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Three-Dimensional Pharyngeal Airway Space Changes Following Isolated Mandibular Advancement Surgery in 120 Patients: A 1-Year Follow-up Study. J Imaging 2022; 8:jimaging8040082. [PMID: 35448209 PMCID: PMC9029548 DOI: 10.3390/jimaging8040082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Lack of evidence exists related to the three-dimensional (3D) pharyngeal airway space (PAS) changes at follow-up after isolated bilateral sagittal split osteotomy (BSSO) advancement surgery. The present study assessed the 3D PAS changes following isolated mandibular advancement at a follow-up period of 1 year. A total of 120 patients (40 males, 80 females, mean age: 26.0 ± 12.2) who underwent BSSO advancement surgery were recruited. Cone-beam computed tomography (CBCT) scans were acquired preoperatively (T0), immediately following surgery (T1), and at 1 year of follow-up (T2). The volume, surface area, and minimal cross-sectional area (mCSA) of the airway were assessed. The total airway showed a 38% increase in volume and 13% increase in surface area from T0 to T1, where the oropharyngeal region showed the maximum immediate change. At T1−T2 follow-up, both volumetric and surface area showed a relapse of less than 7% for all sub-regions. The mCSA showed a significant increase of 71% from T0 to T1 (p < 0.0001), whereas a non-significant relapse was observed at T1−T2 (p = 0.1252). The PAS remained stable at a follow-up period of 1 year. In conclusion, BSSO advancement surgery could be regarded as a stable procedure for widening of the PAS with maintenance of positive space at follow-up.
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Van de Perck E, Op de Beeck S, Dieltjens M, Vroegop AV, Verbruggen AE, Willemen M, Verbraecken J, Van de Heyning PH, Braem MJ, Vanderveken OM. The relationship between specific nasopharyngoscopic features and treatment deterioration with mandibular advancement devices: a prospective study. J Clin Sleep Med 2021; 16:1189-1198. [PMID: 32267227 DOI: 10.5664/jcsm.8474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES The variable efficacy of mandibular advancement device (MAD) treatment necessitates both accessible and accurate methods for patient selection. However, the role of awake nasopharyngoscopy for this purpose remains dubious. We introduced an assessment method based on anatomical upper airway features during tidal breathing for nasopharyngoscopy. The current study aimed to relate these features to MAD treatment outcome. METHODS One hundred patients diagnosed with obstructive sleep apnea were prospectively recruited for MAD treatment in a fixed 75% degree of maximal protrusion. Nasopharyngoscopic observations during Müller's maneuver and tidal breathing were recorded both with and without MAD. Treatment outcome, confirmed by 3-month follow-up polysomnography with MAD, was classified as (1) apnea-hypopnea index reduction ≥ 50%, (2) treatment apnea-hypopnea index < 5 events/h, and (3) ≥ 10% increase in apnea-hypopnea index compared with baseline (treatment deterioration). RESULTS A complete dataset was obtained in 65 patients. After adjusting for baseline apnea-hypopnea index, body mass index, and supine dependency, the position of the soft palate (odds ratio, 4.0; 95% confidence interval, 1.3-11.8; P = .013) and crowding of the oropharynx (odds ratio, 7.7; 95% confidence interval, 1.4-41.4; P = .017) were related to treatment deterioration. Addition of both features significantly (P = .031) improved the accuracy of baseline models based on clinical measurements alone. Moreover, with the MAD in situ, a posteriorly located soft palate (odds ratio, 9.8; 95% confidence interval, 1.7-56.3; P = .010) and a posteriorly located tongue base (odds ratio, 7.4; 95% confidence interval, 1.5-35.9; P = .013) were associated with treatment deterioration. CONCLUSIONS Awake nasopharyngoscopy might be a valuable office-based examination to exclude the risk of treatment deterioration and improve patient selection for MAD treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea (PROMAD); URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050.
