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Navarro RE, Karadede B, Karadede Ünal B, Salvador DM. Predictive factors of therapeutic response according to craniofacial skeletal biotype in patients with sleep apnea syndrome using mandibular advancement devices: a pilot study. Angle Orthod 2024; 94:216-223. [PMID: 37788163 PMCID: PMC10893917 DOI: 10.2319/092822-670.1] [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: 09/01/2022] [Accepted: 08/01/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES To evaluate the influence of facial biotype in the therapeutic effect of mandibular advancement devices (MADs) according to polysomnographic records in patients diagnosed with sleep apnea-hypopnea syndrome (SAHS). MATERIALS AND METHODS A total of 46 patients were recruited. Patients were classified according to facial biotype (mesofacial, brachyfacial, or dolichofacial). The quantitative variables were described as the arithmetic mean and standard deviation or the median and interquartile range. Hypothesis tests used were Pearson's chi-square, paired-sample Student's t- test, the Wilcoxon test, one-way analysis of variance, Kruskal-Wallis test, and Mann-Whitney U-test. P < .05 was considered statistically significant. RESULTS A total of 46 patients were categorized into three facial biotype subgroups with no significant differences among them in age, body mass index, neck circumference, and sex. The respiratory disturbance index (RDI) results were as follows: brachyfacial patients had a reduction to 15 events/h (P < .001), the mesofacial patients had a reduction to 14 events/h (P < .001), and the dolichofacial patients did not show a significant reduction. The oxygen desaturation index (ODI) results were as follows: brachyfacial patients had a reduction in ODI episodes to 45 episodes/h (P = .001), mesofacial patients had a reduction to 18 episodes/h (P = .001). In the brachyfacial group, the number of awakenings with MAD therapy was reduced to 23 events/h (P = .003), while, in the mesofacial group, it was reduced to 37 episodes/h (P = .012). CONCLUSIONS The facial biotype influences the effectiveness of MAD therapy and is considered a good predictive factor.
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Manfredini D, Thomas DC, Lobbezoo F. Temporomandibular Disorders Within the Context of Sleep Disorders. Dent Clin North Am 2023; 67:323-334. [PMID: 36965934 DOI: 10.1016/j.cden.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper provided an overview of the knowledge on the relationship between temporomandibular disorders (TMDs) and the main sleep conditions and disorders of dental interest, namely, sleep bruxism (SB), sleep apnea, and gastroesophageal reflux disease (GERD). It emerged that although the topic of SB as a possible detrimental factor for the stomatognathic structures has been the most studied, evidence is growing that SB, obstructive sleep apnea, and GERD, all belong to a circle of mutually interacting sleep disorders and conditions that, in turn, may be associated with TMDs. The pathophysiology of the cause-and-effect relationships, if existing, has to be elucidated yet.
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Affiliation(s)
- Daniele Manfredini
- Facial Pain Unit, Department of Biomedical Technologies, School of Dentistry, University of Siena, Viale Bracci c/o Policlinico Le Scotte, Siena 53100, Italy.
| | - Davis C Thomas
- Rutgers School of Dental Medicine, 110 Bergen St, Newark, NJ 07103, USA; Eastman Institute of Oral Health, Rochester, NY, USA
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
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Diaz de Teran T, Muñoz P, de Carlos F, Macias E, Cabello M, Cantalejo O, Banfi P, Nicolini A, Solidoro P, Gonzalez M. Mandibular Torus as a New Index of Success for Mandibular Advancement Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14154. [PMID: 36361031 PMCID: PMC9657412 DOI: 10.3390/ijerph192114154] [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: 10/12/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients' Apnoea-Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. METHODS This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. RESULTS A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg/m2), the angle formed by the occlusal plane to the sella-nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. CONCLUSIONS The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA.
