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Gupta S, Ardeshna A, Rossouw PE, Valiathan M. Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis - Part 1. Dent Clin North Am 2024; 68:693-706. [PMID: 39244251 DOI: 10.1016/j.cden.2024.05.004] [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: 09/09/2024]
Abstract
This article explores the intersection of various systemic conditions with orthodontic treatment. Renal diseases, including chronic kidney disease and renal transplant, present challenges such as delayed tooth eruption and gingival overgrowth, necessitating careful orthodontic planning and collaboration with physicians. Liver diseases, particularly hepatitis, heighten the risk of periodontal disease and mandate strict infection control measures during orthodontic procedures. Ehlers-Danlos syndrome poses challenges related to collagen fragility, rapid tooth movement, and orthodontic relapse. Autoimmune diseases like diabetes mellitus and juvenile idiopathic arthritis require tailored orthodontic approaches considering oral complications and joint involvement.
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Affiliation(s)
- Sumit Gupta
- Diplomate, American Board of Orofacial Pain, Private Practice, Rak Dental Care & Implant Centre, Ras Al Khaimah, United Arab Emirates.
| | - Anil Ardeshna
- Diplomate American Board of Orthodontics, Department of Orthodontics, Rutgers School of Dental medicine, 110 Bergen Street, Newark, NJ 07101, USA
| | - Paul Emile Rossouw
- Division of Orthodontics and Dentofacial Orthopedics, University of Rochester Eastman Institute of Oral Health, 625 Elmwood Avenue, Box 683, Rochester, NY 14620, USA
| | - Manish Valiathan
- Department of Orthodontics, Case Western Reserve University, 9601 Chester Avenue, Cleveland, OH 44106, USA
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Magalhães MC, Normando D, Soares CJ, Araujo E, Novaes RMO, Teodoro VV, Flores-Mir C, Kim KB, Almeida GA. Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial. Pediatr Pulmonol 2024. [PMID: 39239911 DOI: 10.1002/ppul.27239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE To determine the impact and best management sequence between adenotonsillectomy (AT) and rapid palatal expansion (RPE) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (MinSaO2) in nonobese pediatric obstructive sleep apnea (OSA) patients presenting balanced maxillomandibular relationship. STUDY DESIGN/METHODS Thirty-two nonobese children with balanced maxillomandibular relationship and a mean age of 8.8 years, with a graded III/IV tonsillar hypertrophy and maxillary constriction, participated in a cross-over randomized controlled trial. As the first intervention, one group underwent AT while the other underwent RPE. After 6 months, interventions were switched in those groups, but only to participants with an AHI > 1 after the first intervention. OSA medical diagnosis with the support of Polysomnography (PSG) was conducted before (T0), 6 months after the first (T1) and the second (T2) intervention. The influence of sex, adenotonsillar hypertrophy degree, initial AHI and MinSaO2 severity, and intervention sequence were evaluated using linear regression analysis. Intra- and intergroup comparisons for AHI and MinSaO2 were performed using ANOVA and Tukey's test. RESULTS The initial AHI severity and intervention sequence (AT first) explained 94.9% of AHI improvement. The initial MinSaO2 severity accounted for 83.1% of MinSaO2 improvement changes. Most AHI reductions and MinSaO2 improvements were due to AT. CONCLUSIONS Initial AHI severity and AT as the first intervention accounted for most of the AHI improvement. The initial MinSaO2 severity alone accounted for the most changes in MinSaO2 increase. In most cases, RPE had a marginal effect on AHI and MinSaO2 when adjusted for confounders.
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Affiliation(s)
- Maria Cecilia Magalhães
- Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil
| | - David Normando
- Department of Orthodontics, Federal University of Para, Belem, Brazil
| | - Carlos José Soares
- Department of Dental Materials, School of Dentistry, Federal University of Uberlândia Uberlândia, Brazil
| | - Eustaquio Araujo
- Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Missouri, USA
| | | | | | - Carlos Flores-Mir
- Department of Dentistry and Dental Hygiene, University of Alberta, Edmonton, Alberta, Canada
| | - Ki Beom Kim
- Department of Orthodontics, Center for Advanced Dental School (CADE), Saint Louis University, Saint Louis, Missouri, USA
| | - Guilherme A Almeida
- Department of Pediatric Dentistry and Orthodontics, Federal University of Uberlândia, Uberlândia, Brazil
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Zhao T, Yang Z, Ngan P, Luo P, Zhang J, Hua F, He H. Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101751. [PMID: 38145836 DOI: 10.1016/j.jormas.2023.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the dentofacial characteristics of children with and without adenoid and/or tonsillar hypertrophy. METHODS A consecutive sample of orthodontic patients aged 6-12 that took pre-treatment lateral cephalograms were included in this study. Those with history of previous orthodontic treatment, adenoidectomy or tonsillectomy, or craniofacial anomalies were excluded. The diagnosis of adenoid and tonsillar hypertrophy was based on Fujioka's and Baroni's methods, according to which the subjects were divided into four groups: the adenoid hypertrophy only (AHO) group; tonsillar hypertrophy only (THO) group; combined adenoid and tonsillar hypertrophy (AH+TH) group; and no adenoid or tonsillar hypertrophy (NH) group. Cephalograms were used for skeletal and dental measurement. Data were analyzed using one-way ANOVA, LSD post-hoc tests and Chi-square test. RESULTS A total of 598 patients were included. Compared with the NH group, the THO group had significantly larger SNB angle (P < 0.001), as well as significantly smaller ANB angle (P<0.001) and Wits value (P = 0.001). The U1-L1 angle of AHO group was significantly smaller than that in the NH group (P = 0.035). The proportion of adenoid hypertrophy in Class II patients was significantly higher than that in Class III patients (P = 0.001). The proportion of tonsillar hypertrophy in Class III patients was significantly higher than that in Class I patients (P < 0.001) and Class II patients (P < 0.001). CONCLUSION Over 80 % of children seeking orthodontic treatment had either adenoid or tonsillar hypertrophy. Children with adenoid hypertrophy tend to have skeletal Class II malocclusion, while those with tonsillar hypertrophy tend to have skeletal Class III malocclusion.
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Affiliation(s)
- Tingting Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zheng Yang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WV, United States of America
| | - Ping Luo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jun Zhang
- Department of Oral Radiology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Thomas DC, Somaiya T, Meira E Cruz M, Kodaganallur Pitchumani P, Ardeshna A, Ravi A, Prabhakar S. The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient. J Am Dent Assoc 2024; 155:735-746. [PMID: 39007793 DOI: 10.1016/j.adaj.2024.05.007] [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: 12/30/2023] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders. TYPES OF STUDIES REVIEWED The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine. RESULTS The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science. CONCLUSIONS AND PRACTICAL IMPLICATIONS The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.
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Jessadapornchai T, Samruajbenjakun B, Chanmanee P, Chalidapongse P. 3D analysis of upper airway morphology related to obstructive sleep apnea severity. J World Fed Orthod 2024; 13:175-180. [PMID: 38688739 DOI: 10.1016/j.ejwf.2024.03.003] [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: 11/09/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep. However, little evidence is available on the differences between the sub-regions of the upper airway morphology and OSA severity. Since orthodontists frequently perform cone beam computed tomography (CBCT) in the neck area, we aimed to investigate the relationship and the differences between upper airway morphology and OSA severity using CBCT. MATERIALS AND METHODS The medical records, CBCT imaging of 21 OSA patients diagnosed by polysomnography, and the apnea-hypopnea index (AHI) results were included to classify OSA severity as mild, moderate, or severe. The minimum cross-sectional areas (MCA) and volumes of the upper pharyngeal airway boundaries in four sub-regions: nasopharynx, retropalatal, retroglossal, and hypopharynx were measured. Dolphin Imaging software was used for upper airway segmentation. The correlation coefficient (r), one-way ANOVA, and the least significant difference post hoc multiple comparison test were applied to fulfill the objectives. RESULTS A statistically significant relationship was found between the MCA of the nasopharynx and the AHI (r = -0.473, P < 0.05). Furthermore, a difference was found between mild and moderate and moderate and severe OSA severity in the MCA results of the retroglossal region (P < 0.05). However, no relationship was found between the upper airway volume and OSA severity. CONCLUSIONS MCA was moderately negatively correlated to AHI only in the nasopharynx subregion. Moderate OSA presented significantly less MCA than mild and severe OSA only in the oropharynx and retroglossal subregions.
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Affiliation(s)
- Tuangporn Jessadapornchai
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Bancha Samruajbenjakun
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | - Pannapat Chanmanee
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Premthip Chalidapongse
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Sambale J, Birk R, Koehler U, Hildebrandt W, Korbmacher-Steiner HM. An Interdisciplinary Approach: Presentation of the Pediatric Obstructive Sleep Apnea Diagnostic Examination Form (POSADEF). Diagnostics (Basel) 2024; 14:1593. [PMID: 39125469 PMCID: PMC11312144 DOI: 10.3390/diagnostics14151593] [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: 06/30/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024] Open
Abstract
This report emphasizes the need for interdisciplinary collaboration in diagnosing and treating pediatric obstructive sleep apnea (OSA). OSA, affecting 1% to 4% of children, often results from adenotonsillar hypertrophy, craniofacial disorders, or obesity. While adenotonsillectomy is the primary treatment, about 75% of children, especially those with craniofacial disorders or obesity, continue to experience OSA symptoms post-surgery. To address these cases, several medical fields emphasize the necessity and demand for interdisciplinary collaboration in managing pediatric OSA. Therefore, the authors aimed to develop the Pediatric Obstructive Sleep Apnea Diagnostic Examination Form (POSADEF). This form, based on clinical experience and the literature, captures craniofacial and functional characteristics linked to pediatric OSA. A case study of an eight-year-old girl with OSA, who was unsuccessfully treated with adenotonsillectomy, underlines the importance of the diagnostic examination form. The orthodontic assessment revealed craniofacial disorders and subsequent treatment with maxillary expansion and functional appliance therapy resolved her OSA symptoms. This case demonstrates the value of POSADEF in enabling comprehensive evaluation and treatment across medical disciplines. POSADEF is designed to assist health care professionals in diagnosing craniofacial and orofacial anomalies contributing to pediatric OSA.
