1
|
Lo Giudice A, La Rosa S, Ronsivalle V, Isola G, Cicciù M, Alessandri-Bonetti G, Leonardi R. Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review. Int J Dent 2024; 2024:1007237. [PMID: 38585252 PMCID: PMC10999292 DOI: 10.1155/2024/1007237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is characterized by repeated airway collapse during sleep. It determines cardiovascular, pulmonary, and neurocognitive consequences and is associated with several daytime and nighttime symptoms that influence the patient's quality of life. The contribution of the dental specialist in the clinical management of OSA patients entails participating in the screening process as diagnostic sentinels and providing adequate treatment using mandibular advancement devices (MADs). Since the treatment of OSA requires a multidisciplinary approach, including different medical specialists, dentists should have a comprehensive understanding of medical and dental factors that influence the strategy and effectiveness of OSA treatment with MAD. Such expertise is crucial in determining the appropriate treatment indications and helps clinicians establish a consolidated position within the multidisciplinary OSA team. In this regard, this review summarizes the evidence of the clinical indications for MAD treatment and provides the dental specialist with helpful information about medical, functional, and other relevant factors that should be considered during diagnosis, treatment plan, and follow-up stages. Information retrieved was organized and discussed, generating specific domains/queries oriented to the clinical management of OSA patients from the clinical perspective of dental specialists.
Collapse
Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Salvatore La Rosa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, Section of Periodontology, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| |
Collapse
|
2
|
Vimal J, Dutt P, Singh N, Singh BP, Chand P, Jurel S. To compare different non-surgical treatment modalities on treatment of obstructive sleep apnea: A systematic review and meta-analysis. J Indian Prosthodont Soc 2022; 22:314-327. [PMID: 36511065 PMCID: PMC9709867 DOI: 10.4103/jips.jips_261_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
The study aimed to assess the effect of mandibular advancement device (MAD) in patients with obstructive sleep apnea for reduction in 24-h mean blood pressure, sleep quality, Apnea Hypopnea Index (AHI), and patient compliance, compared to continuous positive airway pressure (CPAP), other interventions, or no treatment. Three different databases such as PubMed, EMBASE, and CENTRAL were searched using different search terms till July 2021 as per the inclusion and exclusion criteria. After inclusion of studies, data extraction including risk of bias assessment was done. For each study, we used odds ratio, mean difference, and 95% confidence interval to assess and synthesize the outcomes. The quality of evidence was evaluated as per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Twenty-one randomized controlled trials were included: 497 patients in the MAD group, 239 patients in the CPAP group, and 274 patients in the sham group. In MAD-CPAP comparison, the results favored CPAP in the reduction of AHI of 3.48 (1.76-5.19). However, unclear results were found for sleep quality measured as Epworth Sleepiness Scale (ESS), patient compliance, and 24-h mean blood pressure. In MAD-sham comparison, the results favored MAD in the reduction of AHI of - 8.39 (-10.90--5.88] and ESS of - 0.91 (-1.70--0.12) and favored sham in terms of patient compliance while, unclear results for 24-h mean blood pressure. The GRADE score indicated that the quality of evidence is very low, low, and moderate for different outcomes. CPAP in comparison to MAD and MAD in comparison to sham showed a significant AHI reduction. However, patient compliance and 24-h mean blood pressure were not significantly different in MAD-CPAP or MAD-sham. Quality of evidence is very low and low when MAD was compared with CPAP and sham, respectively, for AHI.
Collapse
Affiliation(s)
- Jyotsna Vimal
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pranjali Dutt
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nishi Singh
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Balendra P. Singh
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pooran Chand
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sunit Jurel
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
3
|
Chander NG. Sleep apnea and prosthodontic implications. J Indian Prosthodont Soc 2020; 20:335-337. [PMID: 33487959 PMCID: PMC7814681 DOI: 10.4103/jips.jips_323_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- N Gopi Chander
- Editor, The Journal of Indian Prosthodontic Society, Chennai, Tamil Nadu, India
| |
Collapse
|
4
|
Tegelberg Å, Nohlert E, Bornefalk-Hermansson A, Fransson A, Isacsson G. Respiratory outcomes after a 1-year treatment of obstructive sleep apnoea with bibloc versus monobloc oral appliances: a multicentre, randomized equivalence trial. Acta Odontol Scand 2020; 78:401-408. [PMID: 32125197 DOI: 10.1080/00016357.2020.1730436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that these types of appliances would be equally effective.Material and methods: In this multicentre, randomized equivalence trial, patients with OSA received one type of bibloc or one type of monobloc treatment. At baseline, a 1-night polygraphy study was done, and this was repeated after 1 year. The outcome was any change in the apnoea-hypopnoea index (AHI) and the limits of equivalence between the two devices were set at ±5 AHI units.Results: Of 302 patients, 146 were randomly assigned to bibloc and 156 to monobloc appliances. In 88 and 104 patients, respectively, there were significant reductions in the AHI (p < .001) with a mean change of -16.7 (95% CI -19.4 to -14.1) in the bibloc and -11.8 (-14.9 to -8.7) in the monobloc groups. The proportions of responders defined as having an AHI <10 were 68% and 65% for the bibloc and monobloc groups, respectively. Treatment-related adverse events were mild, transient and the dropouts were more frequent in the bibloc group.Conclusions: Both types of treatments positively and significantly reduced respiratory disturbances, but at the 1-year follow-up, they were not significantly different in treating OSA, with a numerically greater reduction of the AHI value with the bibloc appliance. However, the higher proportion of treatment-related adverse events and higher proportion of dropouts among bibloc users should be balanced against the advantage of a greater reduction in the AHI.