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Affiliation(s)
- Teresa Diaz de Teran
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Pedro Muñoz
- Cantabria Primary Health Care Management, Instituto Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
| | - Felix de Carlos
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain
| | - Emilio Macias
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain
| | - Marta Cabello
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Olga Cantalejo
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Paolo Banfi
- Don Gnocchi Foundation IRCCS, 20121 Milan, Italy
| | | | - Paolo Solidoro
- Division of Respiratory Diseases Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Monica Gonzalez
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
- Instituto Marqués de Valdecilla (IDIVAL), University of Cantabria, 39011 Santander, Spain
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Pollis M, Lobbezoo F, Aarab G, Ferrari M, Marchese-Ragona R, Manfredini D. Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea. J Clin Med 2022; 11:jcm11154572. [PMID: 35956187 PMCID: PMC9369523 DOI: 10.3390/jcm11154572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023] Open
Abstract
Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features of craniofacial morphology and OSA severity in a population of patients with OSA. Material and Methods: A sample of forty-two patients (n = 42, M = 76%, mean age = 57.8 ± 10.8) with a polysomnographically (PSG) confirmed diagnosis of OSA were recruited and underwent cephalometric evaluation of 16 cephalometric variables. In addition, the apnea−hypopnea index (AHI), oxygen desaturation (SatMin), Epworth sleepiness scale (ESS), and body mass index (BMI) were assessed. Then t-tests were performed to compare the values of all cephalometric variables between two AHI severity-based groups (mild-to-moderate = AHI ≤ 30; severe = AHI > 30). Single- and multiple-variable regression analyses were performed to assess the associations between AHI scores and cephalometric features. Results: Mean AHI, SatMin, and BMI were 31.4 ev/h, 78.7%, and 28.1, respectively. The cephalometric variables were not significantly different between the two OSA-severity groups (p > 0.05). Multiple-variable regression analyses showed that gonial angle and nasopharynx space were negatively associated with AHI, explaining 24.6% of the total variance. Conclusion: This investigation reported that severity of AHI scores in patients with OSA showed a negative correlation with gonial angle and nasopharynx space. As a general remark, although maxillofacial anatomy can be a predisposing factor for OSA, disease severity depends mainly upon other variables.
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Affiliation(s)
- Matteo Pollis
- Department of Medical Biotechnology, School of Dentistry, University of Siena, 53100 Siena, Italy
- Correspondence:
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Marco Ferrari
- Department of Medical Biotechnology, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Rosario Marchese-Ragona
- Department of Neurosciences, Otolaryngology Section, University of Padova, Via Belzoni, 160, 35121 Padova, Italy
| | - Daniele Manfredini
- Department of Medical Biotechnology, School of Dentistry, University of Siena, 53100 Siena, Italy
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Cheng L, Jiang Y, Man S, Wang Y, Yang Y, Zhou M. X-Ray Cephalometric Analysis of the Effects of Angle Class II and III Malocclusion on the Upper Airway Width and Hyoid Position between Parents and Children of Uygur Nationality. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2531419. [PMID: 35903431 PMCID: PMC9325337 DOI: 10.1155/2022/2531419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
Objective The objective of this paper is to analyze the effect of angle class II and III malocclusion on the sagittal diameter of the upper airway between parents and children of Uygur nationality and to compare the degree of influence. Methods 29 Uygur adolescents with malocclusion and their fathers (mothers) were selected as our subjects via X-ray cephalometric radiograph to analyze the difference between the upper airway sagittal dimension and normal occlusion and compare the influence of malocclusion on the upper airway between parents and children. Results Compared with normal group, the vertical distance from the hyoid point to orbital-ear plane (H-FH) and vertical distance from hyoid point to the mandibular plane (H-MP) in angle class II malocclusion elevated signally, while the vertical distance from hyoid point to anterior cervical plane (H-VL), PNS-UPW, H-FH, and H-MP decreased significantly; compared with normal group: the distance between the posterior nasal spine and the upper pharynx wall (PNS-UPW), H-FH, and H-MP in angle class III malocclusion visually reduced, while PAS, and horizontal distance from the hyoid point and center point of sella turcica to orbital-ear foot (H-S), increased markedly. The impact of class II malocclusion on parents' U-MPM was greater than their children. Conclusion The oropharyngeal space of upper airway becomes smaller and hyoid shifts downwards due to class II malocclusion. Class III malocclusion results in decreased nasopharyngeal gap with hyoid to shift upward. The influence of class II malocclusion on the upper pharyngeal tract of parents was greater than their children.