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Affiliation(s)
- Janine Sambale
- Department of Orthodontics, Clinic of Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35039 Marburg, Germany
| | - Richard Birk
- Department of Otolaryngology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Ulrich Koehler
- Department of Pneumology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Wulf Hildebrandt
- Department of Anatomy, Philipps-University Marburg, 35037 Marburg, Germany
| | - Heike Maria Korbmacher-Steiner
- Department of Orthodontics, Clinic of Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35039 Marburg, Germany
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Becking BE, Verweij JP, Jonkman REG, van Merkesteyn JPR, Van den Akker-Van Marle ME. Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population. Sleep Med 2024; 119:19-26. [PMID: 38636211 DOI: 10.1016/j.sleep.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/18/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Pediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. METHODS The translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4-18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. RESULTS The factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. CONCLUSIONS Cultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.
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Affiliation(s)
- Bibi E Becking
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Jop P Verweij
- Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, the Netherlands.
| | | | - J P Richard van Merkesteyn
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, the Netherlands.
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Mladenovic M, Freezer S, Dreyer C, Meade MJ. The orthodontic extraction of second premolars: The influence on airway volume. Am J Orthod Dentofacial Orthop 2024; 166:61-68. [PMID: 38678455 DOI: 10.1016/j.ajodo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION The extraction of second premolars and associated changes in the volume of the airway have not been previously explored. This retrospective study aimed to compare the volumetric changes of the airway preorthodontic and postorthodontic treatment in relevant extraction and control samples and to identify variables that may influence the outcome. METHODS Cone-beam computed radiography scans of 54 patients with second premolar extraction and 59 nonextraction patients treated in a private orthodontic practice were matched for crowding. The average age for both samples was 15 years. The images were individually landmarked and measured by applying volumetric, linear, and angular parameters. The results were analyzed using repeated measures, such as variance analysis, correlation testing, and regression statistical analyses. RESULTS There was a statistically significant increase in the airway volume for both groups (P <0.05). The difference in increase between the groups was not statistically significant. Seven variables demonstrated a collectively significant effect on changes to airway volume (F[7,112] = 38.48; P <0.001; r2 = 0.701), with 70% of the variation predicted by the variables. Multiple regression analyses indicated that changes to the area of minimum constriction (B = 32.45; t = 11.95; P <0.001) and changes to airway length (B = 94.75; t = 7.79; P <0.001) had a statistically significant effect on airway volume. CONCLUSIONS The volume of the airway increased in both the extraction and nonextraction samples. The biggest contributors to the increase were an increase in airway length and an increase in the area of minimum constriction, which likely occurred as a result of natural growth.
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Affiliation(s)
- Miodrag Mladenovic
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Freezer
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Dreyer
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
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Kazmierski RH. Obstructive sleep apnea: What is an orthodontist's role? Prog Orthod 2024; 25:21. [PMID: 38945976 PMCID: PMC11214936 DOI: 10.1186/s40510-024-00524-4] [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: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. RESULTS Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. CONCLUSIONS Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.
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Affiliation(s)
- Robert H Kazmierski
- Solo Private Orthodontic Practice, 110 Marter Ave., Suite 404, Moorestown, NJ, 08057, USA.
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Rengasamy Venugopalan S, Allareddy V, Yadav S. Interdisciplinary Role of Orthodontist in Screening and Managing Obstructive Sleep Apnea in Children and Adults. Dent Clin North Am 2024; 68:475-483. [PMID: 38879281 DOI: 10.1016/j.cden.2024.03.005] [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: 06/26/2024]
Abstract
Obstructive sleep apnea (OSA) can affect children and adults, and, if left untreated, could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have an interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by a sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. Currently the evidence in the literature for prophylactic growth modification in children to prevent OSA is weak. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective.
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Affiliation(s)
| | - Veerasathpurush Allareddy
- Department of Orthodontics, University of Illinois College of Dentistry, 801 S. Paulina Street, IL 60612, USA
| | - Sumit Yadav
- Department of Growth and Development, University of Nebraska Medical Center, UNMC College of Dentistry, Room 2432, 4000 East Campus Loop South, Lincoln, NE 68583-0740, USA
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Terawatpothong A, Sessirisombat C, Banhiran W, Hotokezaka H, Yoshida N, Sirisoontorn I. Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea. J Clin Med 2024; 13:3540. [PMID: 38930069 PMCID: PMC11204907 DOI: 10.3390/jcm13123540] [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: 05/16/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Polysomnography and cephalometry have been used for studying obstructive sleep apnea (OSA) etiology. The association between craniofacial skeleton and OSA severity remains controversial. To study OSA's etiology, cephalometry, fiberoptic pharyngoscopy, polysomnography, and sleep endoscopy have been used; however, airway obstructions cannot be located. Recent research suggested ultrasonography for OSA screening and upper airway obstruction localization. Thus, this study aims to investigate the relationship between specific craniofacial cephalometric and ultrasonic airway parameters in adults at high risk of OSA. Methods: To assess craniofacial structure, lateral cephalograms were taken from thirty-three adults over 18 with a STOP-Bang questionnaire score of three or higher and a waist-to-height ratio (WHtR) of 0.5 or higher. Airway parameters were assessed through submental ultrasound. Results: NSBA correlated with tongue base airspace width, while MP-H correlated with oropharynx, tongue base, and epiglottis airspace width. SNA, SNB, and NSBA correlated with tongue width at the oropharynx. At tongue base, ANB and MP-H correlated with tongue width. SNB and NSBA were associated with deep tissue thickness at the oropharynx, while MP-H correlated with superficial tissue thickness at velum and oropharynx. Conclusions: Cephalometric parameters (SNA, SNB, ANB, NSBA, and MP-H) were correlated with ultrasonic parameters in the velum, oropharynx, tongue base, and epiglottis.
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Affiliation(s)
- Anutta Terawatpothong
- Department of Clinical Dentistry, Walailak University International College of Dentistry (WUICD), 87 Ranong 2 Road, Dusit, Bangkok 10300, Thailand
| | - Chidchanok Sessirisombat
- Department of Clinical Dentistry, Walailak University International College of Dentistry (WUICD), 87 Ranong 2 Road, Dusit, Bangkok 10300, Thailand
| | - Wish Banhiran
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Hitoshi Hotokezaka
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Irin Sirisoontorn
- Department of Clinical Dentistry, Walailak University International College of Dentistry (WUICD), 87 Ranong 2 Road, Dusit, Bangkok 10300, Thailand
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Wiener RC, Hnat M, Ngan P. Sleep disruption and premolar absence, NHANES, 2017-2020: A cross-sectional study. Community Dent Oral Epidemiol 2024. [PMID: 38825699 DOI: 10.1111/cdoe.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars. METHODS A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data on participants, aged 18-65 years (n = 4742). Variables of interest included self-reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test. RESULTS There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants. CONCLUSION Concerns of the impact of first premolar extractions on SDB were not supported with this study.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Michael Hnat
- Department of Restorative Dentistry, School of Dentistry, 1073 Health Sciences Center North, West Virginia University, Morgantown, West Virginia, USA
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, 1073 Health Sciences Center North, West Virginia University, Morgantown, West Virginia, USA
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Dokova AF, Lee JY, Mason M, Moretti A, Reside G, Christensen J. Advancements in tooth autotransplantation. J Am Dent Assoc 2024; 155:475-483. [PMID: 38530692 DOI: 10.1016/j.adaj.2024.01.006] [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: 09/03/2023] [Revised: 12/30/2023] [Accepted: 01/13/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Tooth autotransplantation (AT) involves the surgical relocation of a tooth from 1 site in the mouth to another site within the same patient. This approach is a good option in a growing patient when dental implant placements or fixed bridges are not suitable and when preserving natural teeth is a priority. Tooth AT is a complex procedure that requires specialized skills from a multidisciplinary team with careful patient and tooth selection and treatment planning. TYPES OF STUDIES REVIEWED The authors provided a review of the state of knowledge and research on tooth AT and presented a case scenario and barriers to adoption, with a focus on the United States. RESULTS Success rates for tooth AT can vary depending on several factors, including the patient's overall health, specific tooth involved, skill of the dental surgeon, and postoperative care provided. Long-term outcomes of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-up spanning up to 26 years. Results of several systematic reviews showed survival rates from 75% through 98%. CONCLUSIONS AND PRACTICAL IMPLICATIONS Adoption of tooth AT has grown over the years, owing to advancements in dental techniques, improved patient outcomes, and increased awareness among both dentists and patients. Increasing awareness and availability of tooth AT to replace missing teeth can provide a natural and functional alternative to traditional prosthetic options. Tooth AT helps preserve the alveolar bone in growing patients and can offer excellent esthetic and functional outcomes.