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Affiliation(s)
- Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Anneclaire V Vroegop
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Annelies E Verbruggen
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.,Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Paul H Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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Kerbrat A, Vinuesa O, Lavergne F, Aversenq E, Graml A, Kerbrat JB, Trost O, Goudot P. Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:361-366. [PMID: 34118470 DOI: 10.1016/j.jormas.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This pilot randomized crossover study evaluated the outcomes of two custom-made mandibular retention devices (MRDs), a computer-aided design (CAD)/computer-aided manufacturing (CAM) device (Narval CC™) and a non-CAD/CAM device (Narval™), on oropharyngeal airway volume in patients with obstructive sleep apnoea (OSA). METHODS 12 OSA patients were recruited from an University Hospital for MRD therapy with either CAD/CAM or non-CAD/CAM first. A cone-beam computed tomography evaluation (CBCT) and polysomnography assessment was performed during baseline assessment and at the end of each study period. RESULTS Upper airway volume increased significantly with the CAD/CAM device (7725 +/- 6540 mm3, p = 0.008) but not with the non-CAD/CAM device (3805 +/- 7806 mm3, p = 0.13). The CAD/CAM device was also associated with a significant decrease in AHI (mean AHI after treatment 9.4±6.7 events/h, p = 0.003) and oxygen desaturation index (mean ODI of ≥ 3%/h 11.9 ± 6.8, p = 0.011). Changes in AHI (14.7 +/- 11.7 events/h, p = 0.083) and ODI (15.5 +/- 19.2, p = 0.074) were not statistically significant with the non-CAD/CAM device. The vertical dimension of occlusion increased significantly following treatment with both MRD devices (both p = 0.003), but was significantly less pronounced with the CAD/CAM device (mean difference: -2.7 +/- 1.7 mm, p = 0.003). Final mandibular protrusion after titration was the same with both devices (85%, p = 0.317). CONCLUSION The CAD/CAM (Narval CCTM) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.
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Affiliation(s)
- A Kerbrat
- Resident, Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, 81 Boulevard de l'hopital, 75013 Paris, France.
| | | | - F Lavergne
- ResMed Science center - Saint-Priest, France
| | - E Aversenq
- ResMed Science center - Saint-Priest, France
| | - A Graml
- ResMed Science center, Munich, Germany
| | - J B Kerbrat
- Chief of the department of Orthodontics, Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, France
| | - O Trost
- Professor,Chief of the Service de Stomatologie et de Chirurgie Maxillo-faciale du CHU de Rouen, France
| | - P Goudot
- Professor, Chief of the Service de Stomatologie et de Chirurgie Maxillo-faciale de la Pitié Salpétrière, France
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Haskell BS, Voor MJ, Roberts AM. A consideration of factors affecting palliative oral appliance effectiveness for obstructive sleep apnea: a scoping review. J Clin Sleep Med 2021; 17:833-848. [PMID: 33196434 PMCID: PMC8020709 DOI: 10.5664/jcsm.9018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This scoping review allows physicians, researchers, and others interested in obstructive sleep apnea to consider effectiveness of oral appliances (OAs). The intent is to improve understanding of OA effectiveness by considering morphologic interaction in patients with obstructive sleep apnea. METHODS Morphologic and biomechanical criteria for positional alterations of the mandible assessed success rates of OA appliances. Searches of databases (Medline, PubMed, The Cochrane Library, EBSCO) using terms: OA treatment effectiveness and positive and/or negative outcome predictors. Craniofacial predictors of OAs and obstructive sleep apnea biomechanical factors of anatomical traits associated with OA effectiveness were included. Databases searched radiographic cephalometric imaging for morphology/phenotypes and apnea-hypopnea index responses. Articles were excluded if title or abstract was not relevant or a case report. If the analysis did not report mean or standard deviation for apnea-hypoxia index, it was excluded. No language, age, or sex restrictions were applied. RESULTS Analysis of 135 articles included in searched literature indicated alterations in musculature and pharyngeal airway structure through OA use. These alterations were individually unpredictable with wide variability 61.81% ± 12.29 (apnea-hypoxia index mean ± standard deviation). Morphologic variations as predictors were typically weak and idiosyncratic. Biomechanical factors and wide variations in the metrics of appliance application were unclear, identifying gaps in knowledge and practice of OAs. CONCLUSIONS An integrated basis to identify morphologic and biomechanical elements of phenotypic expressions of sleep-disordered breathing in the design and application of OAs is needed. Current knowledge is heterogeneous and shows high variability. Identification of subgroups of patients with obstructive sleep apnea responding to OAs is needed.