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Affiliation(s)
- Lijun Cheng
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Yuxin Jiang
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Shasha Man
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Yanan Wang
- Department of Stomatology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province 050000, China
| | - Yan Yang
- Department of Stomatology, People's Hospital of Bayinguleng Mongolian Autonomous Prefecture, Kuerla, Xinjiang 841000, China
| | - Mi Zhou
- Department of Stomatology, People's Hospital of Bayinguleng Mongolian Autonomous Prefecture, Kuerla, Xinjiang 841000, China
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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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Lee CH, Seay EG, Reese JW, Wu X, Schwab RJ, Keenan B, Dedhia RC. Clinical Radiographic Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2020; 164:1122-1127. [PMID: 33048610 DOI: 10.1177/0194599820963141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if clinically acquired cephalometric measurements, specifically soft palate size, can predict hypoglossal nerve stimulation outcomes. STUDY DESIGN Combined prospective cohort study and retrospective review. SETTING US sleep otolaryngology training program. METHODS Adults with obstructive sleep apnea and apneahypopnea index greater than 15 events/h who underwent hypoglossal nerve stimulation. Eligible subjects had diagnostic preoperative sleep studies and full-night efficacy postoperative studies for analysis. Lateral neck x-rays were obtained as part of routine clinical care and measured for key cephalometric variables by trained head and neck radiologists. Continuous variables were compared using the Student t test, while χ2 testing was used for categorical variables. RESULTS Fifty-one patients met all study criteria. On average, patients were white, middle aged, and overweight. Following hypoglossal nerve stimulation, the overall cohort achieved a significant apnea-hypopnea index reduction from 36.7 events/h to 20.6 events/h (P < .01) and a response rate of 47% (defined as apnea-hypopnea index reduction >50% and apnea-hypopnea index <20 events/h). On average, therapy responders had significantly thinner soft palates than nonresponders (13.4 ± 3.8 mm vs 16.0 ± 3.4 mm, P = .045). CONCLUSIONS Patient-specific anatomic factors, specifically soft palate thickness, may help identify optimal candidates for hypoglossal nerve stimulation. A larger, prospective study including both anatomic and physiologic variables is required to validate these findings.
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Affiliation(s)
- Clara H Lee
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, USA
| | - Everett G Seay
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James W Reese
- Baylor Radiologists: A Radiology Partners Affiliated Practice, Houston, Texas, USA
| | - Xin Wu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raj C Dedhia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Schultz Martins R, Girouard P, Elliott E, Mekary S. Physiological Responses of a Jaw-Repositioning Custom-Made Mouthguard on Airway and Their Effects on Athletic Performance. J Strength Cond Res 2020; 34:422-429. [PMID: 29927893 DOI: 10.1519/jsc.0000000000002679] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Martins, RS, Girouard, P, Elliott, E, and Mekary, S. Physiological responses of a jaw repositioning custom-made mouthguard on airway and their effects on athletic performance. J Strength Cond Res 34(2): 422-429, 2020-Advanced dental techniques such as jaw-repositioning have shown to increase lower body muscular power such as vertical jump, but its effects on acceleration and speed have not been studied. Similarly, jaw repositioning is commonly used to increase airways volume and ventilation in a special population (i.e., obstructive sleep apnea); however, its ergogenic effects on aerobic performance have yet not been studied. The purpose of the cross-over study was to investigate the effects of a jaw-repositioning custom-made mouthguard (JCM) on volumetric changes in airway and jaw position and determine the effects this may have on aerobic and anaerobic performance. Results indicated that jaw-repositioning custom-made mouthguard may have an ergogenic effect on performance. The JCM condition showed an increase of 13% in upper airway volume (p = 0.04), 10% in upper airway width (p = 0.004), 7% in ventilation (p = 0.006), 5% in maximal aerobic power (p = 0.003), 4% in time to exhaustion (p = 0.03), 3% in vertical jump (p = 0.03), 2% in broad jump (p = 0.009), and a decrease of 4% in 20-m (p = 0.04) and 2% in 40-m (p = 0.001) sprint times. This is the first study to demonstrate a significant link between jaw repositioning, airway volumetric change, and performance enhancement in both aerobic and anaerobic performances. The results of this study may lead to a change in culture for the use of mouthguards in different sports applications, from high orofacial injury risk sports to other sports, specifically for ergogenic enhancement.
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Burlon G, Tepedino M, Laurenziello M, Troiano G, Cassano M, Romano L, Rinaldi R, Ciavarella D. Evaluation of factors that influence the success rate of OSA treatment with a customised adjustable MAD device - a retrospective study. ACTA ACUST UNITED AC 2020; 40:297-303. [PMID: 32519991 PMCID: PMC7586197 DOI: 10.14639/0392-100x-n0307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/27/2019] [Indexed: 02/07/2023]
Abstract
The aim of the present study was to evaluate how the features of obstructive sleep apnoea (OSA) and the degree of mandibular advancement influence the outcomes of oral appliance therapy with a fully-customised mandibular advancement device (MAD) in an adult population. A total of 85 adult patients with mild to severe OSA were retrospectively selected. Polysomnography was taken before treatment and after 2 months treatment with overnight MAD. Treatment success was defined as a > 50% reduction in the Apnoea/Hypopnoea Index (AHI) with a residual AHI < 10. Binary logistic regression was used to evaluate the effects of AHI, oxygen desaturation index (ODI), gender and age on the success rate of MAD therapy. MAD therapy was successful in 77.7% of patients, and the ODI was a significant predictor of treatment success. OSA treatment with the MAD was successful in reducing the AHI in adult patients. An ODI value smaller than 33.3 was a significant predictor of treatment success.