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Peanchitlertkajorn S, Chalidapongse P, Jiansuwannapas T, Surinsirirat N, Khamphuang P, Boonyai P, Sipiyaruk K. Dental Sleep Medicine Education Amongst Accredited Orthodontic Programmes in Thailand. Int Dent J 2024; 74:573-580. [PMID: 38044215 PMCID: PMC11123519 DOI: 10.1016/j.identj.2023.10.020] [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: 08/15/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Dental sleep medicine education (DSME) should be emphasised in postgraduate orthodontic training; however, there appears to be no clear guideline for its implementation into the curriculum. OBJECTIVE The aim was to investigate the current status of DSME as well as its feasibility and implementation in postgraduate orthodontic programmes. METHODS A structured interview with predetermined response options was chosen as a data collection method to gather relevant information from representatives of all accredited postgraduate orthodontic programmes in Thailand. These interviews were conducted online via the Cisco Webex Meeting platform. A combination of data analysis techniques was employed to achieve a thorough comprehension of the research findings, including descriptive statistics, quantitative content analysis, thematic analysis, and alignment analysis. RESULTS All participating programmes reported the inclusion of DSME in their curricula. A didactic approach was adopted by all programmes. However, only 2 out of 7 programmes offered clinical sessions for their students. Several challenges in implementing DSME within orthodontic programmes were identified, including a shortage of expertise and limited patient access. The participants also suggested that knowledge and resource sharing amongst institutions could serve as a potential solution to enhance the feasibility of DSME. CONCLUSIONS This research highlighted the significant disparities and inadequacy of DSME within postgraduate orthodontic programmes in Thailand due to various challenges. Consequently, there is a compelling need to place greater emphasis on DSME and establish a national-level standardisation within orthodontic programmes. This effort is essential for enhancing the awareness and competency of orthodontists in the field of DSME.
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Affiliation(s)
| | - Premthip Chalidapongse
- Division of Oral Diagnostic Science, Faculty of Dentistry, Prince of Songkla University, Thailand
| | | | - Nattaporn Surinsirirat
- Doctor of Dental Surgery Program, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Patipan Khamphuang
- Doctor of Dental Surgery Program, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Paweelada Boonyai
- Doctor of Dental Surgery Program, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kawin Sipiyaruk
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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15
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Lockerman LZ. Disclosure orthodontic and TMD - new study. Evid Based Dent 2024; 25:73-74. [PMID: 38418641 DOI: 10.1038/s41432-024-00991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
DESIGN Cooperative analysis of participants and controls. DATA SOURCE Wiley Online Library, National Institute of Health, ResearchGate, ScienceDirect, Google Scholar. STUDY SELECTION Human clinical trials age 18-30 years old, a case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality. EXCLUSION CRITERIA Medical and/or dental emergencies, subjects with a history of drug, alcohol or medication abuse, fibromyalgia, being pregnant or lactating, having a coexisting mental, psychiatric, or physical disability, cancerous or significant medical problems and the consumption of drugs and/or medications that affect the nervous system including narcotics, TCA (tricyclic antidepressants), anticonvulsant, muscle relaxants and medication overuse headache. DATA EXTRACTION SYNTHESIS To identify differences between groups, categorical independent variables were analysed using the chi-square test or likelihood ratio, while numeric independent variables were analysed using independent t-tests and analysis of variance (ANOVA). A two-tailed level of statistical significance (α) was established at 0.05. Analysis of multicollinearity was performed following the univariate analyses to examine the collinearity among the independent variables and select independent variables with minimal correlation. Among the highly correlated variables, only one was selected for inclusion in the multivariate model, with the specific variable chosen based on contextual considerations. RESULTS The research comprised a total of 291 individuals, consisting of two distinct groups: the TMD group (192 participants, 66%) and the control group (99 participants, 34%). Within the TMD group, further subcategorization was conducted, including MMP (masticatory muscle pain) with 44 individuals (15%); TMJD with 26 individuals (9%); and TMP (both MMP and TMJ) with 122 individuals (42%). CONCLUSIONS Using a "holistic" and a "collinearity statistical approach and the utilization of a multivariate model" the conclusion is that TMD is not associated with orthodontics.
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Affiliation(s)
- Larry Z Lockerman
- Clinical Instructor Orofacial Pain, Department of Oral Pathology, Oral Medicine, Maxillofacial Imaging, Tel Aviv University School Dental Medicine, Tel Aviv, Israel.
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16
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Kandasamy S. Obstructive sleep apnea and early orthodontic intervention: How early is early? Am J Orthod Dentofacial Orthop 2024; 165:500-502. [PMID: 38180391 DOI: 10.1016/j.ajodo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Sanjivan Kandasamy
- Center for Advanced Dental Education, Saint Louis University, St Louis, Mo; Dental School, The University of Western Australia, Nedlands, Western Australia, Australia; Private practice, West Australian Orthodontics, Midland, Western Australia, Australia.
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Ronsivalle V, Leonardi R, Lagravere M, Flores-Mir C, Grippaudo C, Alessandri Bonetti G, Lo Giudice A. Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study. J Dent 2024; 144:104934. [PMID: 38461886 DOI: 10.1016/j.jdent.2024.104934] [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: 11/26/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES The medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts of patients. METHODS This retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal cross-sectional area (CSmin) were also considered. RESULTS All PAs' volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p < 0.05). Inter-group comparisons showed significant differences (p < 0.05) for nasopharynx and CSmin parameters (p < 0.05), while no significant changes were recorded for the other UA's sub-regions and PW (p > 0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. CONCLUSIONS Twelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. CLINICAL SIGNIFICANCE From the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.
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Affiliation(s)
- Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Manuel Lagravere
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Grippaudo
- Orthodontic Graduate Program, University of Roma Cattolica - Sacro Cuore
| | | | - Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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18
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Rangarajan H, Ayub II, Padmanabhan S. Assessment of maximal inspiratory and expiratory pressures in skeletal Class II patients with different growth patterns. Angle Orthod 2024; 94:328-335. [PMID: 38639454 PMCID: PMC11050465 DOI: 10.2319/071723-496.1] [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: 07/01/2023] [Accepted: 11/01/2023] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES To evaluate maximal inspiratory (MIP) and expiratory (MEP) pressures, which are reflective of respiratory muscle strength, in skeletal Class II patients with different growth patterns (horizontal, average, and vertical) and to correlate those with airway dimension. MATERIALS AND METHODS Patients with a Class II skeletal base seeking orthodontic treatment were assigned to the following groups: average, horizontal, and vertical growth pattern. The control group (n = 14) comprised patients with a Class I skeletal base and average growth pattern. Airway dimensions were obtained using cone-beam computed tomography scans, and a spirometer with a pressure transducer was used for assessment of MIP and MEP. Routine spirometry for assessment of lung function was also performed. RESULTS No significant differences were found in maximal inspiratory and expiratory pressures for the study groups in comparison with the control group. Class I patients had significantly greater oropharyngeal and nasopharyngeal airway volumes compared with the study groups. No significant difference in minimal cross-section area of the airway was observed among groups. A weak positive correlation between maximal inspiratory pressure and airway volume was observed. CONCLUSIONS Although Class I patients displayed significantly greater oropharyngeal and nasopharyngeal airway volumes, there was no significant difference in respiratory muscle strength or airway function between Class II patients with different growth patterns and the Class I control group. The findings underscore the significance of exploring factors beyond craniofacial growth patterns that may contribute to sleep-related breathing disorders.
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Honglertnapakul Y, Peanchitlertkajorn S, Likitkulthanaporn A, Saengfai NN, Chaweewannakorn C, Boonpratham S. Impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on sleep-related respiratory parameters: A systematic review and meta-analysis. Orthod Craniofac Res 2024. [PMID: 38661057 DOI: 10.1111/ocr.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
A systematic review and meta-analysis was conducted to evaluate the impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on respiratory parameters measured by polysomnography (PSG) and to compare these respiratory parameters between these procedures for class III skeletal correction. Six electronic databases were searched up to June 2023. Studies comparing PSG parameters before and after orthognathic surgery for skeletal class III patients were selected for further analysis. The outcomes of interest were apnoea-hypopnea index (AHI), respiratory disturbance index (RDI), the lowest oxygen saturation (lowest SpO2), the average oxygen saturation (mean SpO2), and the 3% oxygen desaturation index (3% ODI). Data extraction, methodological quality assessment, risk of bias assessment, meta-analysis, and subgroup analysis were performed. Sixteen studies with a total of 476 patients who underwent orthognathic surgery for class III skeletal correction were included for meta-analysis. The risk of bias level was moderate for most studies. All PSG parameters before and after orthognathic surgery were not significantly different. The different surgical procedures also did not significantly affect post-operative PSG parameters. 5.8% of patients developed post-operative obstructive sleep apnoea (OSA). Most of them underwent a large distance of mandibular setback. There is a moderate level of evidence that mandibular setback with or without maxillary advancement for class III skeletal correction does not pre-dispose young and healthy patients to obstructive sleep apnoea when evaluated in the short term after surgery. However, post-operatively developed OSA was found in several isolated cases that underwent a large amount of mandibular setback with or without maxillary advancement.
