment duration was 12.2months (SD=3.4). No statistically significant treatment changes were observed in upper airway dimensions or dentoskeletal cephalometric analyses. Subjects with excessive daytime sleepiness at pre-treatment reported an improvement post-treatment, but no significant difference in the mean ESS score was found. CONCLUSION Treatment of Class II division 1 malocclusion in adults by mandibular dentoalveolar advancement using CAT has no statistically significant effects on the airway and dentoskeletal measurements, or daytime sleepiness.
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Affiliation(s)
- Thikriat Al-Jewair
- State University of New York, School of Dental Medicine, Department of Orthodontics, Buffalo, USA.
| | | | | | - Stephen Warunek
- State University of New York, School of Dental Medicine, Department of Orthodontics, Buffalo, USA
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Dupuy-Bonafe I, Francois C, Lachiche V, Castel M, Duminil G. [OSA in adults: Role of the mandibular advancement device (MAD)]. Orthod Fr 2019; 90:389-399. [PMID: 34643524 DOI: 10.1051/orthodfr/2019024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/ hypopnea syndrome (OSA). Oral appliances advance the mandible and tongue, enlarge and stabilize the upper airways during sleep. Clinical examination is used to select candidates for oral appliances and a particular appliance for a given patient. Titration of the advancement will optimize its effectiveness by resolving subjective clinical symptoms. Polygraphic or ventilatory polysomnography controls the effectiveness of the treatment (IAH reduction, increase of oxygen saturation and improvement of the main symptoms). Clinical follow-up is required to assess longterm outcomes, side effects and treatment adherence. Oral appliances are effective in the short-term provided they achieved a 50% reduction in IAH and complete symptom resolution.
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Affiliation(s)
- Isabelle Dupuy-Bonafe
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Cindy Francois
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Virginie Lachiche
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Manon Castel
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
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Thereza-Bussolaro C, Oh HS, Lagravère M, Flores-Mir C. Pharyngeal dimensional changes in class II malocclusion treatment when using Forsus® or intermaxillary elastics - An exploratory study. Int Orthod 2019; 17:667-677. [PMID: 31492602 DOI: 10.1016/j.ortho.2019.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pharyngeal airway obstruction can facilitate some forms of sleep disorder breathing (SDB) in susceptible children, especially in those having class II malocclusion. Changes in the anatomic areas surrounding the pharyngeal region during orthodontic treatment could hypothetically impact the pharyngeal airway dimensions. Management of a class II malocclusion on a growing individual with either intermaxillary elastics or different removable or fixed class II appliance designs have been proposed over the last century. The objective of this retrospective exploratory cohort study is to investigate to what extent the class II malocclusion treatment with either intermaxillary elastics (IME) or Forsus® fatigue resistance device (FFRD) leads to changes in oropharyngeal airway dimensions. MATERIALS AND METHODS Twenty-nine patients diagnosed as class II with an average age of 12.7years were included in this study, (11 males, 18 females). The sample was divided into group 1: IME and group 2: FFRD. CBCT's scans before (T1) and after treatment (T2) were obtained and analysed using Dolphin software. Reliability was obtained using Intraclass Correlation Coefficient (ICC). Descriptive statistics, ANOVA and paired t-test were used for analysis. RESULTS Intra-rater reliability test was excellent in all measurements for both groups. There were no statistically significant differences in pharyngeal airway dimensions between both groups (P=0.919). A statistically significant correlation was found for sex, where male patients had the highest increase in oro-space area (ORS), and in oropharyngeal volume. Children under 14-year-old in IME group showed statistically negative correlation for sub-mandibular (SM) and for ORS, meaning the younger the greatest increase. Additionally, individuals younger than 14years had a statistically significant increase in the vertical dimension. CONCLUSIONS Both orthodontic treatment approaches appear to be associated with a similar increase in oropharyngeal airway dimensions. Male patients under 14-year-old had a greater significant increase compared to female patients and older children. Normal pharyngeal dimensions changes were not accounted for.