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Affiliation(s)
- Bruce S. Haskell
- Division of Orthodontics, University of Kentucky College of Dentistry, Lexington Kentucky
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
- Comprehensive Dentistry, School of Dentistry, University of Louisville, Louisville, Kentucky
| | - Michael J. Voor
- Department of Orthopedics, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Biomedical Engineering, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Andrew M. Roberts
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
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Tongue Pressure Sensing Array Integrated with a System-on-Chip Embedded in a Mandibular Advancement Splint. MICROMACHINES 2018; 9:mi9070352. [PMID: 30424285 PMCID: PMC6082261 DOI: 10.3390/mi9070352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA), which is caused by obstructions of the upper airway, is a syndrome with rising prevalence. Mandibular advancement splints (MAS) are oral appliances for potential treatment of OSA. This work proposes a highly-sensitive pressure sensing array integrated with a system-on-chip (SoC) embedded in a MAS. The device aims to measure tongue pressure distribution in order to determine the efficacy of the MAS for treating OSA. The flexible sensing array consists of an interdigital electrode pair array assembled with conductive polymer films and an SoC capable of retrieving/storing data during sleep, and transmitting data for analysis after sleep monitoring. The surfaces of the conductive polymer films were patterned with microdomed structures, which effectively increased the sensitivity and reduced the pressure sensing response time. The measured results also show that the crosstalk effect between the sensing elements of the array was negligible. The sensitivity of the sensing array changed minimally after the device was submerged in water for up to 100 h.
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Sprenger R, Martins LAC, Dos Santos JCB, de Menezes CC, Venezian GC, Degan VV. A retrospective cephalometric study on upper airway spaces in different facial types. Prog Orthod 2017; 18:25. [PMID: 28762153 PMCID: PMC5563502 DOI: 10.1186/s40510-017-0180-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Craniofacial growth pattern has been correlated with variations in size of the upper airway spaces. The objective of this study was to evaluate the nasopharyngeal, oropharyngeal, and hypopharyngeal airway spaces variations according to the craniofacial growth pattern, by comparing brachyfacial, mesofacial, and dolichofacial in Angle Class I individuals. Methods To measure the spaces, 45 lateral teleradiographs were used and divided into 3 groups per the craniofacial growth pattern, determined by the Tweed cephalometry angular measurements: FMA and Y-axis. To evaluate the airways, sleep apnea cephalometry was used, containing 28 points that compose 14 factors. Three groups were compared relative to each of the 14 sleep apnea cephalometry measurements. Adherence test to the normal curve was performed. For the non-normally distributed data—measurement of the inferior pharyngeal space—the Kruskal-Wallis test was used for comparison between the groups. For the remaining data, the distribution was normal and ANOVA test was used. Results Statistically significant difference was verified among the groups for the measurement of the median posterior-palatal space, with the difference being pointed out by the post hoc test between the brachyfacial and dolichofacial groups. For the other measurements, there was no statistically significant difference. Conclusions It could be concluded that there was difference in the median posterior-palatal space measurement, in the oropharynx region, which was reduced for individuals with a dolichofacial pattern.
