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Jafarimehrabady N, Scribante A, Defabianis P, Merlati G, Vitale MC. A Systematic Review of Oral Modifications Caused by the Prolonged Application of Continuous Positive Airway Pressure (CPAP) and Intraoral Appliances in Patients with Obstructive Sleep Apnea (OSA). BIOMED RESEARCH INTERNATIONAL 2024; 2024:9361528. [PMID: 38435538 PMCID: PMC10907106 DOI: 10.1155/2024/9361528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Objective Prolonged use of oral devices as a substitute for traditional treatments has been studied in relation to the dental and skeletal changes associated with obstructive sleep apnea syndrome (OSA), which is a sleep-breathing disorder. Materials and Methods A review of articles indexed in PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, and CINHAL databases in September 2022 based on MeSH-based keywords with "dental and skeletal" and "oral appliance" and "obstructive sleep apnea" was examined to ensure that the keywords alone or cross-linked, depending on which base of the searched data, were used. 16 articles out of 289 articles were included in the research, and 273 articles were excluded due to lack of study. Conclusions CPAP treatment has limited dental or skeletal effects in short-term or long-term use. OAs and MADs show significant dental changes with prolonged use. MAS and TSD are more effective in short-term goals than CPAP. OAs' increase may cause dental and skeletal changes. MPD shows notable cephalometric alterations.
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Affiliation(s)
- Niloofar Jafarimehrabady
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Andrea Scribante
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Patrizia Defabianis
- Department of Surgical Sciences, C.I.R. Dental School-Section of Pediatric Dentistry, University of Turin, Turin, Italy
| | - Giuseppe Merlati
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Marina Consuelo Vitale
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
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Zheng P, Chalidapongse P, Changsiripun C. Mandibular advancement devices used with morning occlusal guides for treating obstructive sleep apnea-changed incisor inclination and its associated factors. Sleep Breath 2023; 27:2059-2067. [PMID: 36862328 DOI: 10.1007/s11325-023-02796-2] [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: 11/09/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Mandibular advancement devices (MADs) effectively treat patients with obstructive sleep apnea (OSA). Although the use of morning occlusal guides (MOGs) along with MADs is recommended to prevent dental side effects, there is no evidence to support this. The aim of this study was to evaluate the change in incisor inclination in patients with OSA treated with MADs and MOGs, and to identify its predictive factors. METHODS Patients with OSA who received MAD and MOG therapy and had a reduction in their apnea-hypopnea index greater than 50% were analyzed. Cephalometric measurements were performed at baseline and at a 1-year follow-up or longer to assess the dentoskeletal side effects of MAD/MOG treatment. Multivariable linear regression analysis was used to assess the association between the change in incisor inclination and the independent variables that may cause the observed side effects. RESULTS Among 23 patients enrolled in the study, there was significant upper incisor retroclination (U1-SN: 2.83° ± 2.68°, U1-PP: 2.86° ± 2.46°; P < 0.05) and significant lower incisor proclination (L1-SN: 3.04° ± 3.29°, L1-MP: 1.74° ± 3.13°; P < 0.05). However, no significant skeletal changes were observed. Multivariable linear regression revealed that advancement ≥ 95% of the patients' maximal mandibular protrusion was associated with greater upper incisor retroclination. Increased treatment duration was also associated with increased upper incisor retroclination. No \measured variables were associated with the change in lower incisor inclination. CONCLUSIONS Dental side effects occurred in patients who used MADs with MOGs. The amount of mandibular protrusion by MADs and treatment duration were predictive factors associated with upper incisor retroclination.