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Affiliation(s)
| | - Hee So Oh
- University of Pacific, Department of Orthodontics, San Francisco, CA, USA
| | - Manuel Lagravère
- University of Alberta, Department of Medicine and Dentistry, Edmonton, AB, Canada
| | - Carlos Flores-Mir
- University of Alberta, Department of Medicine and Dentistry, Edmonton, AB, Canada
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PREMARAJ THYAGASEELYSHEELA, JU SIYEONG, PREMARAJ SUNDARALINGAM, KIM SUNGK, GU LINXIA. COMPUTATIONAL FLUID DYNAMICS MODELING OF PHARYNGEAL AIRWAY RESISTANCE BASED ON CONE-BEAM COMPUTED TOMOGRAPHY. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Oral appliances for treating patients with sleep related disorders such as snoring and disturbed sleep could alter the morphology of the pharyngeal airway and thus its flow dynamics as well as airway patency. Splint therapy, i.e., positioning the mandibular condyles in centric relation (CR) with maxillary anterior guided orthotics (MAGO), with regard to pharyngeal airway patency, is causing increased attention. The goal of this work is to quantitatively examine the fluid dynamic changes within the pharyngeal airway when the mandible is positioned in CR and its association with airway patency. Materials and Methods: Patient-specific computational fluid dynamics models were reconstructed from pre- and post- treatment high-resolution cone-beam computed tomography images for two patients who had undergone MAGO therapy. The minimal cross-sectional area and total volume of the pharyngeal airway were measured in the pre- and post-treatment for a total of four models. These two subjects were chosen out of 18 patients based on the airway volume changes in pre- and post-treatment. Subject 1 had a dramatic increase in the airway volume, whereas subject 2 kept a similar airway volume following the therapy. Both subjects anecdotally reported improvement in snoring, breathing and overall sleep quality. Results: We examined three parameters, i.e., the classically defined resistance of airway in terms of pressure drop, the minimal cross-sectional area, and the pharyngeal airway volume. We also proposed a new fluid dynamic parameter: the percentage area of higher vorticity, to be correlated with the clinical efficacy of the appliance for airway patency. All four parameters could be used as index factors for subject 1 to explain the measurable clinical outcomes and the subjective report regarding quality of breathing, snoring cessation, and improvement in sleep of the patient. But only the minimal cross-sectional area and percentage area of higher vorticity could explain the clinical observations and subjective outcome in subject 2 who reported similar effects after the treatment. Conclusion: Splint therapy expanded the minimal cross-sectional area in both subjects, but did not necessarily influence the pharyngeal airway volume. The airway shape changed in terms of the percentage area of higher vorticity and the minimal cross-sectional area. Further studies are needed to assess the clinical efficacy of MAGO in reducing or eliminating the sleep-related breathing difficulties and snoring.
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Affiliation(s)
- THYAGASEELY SHEELA PREMARAJ
- Department of Growth and Development, University of Nebraska Medical Center, College of Dentistry, Lincoln NE 68583-0750, USA
| | - SIYEONG JU
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln NE 68588-0656, USA
| | - SUNDARALINGAM PREMARAJ
- Department of Growth and Development, University of Nebraska Medical Center, College of Dentistry, Lincoln NE 68583-0750, USA
| | - SUNG K. KIM
- Department of Oral Biology, University of Nebraska Medical Center, College of Dentistry, Lincoln NE 68583-0750, USA
| | - LINXIA GU
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln NE 68588-0656, USA
- Florida Institute of Technology, Melbourne, FL 32901-6975, USA
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Pinheiro de Magalhães Bertoz A, Souki BQ, Lione R, Theresa Webber SA, Bigliazzi R, Oliveira PM, Moro A, Cozza P. Three-dimensional airway changes after adenotonsillectomy in children with obstructive apnea: Do expectations meet reality? Am J Orthod Dentofacial Orthop 2019; 155:791-800. [DOI: 10.1016/j.ajodo.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 10/26/2022]
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Mostafiz WR, Carley DW, Viana MGC, Ma S, Dalci O, Darendeliler MA, Evans CA, Kusnoto B, Masoud A, Galang-Boquiren MTS. Changes in sleep and airway variables in patients with obstructive sleep apnea after mandibular advancement splint treatment. Am J Orthod Dentofacial Orthop 2019; 155:498-508. [PMID: 30935605 DOI: 10.1016/j.ajodo.2018.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is an extensive public health problem that imposes considerable morbidity. Mandibular advancement splint (MAS) therapy is a well tolerated treatment, but success rates are difficult to predict. Our objective was to investigate the relationship of oropharyngeal airway dimensions, sleep characteristics, patient biometrics, and treatment response within an OSA patient sample. METHODS Records of 33 adults were assessed retrospectively with the use of Dolphin 3D and Image J to measure the airway on pretreatment supine cone-beam computed tomography images and derived lateral cephalograms. The patients used Somnodent (Somnomed; Crows Nest, Australia) MAS appliances, which were titrated over 6-8 weeks. Appliance titration measurements and pre- and posttreatment polysomnograms were assessed. Respiratory disturbance index (RDI), absolute and percentage changes in RDI, non-rapid eye movement (NREM) RDI, rapid eye movement (REM) RDI, supine and nonsupine NREM and REM RDI, and minimal blood-oxygen saturation variables were evaluated. The associations of measurements from 2D and 3D minimal anterior-posterior linear distance and 3D airway variables with MAS treatment response were estimated. RESULTS AND CONCLUSIONS Combined effects of baseline total airway volume, body mass index, neck circumference, location of minimal cross sectional area, and OSA severity were associated with treatment response. Patients with higher initial OSA and more superiorly located airway constriction showed enhanced treatment response to MAS therapy. Airway constriction due to maxillofacial disproportions rather than soft tissue obstruction also showed better treatment response. No significant relationships were found in lateral cephalogram measurements.
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Affiliation(s)
- Whitney R Mostafiz
- Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill; Department of Orthodontics, New York University, New York, NY
| | - David W Carley
- College of Nursing, College of Medicine, University of Illinois, Chicago, Ill
| | - Maria Grace C Viana
- Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill
| | - Serina Ma
- Department of Orthodontics, University of Sydney, Sydney, New South Wales, Australia
| | - Oyku Dalci
- Department of Orthodontics, University of Sydney, Sydney, New South Wales, Australia
| | - M Ali Darendeliler
- Department of Orthodontics, University of Sydney, Sydney, New South Wales, Australia
| | - Carla A Evans
- Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill; Department of Orthodontic, Henry M. Goldman School of Medicine, Boston, Ma
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill
| | - Ahmed Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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