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Bayat M, Shariati M, Rakhshan V, Abbasi M, Fateh A, Sobouti F, Davoudmanesh Z. Cephalometric risk factors of obstructive sleep apnea. Cranio 2016; 35:321-326. [DOI: 10.1080/08869634.2016.1239850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mohamad Bayat
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Shariati
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Rakhshan
- Research Council, Iranian Center for Tissue Engineering and Graft Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Mohsen Abbasi
- Craniomaxillofacial Research Center, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Ali Fateh
- Craniomaxillofacial Research Center, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Farhad Sobouti
- Department of Orthodontics, Faculty of Dental, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Davoudmanesh
- Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Craniomaxillofacial Research Center, Dental Branch, Islamic Azad University, Tehran, Iran
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8
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Somnoendoskopie. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Oral Appliance for the Treatment of Severe Obstructive Sleep Apnea in Edentulous Patient. J Indian Prosthodont Soc 2015. [PMID: 26199526 DOI: 10.1007/s13191-013-0312-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Oral appliances have attracted interest for the treatment of mild and moderate obstructive sleep apnea (OSA) and the mandibular repositioning device (MRD) or a tongue-retainer device (TRD) is usually indicated to increase the upper air space. Describes a combination of MRD (with 60 % maximum mandibular protrusion) and TRD to treat severe OSA. Polysomnography (PSG) and two questionnaires: the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) evaluated the sleep pattern in two times (after and before the use of oral appliance). The initial PSG exam was compatible with diagnoses severe OSA and the Apnea-Hypopnea Index was 40.4, and 54 % oxygen saturation -spO(2). The ESS and PSQI scores were 11 and 6, respectively. After she began wearing the device she stopped snoring, her Apnea-Hypopnea Index decreased to 17.6, presented a sleep efficiency of 81.6 % and had a 77 % spO(2). The ESS and PSQI scores dropped to three. MRD in association with the tongue-retainer was effective in reducing the severity of the apnea for this edentulous patient.
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Ansar J, Maheshwari S, Verma SK, Singh RK, Agarwal DK, Bhattacharya P. Soft tissue airway dimensions and craniocervical posture in subjects with different growth patterns. Angle Orthod 2015; 85:604-10. [PMID: 25245417 PMCID: PMC8611761 DOI: 10.2319/042314-299.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/01/2014] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To compare the dimensions of the nasopharynx and oropharynx of subjects with different growth patterns and to determine whether any correlation exists with their craniocervical posture. MATERIALS AND METHODS Cephalometric radiograph of 60 subjects (16-25 years old), taken in natural head position, were divided into three groups according to the mandibular plane angle: hypodivergent (SN/MP <26°), normodivergent (SN/MP 26°-38°), and hyperdivergent (SN/MP <38°). Correlations were calculated between nasopharyngeal area, oropharyngeal area, and craniocervical posture. Continuous variables were compared by one-way analysis of variance, and the significance of mean difference between the groups was done by the Tukey post hoc test. A value of P < .05 was considered statistically significant. RESULTS Patients in the hyperdivergent group were found to have significantly smaller nasopharyngeal and oropharyngeal areas than the other groups (P < .001 and P < .05, respectively). Similarly, the oropharyngeal area in the normodivergent group was significantly smaller than that in the hypodivergent group (P < .05). However, no significant differences were found in the nasopharyngeal area between the hypodivergent and normodivergent groups and between the hyperdivergent and normodivergent groups (P > .05). Reduced pharyngeal airways were typically seen in patients with a large craniocervical angle and a large mandibular inclination. CONCLUSIONS Smaller nasopharyngeal and oropharyngeal airways were seen in connection with a large craniocervical and a large mandibular inclination. We therefore suggest that the vertical skeletal pattern may be one of the factors that contribute to nasopharyngeal and oropharyngeal obstruction.