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Affiliation(s)
- Prapaporn Zheng
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Premthip Chalidapongse
- Department of Oral Diagnostic Science, Faculty of Dentistry, Prince of Songkla University, Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
- Dental Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
| | - Chidsanu Changsiripun
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Henri-Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
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Baltaci E, Bilmenoglu C, Ozgur O, Ozveren N. Effect of three different remineralising agents on prevention against acidic erosion of primary teeth: an in vitro study. Eur Arch Paediatr Dent 2023; 24:651-659. [PMID: 37646903 DOI: 10.1007/s40368-023-00834-x] [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: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE This study aimed to evaluate and compare the protective effect of fluoride varnish (Enamelast™, Ultradent Inc., Cologne, Germany), casein phosphopeptide-amorphous calcium phosphate fluoride/CPP-ACPF (MI Paste Plus, GC Corp., Tokyo, Japan) and self-assembling P11-4 peptide (Curodont™ Protect, Credentis AG, Windisch, Switzerland), against acidic erosion of primary teeth. METHODS Forty primary anterior teeth were randomly assigned to four groups (n = 10): group 1: control, group 2: fluoride varnish, group 3: CPP-ACPF and group 4: self-assembling P11-4 peptide. After applying remineralising agents, except for the control group, all specimens underwent an erosive challenge of carbonated soft drink and artificial saliva for 15 cycles of 6 s each at 6-h intervals for a day. Groups were compared in terms of surface microhardness, roughness readings, and surface scanning with an extra-oral scanner (D800; 3Shape A/S) before and after the erosive process. RESULTS All experimental groups showed superior results than the control group regarding microhardness, surface roughness, and substance loss. The fluoride varnish group showed significantly favourable results in microhardness change. There was no significant difference between the experimental groups regarding surface roughness and enamel loss measurements. CONCLUSION 5% NaF fluoride varnish, CPP-ACPF and self-assembling P11-4 peptide protect the enamel of primary teeth against erosion compared to artificial saliva alone.
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Affiliation(s)
- E Baltaci
- Department of Pediatric Dentistry, Faculty of Dentistry, Trakya University, 22030, Edirne, Turkey.
| | - C Bilmenoglu
- Department of Prosthodontics, Faculty of Dentistry, Trakya University, Edirne, Turkey
| | - O Ozgur
- Department of Pediatric Dentistry, Faculty of Dentistry, Trakya University, 22030, Edirne, Turkey
| | - N Ozveren
- Department of Pediatric Dentistry, Faculty of Dentistry, Trakya University, 22030, Edirne, Turkey
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Stipa C, Incerti-Parenti S, Cameli M, Ippolito DR, Gracco A, Alessandri-Bonetti G. Antero-Posterior Mandibular Excursion in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Device: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3561. [PMID: 36834252 PMCID: PMC9960680 DOI: 10.3390/ijerph20043561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Since obstructive sleep apnea (OSA) management with a mandibular advancement device (MAD) is likely to be life-long, potential changes in mandibular movements during therapy should be investigated. The purpose of this study was to use a method that has already been shown to be reliable in order to determine whether the range of antero-posterior mandibular excursion, the procedure upon which MAD titration is based, varies between baseline (T0) and at least 1 year of treatment (T1). The distance between maximal voluntary protrusion and maximal voluntary retrusion determined using the millimetric scale of the George Gauge was retrospectively collected from the medical records of 59 OSA patients treated with the MAD and compared between T0 and T1. A regression analysis was performed to evaluate the influence of treatment time, MAD therapeutic advancement and the patient's initial characteristics in excursion range variation. A statistically significant increase of 0.80 ± 1.52 mm (mean ± standard deviation, p < 0.001) was found for antero-posterior mandibular excursion. The longer the treatment time (p = 0.044) and the smaller the patient's mandibular excursion at T0 (p = 0.002), the greater the increase was. These findings could be explained by a muscle-tendon unit adaptation to the forward mandibular repositioning induced by the MAD. During MAD therapy, patients can develop a wider range of antero-posterior mandibular excursion, especially those with a smaller initial excursion capacity.