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Affiliation(s)
| | | | | | | | | | - Supatchai Boonpratham
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Nakhon Pathom, Thailand
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20
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Guo F, Lv C, Tang B, Lin L, Zhang C, Zheng J, Zhao T, He H. Functional therapy and adenotonsillectomy clinical trial for class II malocclusion (FACT-II): protocol for a randomised controlled trial. BMJ Open 2024; 14:e079571. [PMID: 38626960 PMCID: PMC11029268 DOI: 10.1136/bmjopen-2023-079571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Class II malocclusion with mandibular retrognathia is a common complication of paediatric obstructive sleep apnoea (OSA), often accompanied by transverse maxillary deficiency. In early orthodontic treatment, a twin block (TB) is a regular functional appliance for correcting this malocclusion. For paediatric OSA, the most common risk factor is adenotonsillar hypertrophy (AHT). Untreated AHT may lead to the persistence and worsening of obstructive sleep-disordered breathing traits, including habitual mouth breathing. Additionally, the clockwise mandibular rotation associated with AHT-induced pharyngeal crowding can undermine the effectiveness and stability of TB treatment. Adenotonsillectomy (T&A) is currently the first-line treatment for paediatric OSA. This proposed trial will investigate the impact of T&A surgery timing on the efficacy and stability of TB functional treatment in children with class II mandibular retrognathia and ATH. METHODS AND ANALYSIS This will be a single-centre, parallel-group, superiority randomised controlled trial with participants randomised to intervention (T&A followed by TB treatment) or control arms (TB treatment followed by T&A) in a 1:1 ratio. A total of 40 patients aged 8-14 years, diagnosed with class II mandibular retrognathia and co-existing ATH-induced OSA, and indicated for both T&A surgery and TB treatment, will be recruited at the School and Hospital of Stomatology, Wuhan University. The primary outcomes will be the changes in the apnoea-hypopnoea index and the point A-nasion-point B angle from baseline to postorthodontic treatment between the two groups. Secondary outcomes will include other dental, skeletal, upper airway and soft tissue changes, as well as subjective sleep-related and oral-related quality of life. Outcome changes within each group and between groups will be analysed. ETHICS AND DISSEMINATION This study is approved by the Ethics Committee of the School and Hospital of Stomatology, Wuhan University (no. 2022-D07). The research findings will be faithfully disseminated through scientific conferences or published articles. TRIAL REGISTRATION NUMBER ChiCTR2200061703 (https://www.chictr.org.cn).
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Affiliation(s)
- Feiyang Guo
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chenxing Lv
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bojun Tang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lizhuo Lin
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chen Zhang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development and Sleep Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jie Zheng
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tingting Zhao
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development and Sleep Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hong He
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development and Sleep Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Savoldi F, Dagassan-Berndt D, Patcas R, Mak WS, Kanavakis G, Verna C, Gu M, Bornstein MM. The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing. Dentomaxillofac Radiol 2024; 53:178-188. [PMID: 38265247 PMCID: PMC11003665 DOI: 10.1093/dmfr/twae001] [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: 09/05/2023] [Revised: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032, Switzerland
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
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22
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Dominguez-Mompell R, Zhang B, Paredes N, Combs A, Elkenawy I, Sfogliano L, Fijany L, Colak O, Romero-Maroto M, Moon W. Breathing changes following mini-implant-supported maxillary skeletal expander treatment in late adolescent or adult patients : Assessment of objective and subjective functional breathing changes. J Orofac Orthop 2024:10.1007/s00056-024-00521-6. [PMID: 38466417 DOI: 10.1007/s00056-024-00521-6] [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: 11/09/2022] [Accepted: 01/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The aim of this study was to assess objective and subjective breathing changes in adult patients who underwent maxillary skeletal expansion with the mini-implant-supported maxillary skeletal expander (MSE). METHODS Twenty-nine patients (mean age 18.1 ± 4.3 years) who underwent expansion using the MSE were compared pre- and posttreatment and with a control group (mean age 19.9 ± 2.6 years) to assess objective and subjective functional breathing changes. Objective measurements of the airway including peak nasal inspiratory flow (PNIF) and peak oral inspiratory flow (POIF) were measured utilizing the In-Check medical device (Clement Clarke, Harlow, United Kingdom). Patients reported subjective breathing assessment utilizing the visual analog scale (VAS). Intragroup comparisons were performed with Wilcoxon tests and intergroup comparison with Mann-Whitney U tests. Spearman correlation coefficients were calculated among the studied variables (P < 0.05). RESULTS Following MSE treatment, there were significantly higher values for PNIF total (P < 0.0001), PNIF right (P < 0.0001), PNIF left (P < 0.0001), and POIF (P < 0.01) compared to pretreatment and control group results. Also, patients reported a significant decrease in troubled breathing as measured by the VAS for breathing through the right nostril (P < 0.01), left nostril (P < 0.001), and both nostrils (P < 0.01). Comparing the objective and subjective variables for both the pre-MSE or post-MSE groups, the results indicated no significant correlation between total PNIF and total VAS. However, the values had significant correlations between PNIF and VAS on each side when the patients were asked to block one nostril. CONCLUSIONS Objective functional breathing measurements were increased immediately after treatment with MSE. Subjective functional breathing measurements changes were significantly higher after MSE treatment and compared with the control group. MSE presents a nonsurgical alternative to achieving orthopedic expansion in adult patients which may provide a benefit for patients with nasal airway obstruction.
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Affiliation(s)
| | - Boshi Zhang
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ney Paredes
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA.
| | - Andrew Combs
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Islam Elkenawy
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Luca Sfogliano
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Layla Fijany
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ozge Colak
- Orthodontics Department, State University of New York, 320 Hayes Rd, 14215, Buffalo, NY, USA
| | | | - Won Moon
- Orthodontics and Craniofacial Development Research Forsyth Institute, 245 First Street, 02142, Cambridge, MA, USA.
- Orthodontics Department, AJOU University, Suwon, Korea (Republic of).
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Bariani RCB, Bigliazzi R, Medda MG, Micieli APR, Tufik S, Fujita RR, de Mello CB, Moreira GA. Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study. Am J Orthod Dentofacial Orthop 2024; 165:344-356. [PMID: 38142392 DOI: 10.1016/j.ajodo.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. METHODS A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. RESULTS The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P <0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P <0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. CONCLUSIONS The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.
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Affiliation(s)
- Rita Catia Brás Bariani
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Mariana Gobbo Medda
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Paula Roim Micieli
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Reginaldo Raimundo Fujita
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Cláudia Berlim de Mello
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo Antonio Moreira
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Avinash B, Bharathi MB, Channanayak C, Vasthare R, Arron Lim YR, Nayak PP. Interprofessional collaboration in Paediatric Obstructive Sleep Apnoea (POSA) treatment: Assessment of professional orientation levels amongst otolaryngologists in South India. J Oral Biol Craniofac Res 2024; 14:180-184. [PMID: 38389715 PMCID: PMC10882163 DOI: 10.1016/j.jobcr.2024.02.003] [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: 11/04/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Objective The primary goal was to assess the knowledge, attitude and practice among otorhinolaryngologists regarding orthodontic intervention for Paediatric Obstructive Sleep Apnoea (POSA). Methods An online survey was conducted by sending an email invitation to members of The Association of Otorhinolaryngologists of Karnataka, India. A total of 141 otorhinolaryngologists participated in the survey. Results Most of the participants (70.2%) agreed that orthodontic interventions help in opening up the airway, but very few knew about its application in nasal obstruction management. Conclusion Otorhinolaryngologists are aware of dental effects of POSA and they believe that an interprofessional team is essential for its management. This learning can also be used to initiate interprofessional collaborations and academic and curricular improvisations for enhanced health outcomes.
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Affiliation(s)
| | - M B Bharathi
- Dept of Otorhinolaryngology, JSS Medical College, Mysuru, Karnataka, India
| | | | - Ramprasad Vasthare
- Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, India
| | - Y R Arron Lim
- Discipline of Orthodontics, Department of Family Oral Health, Faculty of Dentistry, National University of Malaysia, Malaysia
| | - Prajna P Nayak
- Dept of Public Health Dentistry, Manipal College of Dental, Sciences, Manipal, Manipal Academy of Higher Education, India
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25
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Shimoyama M, Kanzaki H, Tohyama S, Ida T, Ishikawa M, Katsumata Y, Arai C, Wada S, Manase S, Tomonari H. Mandibular Endochondral Growth Is Specifically Augmented by Nutritional Supplementation with Myo-Inositol Even in Rabbits. Dent J (Basel) 2024; 12:49. [PMID: 38534273 DOI: 10.3390/dj12030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Mandibular retrognathism occurs by insufficient mandibular growth and causes several issues, such as respiratory difficulty and diminished masticatory function. At present, functional orthodontic appliances are used for stimulating mandibular growth in pediatric cases. However, the effectiveness of functional appliances is not always stable in daily practices. A more effective, reliable, and safer therapeutic method for mandibular growth promotion would be helpful for growing mandibular retrognathism patients. As we previously discovered that nutritional supplementation of myo-inositol in growing mice specifically increases mandibular endochondral growth, we performed preclinical animal experiments in rabbits in this study. Briefly, six-week-old male Japanese white rabbits were fed with or without myo-inositol supplementation in laboratory chow until 25 weeks old, and 3D image analysis using micro CT data and histological examinations was done. Myo-inositol had no systemic effect, such as femur length, though myo-inositol specifically augmented the mandibular growth. Myo-inositol increased the thickness of mandibular condylar cartilage. We discovered that the nutritional supplementation of myo-inositol during the growth period specifically augmented mandibular growth without any systemic influence, even in rabbits. Our results suggest the possibility of clinical use of myo-inositol for augmentation of the mandibular growth in growing mandibular retrognathism patients in the future.