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Affiliation(s)
- Juhi Ansar
- a Senior lecturer, Department of Orthodontics, Institute of Dental sciences, Bareilly, India
| | - Sandhya Maheshwari
- b Professor and Chairman, Department of Orthodontics and Dental Anatomy, Aligarh Muslim University, Aligarh, India
| | - Sanjeev K Verma
- c Professor, Department of Orthodontics and Dental Anatomy, Aligarh Muslim University, Aligarh, India
| | - Raj Kumar Singh
- d Senior Lecturer, Department of Orthodontics, Sudha Rastogi Dental College, Faridabad, India
| | - Deepak K Agarwal
- e Professor and Chairman, Department of Orthodontics, Institute of Dental Sciences, Bareilly, India
| | - Preeti Bhattacharya
- f Professor, Department of Orthodontics, Institute of Dental Sciences, Bareilly, India
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Silva VG, Pinheiro LAM, Silveira PLD, Duarte ASM, Faria AC, Carvalho EGBD, Zancanella E, Crespo AN. Correlation between cephalometric data and severity of sleep apnea. Braz J Otorhinolaryngol 2014; 80:191-5. [PMID: 25153101 PMCID: PMC9535488 DOI: 10.1016/j.bjorl.2013.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/10/2013] [Indexed: 11/27/2022] Open
Abstract
Introduction Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome. Objective To correlate cephalometric data with the apnea-hypopnea sleep index. Methods We performed a retrospective and cross-sectional study that analyzed the cephalometric data of patients followed in the Sleep Disorders Outpatient Clinic of the Discipline of Otorhinolaryngology of a university hospital, from June 2007 to May 2012. Results Ninety-six patients were included, 45 men, and 51 women, with a mean age of 50.3 years. A total of 11 patients had snoring, 20 had mild apnea, 26 had moderate apnea, and 39 had severe apnea. The distance from the hyoid bone to the mandibular plane was the only variable that showed a statistically significant correlation with the apnea-hypopnea index. Conclusion Cephalometric variables are useful tools for the understanding of obstructive sleep apnea syndrome. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation with the apnea-hypopnea index.
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Affiliation(s)
| | - Laíza Araújo Mohana Pinheiro
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | | | - Ana Célia Faria
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | - Edilson Zancanella
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Agrício Nubiato Crespo
- Discipline of Otorhinolaryngology, Head and Neck, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Haskell JA, Haskell BS, Spoon ME, Feng C. The relationship of vertical skeletofacial morphology to oropharyngeal airway shape using cone beam computed tomography: possible implications for airway restriction. Angle Orthod 2014; 84:548-54. [PMID: 24168401 PMCID: PMC8667512 DOI: 10.2319/042113-309.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/01/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine if the shape of the oropharyngeal airway is related to the vertical morphology of the skeletofacial complex, including the hyoid bone. MATERIALS AND METHODS Cone beam computed tomography scans from 50 pretreatment adult orthodontic records were used to obtain skeletal and airway measurements. Linear regression statistics were used to compare soft tissue variables to hard tissue predictor variables. RESULTS Transverse airway widening was significantly increased when the distance between the hyoid and vertebrae was reduced; when the three-dimensional (3D) facial axis angle decreased (became more vertical); when the 3D mandibular plane angle increased; when the width of the hyoid increased, or when the calculated length of the geniohyoid decreased. CONCLUSIONS A laterally elliptical airway-found when the face is more vertical and when the hyoid is closer to the cervical vertebrae-is hypothetically more resistant to collapse. Patients with a retrognathic, skeletal deep bite and a rounded oropharynx should be identified and corrected early to prevent potential airway problems.
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Affiliation(s)
| | - Bruce S. Haskell
- Professor (Part-time), Division of Orthodontics, College of Dentistry, University of Kentucky, Lexington, KY, and University of Louisville, Louisville, KY
| | - Michael E. Spoon
- Private Practice, Victor, New York and Assistant Professor (P/T) Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY
| | - Changyong Feng
- Associate Professor of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
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Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1348-8643(12)00028-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ahn HW, Cho IS, Cho KC, Choi JY, Chung JW, Baek SH. Surgical treatment modality for facial esthetics in an obstructive sleep apnea patient with protrusive upper lip and acute nasolabial angle. Angle Orthod 2012; 83:355-63. [DOI: 10.2319/041512-310.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
For patients with severe obstructive sleep apnea syndrome (OSAS), maxillomandibular advancement (MMA) offers a good treatment option by physically expanding the skeletal framework. However, facial esthetics can be aggravated by MMA in patients with OSAS who have a normally positioned maxilla, a protrusive upper lip, and an acute nasolabial angle. Therefore, surgical treatment planning should be customized according to diverse skeletodental and soft-tissue patterns to produce a favorable change in facial esthetics and sleep function in patients with OSAS. In this case report, good treatment results were achieved in a young female patient with OSAS and skeletal Class II, a normally positioned maxilla, a protrusive upper lip, and acute nasolabial angle by impaction of the maxilla, autorotation/advancement of the mandible, and advancement of the chin. A customized flowchart for surgical treatment planning in OSAS that considers facial esthetics was suggested.