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Affiliation(s)
- Chiara Stipa
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Serena Incerti-Parenti
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Matteo Cameli
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Daniela Rita Ippolito
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Antonio Gracco
- Department of Neurosciences, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Giulio Alessandri-Bonetti
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
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Baldini N, Gagnadoux F, Trzepizur W, Meslier N, Dugas J, Gerves-Pinquie C, Chouet-Girard F, Kün-Darbois JD. Long-term dentoskeletal side effects of mandibular advancement therapy in patients with obstructive sleep apnea: data from the Pays de la Loire sleep cohort. Clin Oral Investig 2021; 26:863-874. [PMID: 34263409 DOI: 10.1007/s00784-021-04064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mandibular advancement devices (MADs) are the main therapeutic alternative to continuous positive airway pressure for obstructive sleep apnea. Our aim was to evaluate the long-term dentoskeletal side effects of MADs and to identify the predictive factors for these side effects. MATERIALS AND METHODS Patients from the Pays de la Loire cohort treated with a custom-made MAD for at least 1 year were included in this retrospective study. Digital cephalometric analyses were performed at baseline and at follow-up. RESULTS We included a total of 117 patients, treated with a MAD for a median [interquartile range] of 4.6 [2.6-6.6] years. The main significant side effects were a decrease in overbite (- 0.5 ± 1 mm), overjet (- 0.7 ± 1 mm) and maxillary incisor inclination (- 2.5 ± 2.8°) and an increase in mandibular incisor inclination (+ 2.2 ± 2.7°). Subjective side effects were not linked to the observed dentoskeletal changes. Current smokers were at higher risk of overjet modifications. A pre-existing anterior open-bite was associated with a greater decrease in overbite. Treatment duration was associated with a more pronounced mandibular incisor proclination. Propulsion was negatively associated with maxillary incisor retroclination. CONCLUSIONS Long-term dentoskeletal side effects were mainly moderate dental side effects. Some predictive factors were shown to be associated with more pronounced changes. Subjective side effects did not appear to be reliable tools to detect dentoskeletal side effects. CLINICAL RELEVANCE Regular follow-up with clinical examination and regular radiographs is mandatory. The predictive factors could be of interest for a better selection of patients and to individualize follow-up.
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Affiliation(s)
- Nicolas Baldini
- Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.
| | - Frédéric Gagnadoux
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Wojciech Trzepizur
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Nicole Meslier
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Julien Dugas
- Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France
| | - Chloé Gerves-Pinquie
- Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France
| | - Frédérique Chouet-Girard
- Department of Maxillofacial Surgery, Le Mans Hospital, 194 avenue Rubillard, 72037, Le Mans Cedex, France
| | - Jean-Daniel Kün-Darbois
- Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.,Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France
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Bosi M, Incerti Parenti S, Fiordelli A, Poletti V, Alessandri-Bonetti G. Upper airway collapsibility in patients with OSA treated with continuous positive airway pressure: a retrospective preliminary study. J Clin Sleep Med 2021; 16:1839-1846. [PMID: 32621580 DOI: 10.5664/jcsm.8674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES To investigate the prevalence of mildly collapsible upper airways (defined by therapeutic continuous positive airway pressure [CPAP] values ≤ 8 cm H₂O) in moderate to severe obstructive sleep apnea patients treated with CPAP and to determine their clinical, functional, and nocturnal polysomnographic characteristics. METHODS Eighty-seven patients with moderate to severe obstructive sleep apnea consecutively treated with CPAP were retrospectively investigated. Two nocturnal home sleep portable monitoring studies were performed at baseline and during treatment. Participants were categorized according to therapeutic CPAP values: ≤ 8 cm H₂O (group 1), 8-12 cm H₂O (group 2), ≥ 12 cm H₂O (group 3). Anthropometric, awake respiratory function, symptoms, comorbidities, and nocturnal home sleep portable monitoring studies data were collected. RESULTS Mild upper airway collapsibility (therapeutic CPAP values ≤ 8 cm H₂O) was present in 25.3% of patients. They showed more favorable apnea-hypopnea index, oxygen desaturation index, mean nocturnal saturation, sleep time with oxygen saturation < 90%, desaturation nadir, and supine position. Oxygen desaturation index showed a weak association with anatomical collapsibility. Using the receiver operating characteristic curve, the area under the curve for the oxygen desaturation index vs CPAP pressure requirements ≤ 8 cm H₂O was low and oxygen desaturation index ≤ 40.8/h showed a sensitivity of 63.3% and a specificity of 69.2% to detect patients with mild collapsibility. CONCLUSIONS A quarter of moderate to severe patients under CPAP therapy had mild collapsibility and were likely to also be good candidates for alternative and better tolerated non-CPAP therapies. Baseline anthropometric, clinical, and respiratory function characteristics did not predict mild upper airway collapsibility determined by CPAP pressure requirements ≤ 8 cm H₂O.
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Affiliation(s)
- Marcello Bosi
- Department of Thoracic Diseases, Sleep Respiratory Unit, Umberto I Hospital, Lugo, Italy
| | - Serena Incerti Parenti
- Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Andrea Fiordelli
- Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Venerino Poletti
- Department of Thoracic Diseases, Pulmonary Operative Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Giulio Alessandri-Bonetti
- Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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