Collapse
Affiliation(s)
- Åke Tegelberg
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
| | - Eva Nohlert
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | | | - Anette Fransson
- Postgraduate Dental Education Center and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Göran Isacsson
- Department of Orofacial Pain and Jaw Function, Västmanland County Hospital, Västerås, Sweden
| |
Collapse
|
5
|
Review of systematic reviews on mandibular advancement oral appliance for obstructive sleep apnea: The importance of long-term follow-up. JAPANESE DENTAL SCIENCE REVIEW 2019; 56:32-37. [PMID: 31871511 PMCID: PMC6909077 DOI: 10.1016/j.jdsr.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/23/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
The purpose of this review was to present the currently available information on oral appliance (OA) therapy for dentists, especially clinic-based dentists, to aid them in performing this treatment for the management of symptoms of obstructive sleep apnea (OSA). The clinical research evidence comprised of systematic reviews concerned with the mandibular advancement oral appliance (OAm). Continuous positive airway pressure (CPAP) is superior to OA therapy in improving OSA symptoms. It is necessary to survey the adherence of patients who stopped CPAP therapy to OAm therapy. There is little evidence supporting the theory that OAm therapy prevents cardiovascular disease or improves prognosis. There is still room to investigate the types of OAm. OAm therapy has clear dental and skeletal side effects with long-term use, and these are important for dentists. However, a certain percentage of patients discontinue consultations. Regarding consultation rate for follow-up and repair/adjustments of OAm, there are advantages for the clinic-based dentists treating OSA with OAm. We believe that enhancing under-graduate and post-graduate education on sleep medicine, and establishing a specialist system could be the strategies for enabling the dentists to handle OAm therapy in dental clinics.
Collapse
|
6
|
Ujjwal S, Kaurani P, Padiyar UN, Meena S, Singh DP, Sharma HK. A spirometric and cephalometric comparative evaluation of mandibular advancement devices and occlusal jig. J Indian Prosthodont Soc 2019; 19:66-73. [PMID: 30745756 PMCID: PMC6340075 DOI: 10.4103/jips.jips_94_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/21/2018] [Indexed: 11/04/2022] Open
Abstract
Aim Aim of the current study was to evaluate the effect of occlusal jig with increased vertical dimension and mandibular advancement device on the oropharangeal volume in completely edentulous patients using spirometry and cephalometry. Materials and Methods The current study included includes 30 completely edentulous patient according to inclusion criteria. They were each subjected to cephalometric and spirometric analysis wearing CCD, OJ & MAD. Results obtained were subjected to following statistical analysis, one-way ANOVA test, unpaired t-test, and Dunnett's test. Result Both OJ & MAD brings about significant change in oropharangeal volume hence both the devices are effective treatment of choice for OSA, while greater increase was observed in oropharangealvolume of OJ as compared to MAD. Spirometric analysis shows insignificant changes in the oropharangeal volume caused by MAD while OJ causes small but significant change in oropharangeal volume (PIFR]. Conclusion Within the limitation of the study, it can be concluded that, on cephalometric & spirometric evaluation, OJ shows greater increase in oropharangeal volume when compared to MAD in completely edentulous patient.
Collapse
Affiliation(s)
- Shaily Ujjwal
- Department of Prosthodontics, MGDCH, Jaipur, Rajasthan, India
| | - Pragati Kaurani
- Department of Prosthodontics, MGDCH, Jaipur, Rajasthan, India
| | | | - Sudhir Meena
- Department of Prosthodontics, MGDCH, Jaipur, Rajasthan, India
| | | | | |
Collapse
|