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Affiliation(s)
- Hyo-Won Ahn
- Graduate student (PhD), Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Il-Sik Cho
- Graduate student (PhD), Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Keun-Chul Cho
- Graduate student (PhD), Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jin-Young Choi
- Professor and Chair, Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Jin-Woo Chung
- Professor, Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Seung-Hak Baek
- Professor and Chair, Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
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15
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Cillo JE, Thayer S, Dasheiff RM, Finn R. Relations between obstructive sleep apnea syndrome and specific cephalometric measurements, body mass index, and apnea-hypopnea index. J Oral Maxillofac Surg 2012; 70:e278-83. [PMID: 22449433 DOI: 10.1016/j.joms.2011.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 12/03/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the relation of specific cephalometric landmarks, body mass index, and the apnea-hypopnea index in patients diagnosed with obstructive sleep apnea syndrome (OSAS) and treated with functional upper airway surgery. MATERIALS AND METHODS This was a retrospective cohort analysis of 89 consecutive patients over a 3-year period diagnosed with overnight-attended polysomnogram-confirmed OSAS who underwent functional upper airway surgery. Five predetermined specific cephalometric parameters were analyzed: posterior airway space, soft palate length, hyoid to mandibular plane angle, sella-nasion to mandibular plane angle, and gonion to gnathion length. Simple and multiple linear regression analyses were used to establish a relation between independent and dependent variables. RESULTS There were no statistically significant associations between the 5 specific cephalometric craniofacial structures in combination with other potential confounders, body mass index and apnea-hypopnea index, and the presence of OSAS. CONCLUSIONS No one skeletal or soft tissue parameter can be directly linked to OSAS.
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Affiliation(s)
- Joseph E Cillo
- Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, PA, USA
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16
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Lowell SY, Kelley RT, Colton RH, Smith PB, Portnoy JE. Position of the hyoid and larynx in people with muscle tension dysphonia. Laryngoscope 2012; 122:370-7. [DOI: 10.1002/lary.22482] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/21/2011] [Accepted: 11/04/2011] [Indexed: 11/11/2022]
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17
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Haskell JA, McCrillis J, Haskell BS, Scheetz JP, Scarfe WC, Farman AG. Effects of Mandibular Advancement Device (MAD) on Airway Dimensions Assessed With Cone-Beam Computed Tomography. Semin Orthod 2009. [DOI: 10.1053/j.sodo.2009.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Dispositivos de avance mandibular (DAM) en el tratamiento del SAHS. Arch Bronconeumol 2005. [DOI: 10.1016/s0300-2896(05)70755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Re: Reliability and Validity of a Modified Lateral Cephalometric Analysis for Evaluation of Craniofacial Morphology and Growth in Cleft Patients. J Craniofac Surg 2004. [DOI: 10.1097/00001665-200405000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Gao X, Otsuka R, Ono T, Honda EI, Sasaki T, Kuroda T. Effect of titrated mandibular advancement and jaw opening on the upper airway in nonapneic men: a magnetic resonance imaging and cephalometric study. Am J Orthod Dentofacial Orthop 2004; 125:191-9. [PMID: 14765057 DOI: 10.1016/s0889-5406(03)00508-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to examine adaptive changes in the cross-sectional area of the upper airway during mandibular advancement and jaw opening and to explore whether these changes are directly related to morphologic features of the mandible. Fourteen nonapneic men participated in this study. A custom-made oral device was used to keep the mandible at 0% (F(0)V(0)), 50% (F(50)V(0)), 75% (F(75)V(0)), or 100% (F(100)V(0)) of maximum advancement, and at 50% (F(75)V(50)), 75% (F(75)V(75)), or 100% (F(75)V(100)) of maximum gape at F(75)V(0). Magnetic resonance imaging was used to investigate differences in the upper-airway cross-sectional area in these 7 positions. To eliminate excessive individual variation, changes in the mean (mean%) and minimum (min%) cross-sectional area of the upper airway were calculated as percentages of those at F(0)V(0). Cephalograms were taken to analyze morphologic features of the mandible. A dose-dependent change was seen when the mandible was advanced. The min% in F(100)V(0) was significantly greater than those in F(50)V(0) and F(75)V(0). The change in the upper airway size varied between subjects during jaw opening. At F(75)V(0), the min% of the whole upper airway was significantly associated with morphologic features of the mandible, such as the mandibular plane angle and lengths of the mandibular body and ramus.