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Affiliation(s)
- Miho Shimoyama
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Hiroyuki Kanzaki
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Syunnosuke Tohyama
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Tomomi Ida
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Misao Ishikawa
- Department of Anatomy, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Yuta Katsumata
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Chihiro Arai
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Satoshi Wada
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Kanazawa 920-0293, Japan
| | - Shugo Manase
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Hiroshi Tomonari
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
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26
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Raoof M, Verhoeff MC, Kooshki R, Aarab G, Lobbezoo F. Self-reported oral moistening disorders in obstructive sleep apnoea: A scoping review. J Oral Rehabil 2024; 51:226-239. [PMID: 37282351 DOI: 10.1111/joor.13532] [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: 12/15/2022] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a highly prevalent problem with significant consequences. Continuous positive airway pressure (CPAP) and oral mandibular advancement device (MAD) are considered the standard treatments for OSA. Patients may experience self-reported oral moistening disorders (OMDs) (i.e. xerostomia or drooling) at the beginning, throughout and after treatment. This affects oral health, quality of life and treatment effectiveness. The exact nature of the associations between OSA and self-reported OMD is still unknown. We aimed to provide an overview of the associations between self-reported OMD on the one hand and OSA and its treatment (namely CPAP and MAD) on the other hand. In addition, we sought to determine whether OMD affects treatment adherence. MATERIALS AND METHODS A literature search in PubMed was performed up to 27 September 2022. Two researchers independently assessed studies for eligibility. RESULTS In total, 48 studies were included. Thirteen papers investigated the association between OSA and self-reported OMD. They all suggested an association between OSA and xerostomia but not between OSA and drooling. The association between CPAP and OMD was addressed in 20 articles. The majority of studies have indicated xerostomia as a CPAP side effect; however, some have observed that xerostomia diminishes with CPAP therapy. In 15 papers, the association between MAD and OMD was investigated. In most publications, both xerostomia and drooling have been described as common side effects of MADs. These side effects are often mild and transient, and they improve as patients continue to use their appliance. Most studies found that these OMDs do not cause or are not a strong predictor of non-compliance. CONCLUSION Xerostomia is a common side effect of CPAP and MAD, as well as a significant symptom of OSA. It may be regarded as one of the indicators of sleep apnoea. Moreover, MAD therapy can be associated with OMD. However, it seems that OMD may be mitigated by being adherent to the therapy.
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Affiliation(s)
- Maryam Raoof
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Merel C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Razieh Kooshki
- Department of Biology, Faculty of Sciences, Lorestan University, Khorramabad, Iran
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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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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Mohammadi I, Adibparsa M, Najafi A, Sehat MS, Sadeghi M. A systematic review with meta-analysis to assess Alzheimer's disease biomarkers in adults with or without obstructive sleep apnoea. Int Orthod 2023; 21:100814. [PMID: 37776696 DOI: 10.1016/j.ortho.2023.100814] [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: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The aim was to design a meta-analysis evaluating the positron emission tomography (PET) uptake and cerebrospinal fluid (CSF), circulating levels of amyloid-β (Aβ), and tau proteins OSA group versus control group, as well as the association of these biomarkers with the severity of OSA. MATERIAL AND METHODS Four databases were searched until April 17, 2023, without any restrictions. The effect sizes were the standardized mean difference (SMD) along with a 95% confidence interval (CI). RESULTS A total of 21 articles were entered into the meta-analysis. The pooled SMDs of the CSF levels in OSA adults compared to controls were: -0.82 (P=0.004) for Aβ42, -1.13 (P<0.001) for Aβ40, 0.17 (P=0.23) for p-tau, 0.04 (P=0.65) for t-tau, 0.08 (P=0.89) for Aβ42/Aβ40 ratio, and 0.81 (P=0.001) for t-tau/Aβ42 ratio. The pooled SMD for the PET uptake of Aβ burden in OSA adults compared to controls was 0.30 (P=0.03). The pooled SMDs of the circulating levels in OSA adults compared to controls were: 0.67 (P=0.002) for Aβ42, 0.11 (P=0.82) for Aβ40, 0.35 (P=0.06) for p-tau, and 1.41(P=0.005) for t-tau. The pooled SMDs for levels of Aβ42, Aβ40, total Aβ, p-tau, t-tau, and Aβ42/Aβ40 ratio in severe OSA adults compared to mild/moderate OSA adults were -0.15 (P=0.33), 0.25 (P=35), 0.04 (P=87), -2.53 (P=0.24), -0.24 (P=0.52), and -0.28 (P=0.30), respectively. CONCLUSIONS The results indicated that CSF levels of Aβ42 and Aβ40 in OSA adults were significantly lower, but the CSF level of t-tau/Aβ42 ratio and PET Aβ burden uptake in OSA adults significantly were higher than in controls.
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Affiliation(s)
- Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mehrdad Adibparsa
- Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Amir Najafi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mohammad Soroush Sehat
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, 67144-15185 Kermanshah, Iran.
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Desai R, Komperda J, Elnagar MH, Viana G, Galang-Boquiren MTS. Evaluation of upper airway characteristics in patients with and without sleep apnea using cone-beam computed tomography and computational fluid dynamics. Orthod Craniofac Res 2023; 26 Suppl 1:164-170. [PMID: 38009653 DOI: 10.1111/ocr.12728] [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: 01/26/2023] [Revised: 09/26/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To determine if upper airway characteristics and airway pressure change significantly between low risk, healthy non-OSA subjects, and OSA subjects during respiration using cone-beam computed tomography (CBCT) imaging and steady-state k-ω model computational fluid dynamics (CFD) fluid flow simulations, respectively. MATERIALS AND METHODS CBCT scans were collected at both end-inhalation and end-exhalation for 16 low-risk non-OSA subjects and compared to existing CBCT data from 7 OSA subjects. The CBCT images were imported into Dolphin Imaging and the upper airway was segmented into stereolithography (STL) files for area and volumetric measurements. Subject models that met pre-processing criteria underwent CFD simulations using ANSYS Fluent Meshing (Canonsburg, PA) in which unstructured mesh models were generated to solve the standard dual equation turbulence model (k-ω). Objective and supplemental descriptive measures were obtained and statistical analyses were performed with both parametric and non-parametric tests to evaluate statistical significance at P < .05. RESULTS Regarding area and volumetric assessments, there were statistically significant mean differences in Total Volume and Minimum CSA between non-OSA and OSA groups at inhalation and exhalation (P = .002, .003, .004, and .007), respectively. There were also statistically significant mean differences in volume and min CSA between the inhalation and exhalation for the non-OSA group (P < .001 and .002), respectively. CONCLUSION While analysis of the CFD simulation was limited by the collected data available, a finding consistent with published literature was that the OSA subject group simulation models depicted the point of lowest pressure coinciding with the area of maximum constriction.
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Affiliation(s)
- Raj Desai
- Department of Orthodontics, University of Illinois Chicago, Chicago, Illinois, USA
- Private Practice of Orthodontics, Chicago, Illinois, USA
| | - Jonathan Komperda
- Department of Mechanical and Industrial Engineering, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mohammed H Elnagar
- Department of Orthodontics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Grace Viana
- Department of Orthodontics, University of Illinois Chicago, Chicago, Illinois, USA
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Cozzi-Machado C, Albertini FR, Silveira S, Machado-Júnior AJ. Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review. Sleep Sci 2023; 16:e468-e475. [PMID: 38197023 PMCID: PMC10773500 DOI: 10.1055/s-0043-1776747] [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: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.
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Affiliation(s)
- Carolina Cozzi-Machado
- Postgraduate Program in Surgical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fátima Rosana Albertini
- Postgraduate Program in Child and Adolescent Health, Centro de Investigação em Pediatria (CIPED), Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Silvana Silveira
- Postgraduate Program in Surgical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Almiro José Machado-Júnior
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; Institute of Science and Technology, Universidade Estadual de São Paulo (UNESP), São José dos Campos, SP, Brazil
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Lin L, Zhao T, Ngan P, Zhuang Y, Qin D, Hua F, He H. Obstructive sleep apnea-related knowledge, attitude, experience, and behaviors among orthodontic professionals: a survey. Sleep Breath 2023; 27:2361-2369. [PMID: 37222934 DOI: 10.1007/s11325-023-02852-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To assess obstructive sleep apnea (OSA)-related experience, knowledge, attitude, and behaviors among orthodontic professionals in China and identify factors associated with their knowledge levels, attitude toward referring, and self-confidence in the management of patients with OSA. METHODS An online cross-sectional survey was conducted using a 31-item questionnaire developed with a professional online survey tool ( www.wjx.cn ) and distributed via WeChat (Tencent, Shenzhen, China). Data were collected between January 16 and 23, 2022 and analyzed using the chi-square test, Fisher's exact test, and multivariate generalized estimation equations. RESULTS A total of 1760 professionals responded to the survey, and responses to 1611 questionnaires were valid. The average score of correct answers to the 15 OSA knowledge questions was 12.1 ± 2.0. Most of the professionals agreed that it was necessary to identify patients who might have OSA in practice. The top three sources for gaining knowledge of OSA according to the survey were classrooms and textbooks (76.3%), medical lectures (75.7%), and academic conferences (73.2%). The level of knowledge was significantly correlated with self-confidence in treatment (P < 0.001) and willingness to refer patients to otolaryngologists or clinicians of related disciplines (P < 0.001). CONCLUSIONS Most orthodontic professionals agreed that there was a need to identify patients with OSA and learn further about related problems. Treatment confidence and willingness of professionals to refer patients were related to the level of OSA knowledge. These findings suggest that promotion of OSA-related education may help improve the care of patients with OSA.
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Affiliation(s)
- Lizhuo Lin
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tingting Zhao
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, USA
| | - Yimin Zhuang
- Nanshan Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Danchen Qin
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Hong He
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Center for Dentofacial Development & Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Díaz-Díaz MF, Schlaefli-Arrieta X, Caballero García S, Geller Palti D. Association between knowledge and attitudes towards pediatric obstructive sleep apnea and dental specialty. Cranio 2023:1-10. [PMID: 37982430 DOI: 10.1080/08869634.2023.2281286] [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: 11/21/2023]
Abstract
OBJECTIVE To associate the knowledge and attitudes about Pediatric Obstructive Sleep Apnea (POSA) with the specialty of dentists in Metropolitan Lima, Peru. METHODS A cross-sectional, analytical observational study was carried out during 2021-2022. Two hundred and ten orthodontists and pediatric dentists were surveyed using the adapted and validated Spanish translation of the OSAKA-KIDS questionnaire and additional sociodemographic questions. RESULTS The data indicated an association between dental specialty and the professional's knowledge about POSA. Orthodontists were 59% less likely to have acceptable knowledge, compared to pediatric dentists (p = .013, IC 95% 0.21-0.83). The study revealed an association between the professional's attitudes and three intervening variables: age (p = .025), clinical experience (p = .049) and sector of practice (p = .020). CONCLUSION Knowledge was associated with the dental specialty of professionals in the sample included, whilst attitudes were not.
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Affiliation(s)
- María Fernanda Díaz-Díaz
- School of Dentistry, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Ximena Schlaefli-Arrieta
- School of Dentistry, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Stefany Caballero García
- School of Dentistry, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Dafna Geller Palti
- School of Dentistry, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Claudino LV, Mattos CT, Caldas LD, Mota-Júnior SL, Sant'Anna EF. Pharyngeal airway subdivisions in 3-dimensional analysis: Differences between anterior and posterior anatomic boundaries. Am J Orthod Dentofacial Orthop 2023; 164:741-749. [PMID: 37565947 DOI: 10.1016/j.ajodo.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION This study aimed to evaluate if there were differences between anterior and posterior anatomic boundaries used for the 3-dimensional determination of pharyngeal airway. METHODS The sample included 150 cone-beam computed tomography scans from healthy patients divided according to (1) age: 6-11, 12-16, and ≥16 years; (2) sex: female and male; (3) anteroposterior skeletal pattern: Class I, II, and III; (4) vertical pattern: brachyfacial, mesofacial, and dolichofacial; and (5) craniocervical inclination (CCI): natural head posture, head flexion, and head extension. Anatomic regions were created to determine the correspondences between structures anteriorly and posteriorly to the pharyngeal airway. RESULTS The location of the epiglottis, vallecula, hyoid, C2, and C3 were statistically different according to the CCI, and the location of vallecula, C3, and C4 were different according to sex. However, no statistically significant differences were observed between the frequencies of anterior and posterior anatomic region locations among age and different anteroposterior and vertical skeletal patterns. Posterior landmarks tend to be located below the anterior ones; consequently, the anatomic subregion they define will also be located below. CONCLUSIONS Anterior and posterior structures and vertical and anteroposterior skeletal patterns may determine upper airway limits regardless of age. However, the studies must be paired according to sex, and CCI must be standardized.
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Affiliation(s)
- Lígia Vieira Claudino
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luciana Duarte Caldas
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Eduardo Franzotti Sant'Anna
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Manrikyan GE, Vardanyan IF, Markaryan MM, Manrikyan ME, Badeyan EH, Manukyan AH, Gevorgyan MA, Khachatryan SG. Association between the Obstructive Sleep Apnea and Cephalometric Parameters in Teenagers. J Clin Med 2023; 12:6851. [PMID: 37959316 PMCID: PMC10650301 DOI: 10.3390/jcm12216851] [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: 10/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND OSA is a common problem in children and adolescents. Angle class II malocclusion, a tendency toward the vertical type of growth, causes a decrease in the volume of the oral air space, increasing the risk of OSAS. The aim of this study was to evaluate the relationship between cephalometric and OSA parameters, to develop collaborative approaches between orthodontists and somnologists in the treatment of adolescents with OSA. METHODS We analyzed data from 41 adolescents with OSA. Their mean age was 15.8 ± 1.08 years. Orthodontic and polysomnographic examinations of patients were conducted. Statistical analysis was performed in SPSS 19.0.0. RESULTS Most often in patients with distal occlusion, a violation of the harmony in the development of the dental system was observed. The sagittal incisive fissure, characteristic of a distal occlusion, was absent due to the palatal inclination of the upper incisors in 25 (60.98%) patients. The SNB was 79.4 ± 3.1°, indicating a distal position of the mandible relative to the anterior cranial base. The SNA exceeded the normal value, which is one of the prerequisites for mandibular retrognathia. The ANB angle was 4.3 ± 1.9°. Tonsillar hypertrophy affected 6 patients, 21 had adenoid hypertrophy, and 3 had both of them. Movements of the masticatory muscles during sleep were recorded in 22.0% of patients. CONCLUSION To improve the quality of diagnosis and treatment of OSA, a multidisciplinary approach is needed that will correct the processes of child growth and development.
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Affiliation(s)
- Gayane E. Manrikyan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Izabella F. Vardanyan
- Department of Pediatric Dentistry and Orthodontics, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (I.F.V.); (M.E.M.)
| | - Marina M. Markaryan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Mikayel E. Manrikyan
- Department of Pediatric Dentistry and Orthodontics, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (I.F.V.); (M.E.M.)
| | - Elen H. Badeyan
- Department of Pediatric Dentistry and Orthodontics, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (I.F.V.); (M.E.M.)
| | - Anna H. Manukyan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Mariana A. Gevorgyan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Samson G. Khachatryan
- “Somnus” Neurological Clinic, Department of Neurology and Neurosurgery, National Institute of Health, Yerevan 0051, Armenia;
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Alrejaye NS, Alnasser LA, Alsuliman AF, Alomran DK, Alshehri HH, Almalki MM, Alenazi SS, Bushnak IA, Abolfotouh MA. Physicians' Examination and Referral Practices on Orthodontic Problems Among 6-12-Year-Old Children in Saudi Arabia. Clin Cosmet Investig Dent 2023; 15:225-236. [PMID: 37881242 PMCID: PMC10596035 DOI: 10.2147/ccide.s438306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
Background Physicians are more likely to examine children than dentists; thus, they may have a significant role in detecting oral and dentofacial problems. This study aimed to determine the rate and comprehensiveness of examinations, the rate and quality of referral practices, and the predictors of referral practice of physicians regarding orthodontic problems among children. Methods In a multi-center cross-sectional study, a total of 518 physicians in Saudi Arabia were subjected to an e-questionnaire of four sections: (1) Physicians' demographic and work-related characteristics; (2) Physicians' comprehensiveness of oral and orthodontic examinations; (3) Physicians' referral practices to orthodontists and reasons considered for referral; and (4) Physicians' sources of orthodontic education. Logistic regression analysis was applied to identify the significant predictors of referral practice. The significance was set at p < 0.05. Results Most physicians reported partial oral (78.5%) and orthodontic (72.2%) examinations, while the full examination was reported by only 12% and 2.5% of physicians, respectively. Referral to orthodontists was practiced by most of the physicians (83.8%), yet for the majority of them, the quality of referral was poor (40.3%) or fair (46.1%), with only 13.6% who practiced quality referral. Dental development issues (53.3%) and functional issues (51.5%) were reported as the main reasons for referral, followed by family/patient request (42.9%), dental alignment (42.5%), oral respiratory issues (32.4%), and finally jaw relation (26.1%). Referral practice was predicted by the comprehensive oral (OR = 2.37, p = 0.007) and orthodontic (OR = 4.26, p < 0.001) examinations, number of patients seen by the physician (OR = 1.58, p = 0.007), and level of training (OR = 1.88, p = 0.03). Conclusion Although most physicians reported high rates of examination and referral practices on orthodontic problems among children in Saudi Arabia, only a small portion showed comprehensive examinations and quality referral practice. Including dental courses in medical curricula and improving oral and orthodontic examination guidelines for physicians are recommended.
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Affiliation(s)
- Najla S Alrejaye
- Dental Health Services, King Abdulaziz Medical City/Ministry of National Guard Health Affairs, Riyadh, 11426, Saudi Arabia
- King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 14611, Saudi Arabia
- College of Dentistry/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 11426, Saudi Arabia
| | - Lubna A Alnasser
- King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 14611, Saudi Arabia
| | | | | | - Hanan H Alshehri
- College of Dentistry/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 11426, Saudi Arabia
| | - Maram M Almalki
- College of Dentistry/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 11426, Saudi Arabia
| | - Suha S Alenazi
- College of Dentistry/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 11426, Saudi Arabia
| | - Ibraheem A Bushnak
- King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 14611, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences/ Ministry of National Guard Health Affairs, Riyadh, 14611, Saudi Arabia
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Teixeira R, Massaro C, Garib D. Comparison of nasal cavity changes between the expander with differential opening and the fan-type expander: a secondary data analysis from an RCT. Clin Oral Investig 2023; 27:5999-6006. [PMID: 37620440 DOI: 10.1007/s00784-023-05213-w] [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: 02/18/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE). METHODS This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05). RESULTS The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity. CONCLUSIONS Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla. CLINICAL RELEVANCE EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE.
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Affiliation(s)
- Rodrigo Teixeira
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-901, Brazil.
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-901, Brazil
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-901, Brazil
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Tse KL, Savoldi F, Li KY, McGrath CP, Yang Y, Gu M. Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study. Prog Orthod 2023; 24:31. [PMID: 37691059 PMCID: PMC10493207 DOI: 10.1186/s40510-023-00481-4] [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: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Identifying the prevalence of adenoid hypertrophy (AH) and craniofacial factors associated with this condition requires studies with random sampling from the general population, and multiple criteria can be used for assessing AH on lateral cephalometric radiograph (LCR). The present analysis represents the first report performed according to these requirements in a large cross-sectional sample of children. METHODS LCRs of 517 12-year-old children (286 males, 231 females) randomly selected from the general population were retrospectively retrieved. AH was defined using three criteria (At/Nd, Ad-Ba/PNS-Ba, 1-Npaa/Npa), and twelve craniofacial variables were measured (SNA, SNB, ANB, Wits, Cd-Gn, MnP^SN, MxP^MnP, TPFH/TAFH, OPT^SN, C2ps-C4pi^SN, H-CV, H-FH). Skeletal characteristics were compared between children with and without AH using Mann-Whitney U test. Binary logistic regression (adjusted for sex and skeletal growth) was used to independently quantify the association between craniofacial factors and AH. RESULTS The prevalence of children with AH was 17.6% (according to At/Nd), 19.0% (according to Ad-Ba/PNS-Ba), and 13.9% (according to 1-Npaa/Npa). Children with AH presented greater antero-posterior jaw discrepancy (larger ANB, smaller SNB), greater mandibular divergence (larger MnP^SN), forward head posture (larger OPT^SN and C2ps-C4pi^SN), and anteriorly positioned hyoid bone (larger H-CV). Larger SNA (OR = 1.39-1.48), while smaller SNB (OR = 0.77-0.88) and Wits (OR = 0.85-0.87), were associated with greater likelihood of having AH, independently from the assessment method used. CONCLUSIONS The prevalence of children with AH ranged from 13.9 to 19.0% based on LCR. Greater antero-posterior maxillo-mandibular discrepancy and mandibular retrusion were independently associated with higher likelihood of having AH.