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Affiliation(s)
- Xuemei Gao
- Department of Orthodontics, School of Stomatology, Peking University, Beijing, China
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21
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Ringqvist M, Walker-Engström ML, Tegelberg A, Ringqvist I. Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study. Am J Orthod Dentofacial Orthop 2003; 124:53-60. [PMID: 12867898 DOI: 10.1016/s0889-5406(03)00240-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this prospective, randomized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea (OSA) patients with a mandibular advancement device (MAD) compared with uvulopalatopharyngoplasty (UPPP). With the appliance in position, the mandible was advanced 50% of maximum protrusion capacity (ie, 4-6 mm); the vertical opening between the incisal edges was, on average, 3 mm. Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up. There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period. In the MAD group, small but statistically significant changes were found: there was a posterior rotation of the mandible (mandibular line [ML]/nasion-sella line [NSL]) (mean 0.5 degrees [95% confidence interval (CI) 0.1-0.8 degrees ]). Correlated to the posterior rotation of the mandible, the distances incision superius ML, incision superius-NSL, and incision inferius-NSL increased by means (95% CI) of 0.7 (0.5-1.2), 0.8 (0.4-1.1), and 1.3 (0.8-1.8) mm, respectively. Overjet and overbite did not change significantly, nor was there a significant change in the mandibular length. The observed changes were considered clinically insignificant because overbite and overjet stayed within normal limits. Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95% CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error. Treatment of OSA with a dental appliance is probably a lifelong process, and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system.
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Affiliation(s)
- Margareta Ringqvist
- Associate professor of clinical orthodontics, Centre for Clinical Research, Central Hospital, Uppsala University, Västerås, Sweden.
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22
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Abstract
The development of oral appliance treatment for OSA represents an important step in the management of this disease. Randomized, controlled clinical trials have shown them to be an effective treatment option for snoring and OSA in some patients, particularly patients with less severe OSA or simple snoring and patients who have failed other treatment modalities. Although oral appliances are not as effective as CPAP therapy, they work in most patients to relieve symptoms and apnea and are well tolerated by patients. Most patients report improvements in sleep quality and excessive daytime sleepiness. Short-term side effects are generally minor and are related to excessive salivation, jaw and tooth discomfort, and occasional joint discomfort. These symptoms may lead to discontinuation of appliance therapy but usually improve in most patients over time. Serious complications are not common, but occlusal changes are more common than previously believed.
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Affiliation(s)
- Kathleen A Ferguson
- Division of Respirology, London Health Sciences Centre, University of Western Ontario, 375 South Street, London, Ontario, N6A 4G5, Canada.
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23
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Cobo J, de Carlos F, Díaz Esnal B, Fernández MP, Llorente S, Llorente J. [Changes in the upper airway in patients with sleep obstructive apnea and/or chronic snoring treated with mandibular appliances]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2001; 52:470-4. [PMID: 11692961 DOI: 10.1016/s0001-6519(01)78238-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have analysed the possible modifications in the upper airways (UA) of the lateral cranial teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharynx in all the subjects studied. The study of the changes in the UA using the lateral cranial teleradiography in order to evaluate the effectiveness of the MAD can contribute to consider its effectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography.