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Affiliation(s)
- Kwan Lok Tse
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, 5/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Colman P McGrath
- Dental Public Health, Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, 1/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People's Republic of China.
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Flouris L, Millar B. Evaluation of a custom-made mandibular repositioning device for the treatment of obstructive sleep apnoea syndrome. Br Dent J 2023; 235:385-390. [PMID: 37737404 PMCID: PMC10516745 DOI: 10.1038/s41415-023-6267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 09/23/2023]
Abstract
Obstructive sleep apnoea (OSA) is a common, chronic condition that affects breathing during sleep. The gold standard for treatment is continuous positive airway pressure (CPAP) which is often not well-tolerated. Mandibular repositioning appliances (MRDs) are an alternative that dentists may be requested to provide.The purpose of this audit is to evaluate the effectiveness of an MRD in improving the Oxygen Desaturation Index (ODI) and Epworth Sleepiness Scale (ESS). A total of 52 patients diagnosed with OSA in an NHS hospital respiratory clinic were fitted with an MRD. Analysis of the digitally recorded oximeter signals was recorded among other treatment outcomes before and 6-8 weeks after the fit of the appliance.The meta-analysis of the audit data showed supportive evidence for MRD treatment in OSA patients. There was a statistically significant reduction in ODI and ESS. The audit population consisted of 138 patients (91 men, 47 women; mean age: 49.49 ± 11.93 years). The ODI outcomes improved significantly, from 10.68 to 6.58 (p <0.02). The ESS improved significantly from 9.46 to 6.02 (p <0.01).This audit demonstrates that MRDs are effective and should be considered as an alternative to CPAP in some specific OSA phenotypes.
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Affiliation(s)
- Lampros Flouris
- Grange Green Dental Practice, 42 Grange Road, Billericay, Essex, CM11 2RG, UK
| | - Brian Millar
- Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, London, UK.
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Shen Y, Li X, Feng X, Yu L, Weng L, Zhang C, Shang Y, Lin J. Differences in the effects of orthodontic treatment on airway-craniocervical functional environment in adult and adolescent patients with skeletal class II high-angle: a retrospective pilot study. BMC Oral Health 2023; 23:605. [PMID: 37644470 PMCID: PMC10464110 DOI: 10.1186/s12903-023-03328-w] [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: 04/10/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION This retrospective cohort study aimed to compare the change in upper airway and craniocervical posture after orthodontic treatment between adolescent and adult patients with Class II high-angle malocclusion. METHODS A total of 12 adolescent (mean ± standard deviation age = 13.0 ± 2.0 years) and 12 adult patients with Class II high-angle malocclusion (mean ± standard deviation age = 23.7 ± 6.4 years) were selected in this study. The lateral cephalograms and cone beam computed tomography images of adolescent and adult patients were taken before and after treatment, which can be employed to evaluate the variables of craniofacial morphology, upper airway, and craniocervical posture through paired t tests, respectively. An independent sample t test was performed to observe the differences between two groups after orthodontic intervention. For adults and adolescents, the correlation between craniofacial morphology, upper airway, and craniocervical posture was determined through Pearson correlation analysis. RESULTS In all subjects, the improvements in vertical and sagittal facial morphology after treatment were observed. Anterior and inferior movements of the hyoid bone, an increase of upper airway dimension, posterior tipping of the head and a reduction of cervical inclination in the lower and middle segments post-treatment were identified in adolescence (P < 0.05). Adults displayed anterior movements of the hyoid bone, whereas no significant difference was observed in upper airway dimension and craniocervical posture (P < 0.05). Notable differences were identified in the change of hyoid position and airway volume between two groups (P > 0.05). Mandibular plane inclination, growth pattern, occlusal plane inclination, and chin position were all significantly correlated with craniocervical posture in adolescent patients. Besides, the mandibular growth pattern and chin position in adult patients were significantly correlated with craniocervical posture (P < 0.05). CONCLUSIONS Orthodontic treatment is capable of enhancing the facial profile of patients with skeletal class II high-angle while improving their upper airway morphology and craniocervical posture, where adolescents and adults differ substantially in that the former exhibit a more favorable alteration in the airway-craniocervical functional environment.
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Affiliation(s)
- Yiyang Shen
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Xin Li
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Xiaoyan Feng
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Lan Yu
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Luxi Weng
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Chenxing Zhang
- Department of Stomatology, Hangzhou Geriatric Hospital, Hangzhou, Zhejiang, China
| | - Yufeng Shang
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Jun Lin
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China.
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Stanford ND. Evidence for orthodontic interventions is lacking. Sleep 2023; 46:zsad140. [PMID: 37235741 DOI: 10.1093/sleep/zsad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Nicky D Stanford
- Department of Orthodontics, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Department of Orthodontics, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
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Yoon A, Gozal D, Pelayo R, Kushida C, Liu S, Hong C. In response to the Letter to the Editor regarding "A roadmap of craniofacial growth modification for children with sleep-disordered breathing: a multidisciplinary proposal". Sleep 2023; 46:zsad163. [PMID: 37358845 DOI: 10.1093/sleep/zsad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- Audrey Yoon
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, USA
| | - David Gozal
- Department of Child Health, and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Rafael Pelayo
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Clete Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Christine Hong
- Division of Orthodontics, Department of Orofacial Science, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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Platon AL, Stelea CG, Boișteanu O, Patrascanu E, Zetu IN, Roșu SN, Trifan V, Palade DO. An Update on Obstructive Sleep Apnea Syndrome-A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1459. [PMID: 37629749 PMCID: PMC10456880 DOI: 10.3390/medicina59081459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) is the most common breathing-related sleep disorder. It is characterized by recurrent episodes of partial or complete airway obstruction during sleep, resulting in a reduction in or the total cessation of airflow, despite ongoing respiratory efforts, leading to oxygen desaturation and arousal. The purpose of this literature review is to evaluate the most common characteristics of this pathology, as well as to investigate the most effective treatment options, providing an update on the management of OSA patients.
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Affiliation(s)
- Alexandra Lorina Platon
- Department of Orthodontics and Dentofacial Orthopaedics, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.L.P.); (I.N.Z.)
| | - Carmen Gabriela Stelea
- Department of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
| | - Otilia Boișteanu
- Department of Anesthesia and Intensive Care, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania;
| | - Emilia Patrascanu
- Department of Anesthesia and Intensive Care, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania;
| | - Irina Nicoleta Zetu
- Department of Orthodontics and Dentofacial Orthopaedics, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.L.P.); (I.N.Z.)
| | - Sorana Nicoleta Roșu
- Department of Community and Oral Health, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania;
| | - Valentina Trifan
- Department of Orthodontics and Dentofacial Orthopaedics, Nicolae Testemițanu State University of Medicine and Pharmacy, Stefan cel Mare si Sfant Boulevard 165, 2004 Chișinău, Moldova;
| | - Dragoș Octavian Palade
- ENT, 2nd Surgery Department, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania;
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Bariani RCB, Bigliazzi R, de Moura Guimarães T, Tufik S, Moreira GA, Fujita RR. The effects of rapid maxillary expansion on persistent pediatric snoring post-tonsillectomy. Sleep Breath 2023; 27:1227-1235. [PMID: 36251209 DOI: 10.1007/s11325-022-02724-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/05/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the short-term effects of rapid maxillary expansion (RME) on the quality of life of children who had persistent snoring post-adenotonsillectomy (AT). METHODS The study included children with maxillary constriction aged 5 to 12 years, two or more years after AT whose parents/guardians reported that they still snored ≥ 5 nights per week. We enrolled children with sleep-disordered breathing, including children with primary snoring and children with obstructive sleep apnea (OSA). All patients underwent laryngeal nasofibroscopy and complete polysomnography. Quality of Life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), Conners Abbreviated Scale (CAS), and the Epworth Sleepiness Scale (ESS) were administered before and after RME. RESULTS Of 24 children enrolled, 13 had primary snoring and 11 had OSA. Overall OSA-18 scores were reduced in both groups (intragroup difference, p < 0.001). The PSQ total score, CAS, and ESS were significantly reduced in both groups (p < 0.001) In the evaluation of snoring, there was a reduction due to the treatment effect in both groups (p < 0.001). Daytime sleepiness and attention deficit hyperactivity disorders were also positively affected in both groups. CONCLUSIONS Our study demonstrated the potential benefit of RME in treating children with persistent snoring and transverse maxillary deficiency (TMD). RME can improve snoring and the QOL of children with refractory SDB after AT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: RBR-463byn.
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Affiliation(s)
- Rita Catia Brás Bariani
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Thais de Moura Guimarães
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo Antônio Moreira
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Reginaldo Raimundo Fujita
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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44
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Bhosale TB, Shetty V, Bhandary M, Nayak PP. Salivary biomarker C-reactive protein levels in children with sleep problems and Class II malocclusion before and after twin-block therapy. J Indian Soc Pedod Prev Dent 2023; 41:190-196. [PMID: 37861632 DOI: 10.4103/jisppd.jisppd_338_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Context Disturbances in sleep affects the overall quality of a child's life, with several short- and long-lasting consequences. Hence, early diagnosis and monitoring is crucial in the management of sleep disorders in children. Aims The aim of this study was to evaluate salivary C-reactive protein (CRP) levels in a group of children with Class II malocclusion and sleep problems before and after twin-block appliance therapy. Settings and Design The study was a prospective clinical study with a 9-month follow-up period. Subjects and Methods Eleven children aged 8-12 years with skeletal Class II malocclusion and at least one sleep disorder were enrolled in the study. All children were subjected to a recording of their sleep history and a clinical as well as radiographic examination. Pretreatment levels of salivary CRP were recorded. A twin-block appliance was custom made and delivered to every child. At the end of 9-month follow-up, all children were recalled for a re-evaluation of salivary biomarker levels. Statistical Analysis Pretreatment and posttreatment changes in biomarker levels were assessed statistically using the students paired t-test. Results Levels of salivary biomarker CRP were significantly decreased in children following myofunctional therapy using a twin-block appliance (P < 0.001). There was a considerable improvement in the clinical symptoms such as a decrease in snoring and noisy breathing in most children post-twin-block therapy. Conclusion The measurement of salivary biomarker CRP could be used as an alternative and noninvasive method to evaluate prognosis of oral myofunctional therapy for children with sleep disordered breathing.
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Affiliation(s)
- Trupti B Bhosale
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Vabitha Shetty
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Meghna Bhandary
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Prajna P Nayak
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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45
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Gurgel M, Cevidanes L, Costa F, Pereira R, Cunali P, Bittencourt L, Ruellas A, Gonçalves J, Bianchi J, Chaves C. Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway. BMC Oral Health 2023; 23:436. [PMID: 37391785 PMCID: PMC10314553 DOI: 10.1186/s12903-023-03125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA. METHODS The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation. RESULTS Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region. CONCLUSIONS The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil.
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joao Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Cauby Chaves
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
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46
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Fleming PPS, Andrews DJ. Orthodontic Treatment: Getting the timing right. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Wellham A, Kim C, Kwok SS, Lee R, Naoum S, Razza JM, Goonewardene MS. Sleep-disordered breathing in children seeking orthodontic care-an Australian perspective. Aust Dent J 2023; 68:26-34. [PMID: 36346173 DOI: 10.1111/adj.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of sleep-disordered breathing in children is underestimated due to impediments in detection and diagnosis. Consequently, delayed management may affect the quality of life and the growth and development of a child. Due to their patient demographic, orthodontists are optimally positioned to identify those at risk of sleep-disordered breathing and make referrals for investigation and management. This study aims to determine the prevalence of children at risk of sleep-disordered breathing in an Australian orthodontic population. METHODS A 1-year retrospective study was conducted in an urban Western Australian private orthodontic practice with two branches in similar socioeconomic demographics. The responses of new patients to a modified paediatric sleep questionnaire and standard medical history form were recorded. RESULTS In 1209 patients (4-18 years), 7.3% were at risk of sleep-disordered breathing. An association between sex and the potential risk of sleep-disordered breathing was found with 11% of males at risk of sleep-disordered breathing compared to 7% of females (P = 0.012). CONCLUSIONS The relatively high prevalence of children at risk of sleep-disordered breathing presenting for orthodontic care presents an opportunity to identify at-risk individuals through routine use of the paediatric sleep questionnaire. This would facilitate early referral for diagnosis and management of sleep-disordered breathing.
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Affiliation(s)
- A Wellham
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - C Kim
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - S S Kwok
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Rjh Lee
- School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia
| | - S Naoum
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - J M Razza
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - M S Goonewardene
- Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
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Liu Y, Zhao T, Ngan P, Qin D, Hua F, He H. The dental and craniofacial characteristics among children with obstructive sleep apnoea: a systematic review and meta-analysis. Eur J Orthod 2023; 45:346-355. [PMID: 36763565 DOI: 10.1093/ejo/cjac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Paediatric obstructive sleep apnoea (OSA) is a sleep breathing disorder which may have dramatic effects on childhood behaviour, neurodevelopment, metabolism, and overall health in children. Malocclusion and craniofacial morphology may be related to paediatric OSA, and therefore provide information for clinicians to recognize, evaluate and treat patients with this sleeping disorder. OBJECTIVE The aim of this systematic review was to summarize evidence regarding the association between paediatric OSA and children's dental and craniofacial characteristics. SEARCH METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to 1 June 2022. SELECTION CRITERIA Cross-sectional studies, comparing dental or craniofacial characteristics using clinical dental examinations or radiographic findings between OSA children (less than 18 year, diagnosed with overnight polysomnography) and healthy children, were included. DATA COLLECTION AND ANALYSIS The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used to assess the quality of included studies. RevMan software was used for performing the Meta-analyses. RESULTS Sixteen studies were included. Meta-analyses showed that the overjet (MD = 0.86, 95% CI: 0.20 to 1.51; P = 0.01), the saggital skeletal jaw discrepancy (ANB; MD = 1.78, 95% CI: 1.04 to 2.52; P < 0.00001) and mandibular plane angle (FH-MP; MD = 3.65, 95% CI: 2.45 to 4.85; P < 0.00001) were greater in OSA-affected children. In contrast, the upper molar arch width (upper first deciduous molar width; MD = -1.86, 95% CI: -3.52 to -0.20; P = 0.03), (Upper second deciduous molar width; MD = -1.06, 95% CI: -1.88 to -0.24; P = 0.01), SNB (MD = -2.10, 95% CI: -3.11 to -1.09; P < 0.0001), and maxillary length (ANS-PNS; MD = -1.62, 95% CI: -2.66 to -0.58; P = 0.002) were smaller in the OSA group. CONCLUSIONS This review shows that OSA-affected children tend to present with mandibular retroposition or retrognathia, increased mandibular plane angle and excess anterior overjet. However, these findings need to be viewed with caution as the corresponding differences may not be significant clinically. REGISTRATION PROSPERO (CRD42020162274).
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Affiliation(s)
- Yanxiaoxue Liu
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Tingting Zhao
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, School of Dentistry, Morgantown, WV, USA
| | - Danchen Qin
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hong He
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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49
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Huang Z, Zhou N, Lobbezoo F, Almeida FR, Cistulli PA, Dieltjens M, Huynh NT, Kato T, Lavigne GJ, Masse JF, Pliska BT, van de Rijt L, Sutherland K, Thymi M, Vanderveken OM, de Vries R, Aarab G. Dental sleep-related conditions and the role of oral healthcare providers: A scoping review. Sleep Med Rev 2023; 67:101721. [PMID: 36446166 DOI: 10.1016/j.smrv.2022.101721] [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: 08/25/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Dental sleep medicine as a discipline was first described about a quarter of a century ago. Snoring, obstructive sleep apnea, sleep bruxism, xerostomia, hypersalivation, gastroesophageal reflux disease, and orofacial pain were identified as dental sleep-related conditions. This scoping review aimed to: i) identify previously unidentified dental sleep-related conditions; and ii) identify the role of oral healthcare providers in the prevention, assessment, and management of dental sleep-related conditions in adults. A systematic literature search was conducted in PubMed, Embase.com, Web of Science, and Cochrane. Studies that reported an actual or likely role of oral healthcare providers in the prevention, assessment, and/or management of sleep-related conditions were included. Of the 273 included studies, 260 were on previously listed dental sleep-related conditions; the other 13 were on burning mouth syndrome. Burning mouth syndrome was therefore added to the list of dental sleep-related conditions for the first aim and categorized into sleep-related orofacial pain. For the second aim, the role of oral healthcare providers was found to be significant in the prevention, assessment, and management of obstructive sleep apnea and sleep bruxism; in the assessment and management of snoring, sleep-related orofacial pain, and oral dryness; and in the assessment of sleep-related gastroesophageal reflux condition.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands.
| | - Ning Zhou
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Fernanda R Almeida
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Nelly T Huynh
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Gilles J Lavigne
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
| | | | - Benjamin T Pliska
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Liza van de Rijt
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Magdalini Thymi
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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50
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Xie B, Zhang L, Lu Y. The role of rapid maxillary expansion in pediatric obstructive sleep apnea: Efficacy, mechanism and multidisciplinary collaboration. Sleep Med Rev 2023; 67:101733. [PMID: 36566679 DOI: 10.1016/j.smrv.2022.101733] [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: 09/03/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
This review aims to provide current knowledge about the efficacy, mechanism, and multidisciplinary collaboration of rapid maxillary expansion (RME) treatment in pediatric obstructive sleep apnea (OSA). OSA is a chronic disease characterized by progressively increasing upper airway resistance, with various symptoms and signs. Increasingly the evidence indicates that RME is a non-invasive and effective therapy option for children with OSA. Besides, the therapeutic mechanism of RME includes increasing upper airway volume, reducing nasal resistance, and changing tongue posture. Recent clinical researches and case reports also show that a multidisciplinary approach improves sleep-disordered breathing in children. Applied with adenotonsillectomy, mandibular advancement, continuous positive airway pressure, and comprehensive orthodontic treatment, RME can be more effective in recurrent or residual OSA.
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Affiliation(s)
- Bintao Xie
- Hunan Key Laboratory of Oral Health Research, China; Hunan Clinical Research Center of Oral Major Diseases and Oral Health, China; Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Lingling Zhang
- Hunan Key Laboratory of Oral Health Research, China; Hunan Clinical Research Center of Oral Major Diseases and Oral Health, China; Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Yanqin Lu
- Hunan Key Laboratory of Oral Health Research, China; Hunan Clinical Research Center of Oral Major Diseases and Oral Health, China; Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China.
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