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Affiliation(s)
- J Cobo
- Servicio de Ortodoncia, Escuela de Estomatología, Universidad de Oviedo, Catedrático Serrano s/n, 33006 Oviedo, Asturias
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Abstract
BACKGROUND Dentists who wish to provide sleep-disordered-breathing therapy have many different mandibular advancement devices, or MADs, from which to select. Documented research directly about the variations in MADs is sparse. TYPES OF STUDIES REVIEWED The author reviewed dental and medical literature dealing with biological and mechanical principles affecting the function of MADs. RESULTS The author found that MADs vary in four major areas: freedom of mandibular movement, amount and rigidity of dental coverage, amount of mandibular advancement and amount of bite opening. Each of these areas appears to affect the appliance's efficacy, safety or both. The main potential detrimental effect of MADs is occlusal shifting. The author presents biological and mechanical considerations in an attempt to determine the optimum parameters for each of the MAD variation areas. The MAD must be constructed in a manner and with material that secures the mandible in its optimum position. The optimum mandibular position needs to be captured and transferred to the articulator with an accurate construction bite. CLINICAL IMPLICATIONS MAD therapy may last a lifetime. Therefore, dentists must consider the efficacy and the safety of an MAD when selecting an appliance. Since occlusal shifting appears to be the main potential detrimental effect, dentists should consider all available means to monitor and minimize these changes.
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Affiliation(s)
- P T George
- John A. Burns School of Medicine, University of Hawaii, USA.
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25
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Turnbull NR, Battagel JM. The effects of orthognathic surgery on pharyngeal airway dimensions and quality of sleep. J Orthod 2000; 27:235-47. [PMID: 11099556 DOI: 10.1179/ortho.27.3.235] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Orthognathic surgery has been associated with airway narrowing and induction of sleep-related breathing disorders. Therefore, the pharyngeal airway dimensions of 32 orthognathic surgery cases were prospectively investigated, and the relationship between the surgery and sleep quality assessed. Digitized lateral cephalometric radiographs were used to compare oropharyngeal airway morphologies before and after surgery. Patients were assessed in two main surgical groups based on sagittal jaw relationship. A questionnaire was used to assess changes in daytime sleepiness. The mandibular surgery cases were also assessed by overnight domiciliary sleep monitoring. A significant decrease in the retrolingual airway dimension was found in all patients after mandibular setback surgery and a significant increase in this dimension after mandibular advancement. The questionnaire and sleep study revealed no significant changes in snoring incidence or apnoeic events after mandibular setback surgery. For the mandibular advancement group, a change in sleep quality was found, but only in cases with signs of a pre-existing sleep disorder.
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Affiliation(s)
- N R Turnbull
- Maxillofacial Unit, Royal Hospital Haslar, Gosport, Hampshire PO12 2AA, UK
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Ivanhoe JR, Cibirka RM, Lefebvre CA, Parr GR. Dental considerations in upper airway sleep disorders: A review of the literature. J Prosthet Dent 1999; 82:685-98. [PMID: 10588805 DOI: 10.1016/s0022-3913(99)70010-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Upper airway sleep disorders are becoming recognized as common medical concerns. Multiple treatment options have been advocated, including the use of dental devices. Dental practitioners are being asked by the medical profession to become a part of the treatment team. This may be a challenging task because of the large number of dental devices available, rapid advancement in the understanding of this disease, and numerous publications. PURPOSE This article reviews the anatomic features and etiologic factors of upper airway sleep disorders and medical and dental treatment options. METHODS The literature review was conducted with an accepted literature research tool, PubMed, developed by the National Library of Medicine. Key words searched included "obstructive sleep apnea," "sleep apnea," "sleep disorders," and "snoring". CONCLUSION Dental devices are indicated in snoring and mild-to-moderate obstructive sleep apnea patients after medical evaluation and referral.
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Affiliation(s)
- J R Ivanhoe
- School of Dentistry, Medical College of Georgia, Augusta, GA 30912-6276, USA.
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