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Affiliation(s)
- Giuseppe Burlon
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | | | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Michele Cassano
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Luigi Romano
- Department of Otolaryngology Head and Neck Surgery, San Bassiano Hospital, Bassano del Grappa (VI), Italy
| | - Raffaella Rinaldi
- Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
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Abstract
Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA compared with CPAP therapy. Measures can be taken to improve predictability of oral appliance treatment.
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Affiliation(s)
- Jing Hao Ng
- Department of Orthodontics, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore.
| | - Mimi Yow
- Department of Orthodontics, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore
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11
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García M, Cabrera JA, Bataller A, Vila J, Mayoral P. Mandibular movement analisys by means of a kinematic model applied to the design of oral appliances for the treatment of obstructive sleep apnea. Sleep Med 2020; 73:29-37. [PMID: 32769030 DOI: 10.1016/j.sleep.2020.04.016] [Citation(s) in RCA: 4] [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: 02/20/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mandibular advancement devices (MADs) are one of the treatment options used for the obstructive sleep apnea syndrome (OSAS). At present, MADs are designed with standard titration systems, without considering each patient's anatomical characteristics of the temporomandibular joint and mandible shape. The main objective of this study is to evaluate if a variability in mandibular morphology will influence the displacement of the jaw with a MAD. Such knowledge will be of help to find optimal mandibular positions with MAD even when opening the mouth. METHODS By using a mandibular movement model, the movement patterns of different points on the chin have been analyzed. The influence of different skeletal mandibular shapes on these movements have also been studied. The results show differences in the movement patterns of the lower front teeth depending on its distance to the center of the condyle, with a more horizontal direction in those in which there is a greater distance. RESULTS Variations in mandibular morphology imply differences in movement patterns of the analyzed points of the mandible. Consequently, MADs should be designed according to each patient's anatomy to avoid mandibular retrusion in those areas that may narrow the upper airways. CONCLUSIONS This study may help to understand why not all patients move their lower jaws forwards equally with the same degree of mandibular protrusion measured in relation to the teeth. These results might also partially explain why airway obstruction is more severe in certain untreated sleep apnea subjects than in others when opening their mouth during sleep.
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Affiliation(s)
- Marcos García
- Department of Mechanical Engineering, University of Málaga, Spain
| | - Juan A Cabrera
- Department of Mechanical Engineering, University of Málaga, Spain.
| | - Alex Bataller
- Department of Mechanical Engineering, University of Málaga, Spain
| | - Javier Vila
- Otorhinolaryngology, Hospital Vall d Hebron, Barcelona, Spain
| | - Pedro Mayoral
- Master Program of Dental Sleep Medicine, Catholic University of Murcia, Spain
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12
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Flores-Orozco EI, Tiznado-Orozco GE, Díaz-Peña R, Orozco EIF, Galletti C, Gazia F, Galletti F. Effect of a Mandibular Advancement Device on the Upper Airway in a Patient With Obstructive Sleep Apnea. J Craniofac Surg 2020; 31:e32-e35. [PMID: 31449205 DOI: 10.1097/scs.0000000000005838] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The authors present a case of a 33-year-old male patient with obstructive sleep apnea syndrome who was treated with a mandibular advancement device with excellent results. The aim of this study is to underline the importance of new instruments that allow evaluating the upper airway with greater precision, such as cone beam tomography. Given the diagnosis and treatment, the upper airway was assessed using cone beam tomography; an increase in UA volume of 22% was observed (initial volume 22,962 mm), along with a 28% increase in area (initial area 971 mm). The evaluation of the UA using teleradiography also showed an increase in the points evaluated, with the midpoint of the soft palate presenting the greatest increase.
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Affiliation(s)
| | | | - Rogelio Díaz-Peña
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Tepic, Mexico
| | - Esteban Isaí Flores Orozco
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University (UNESP), São José dos Campos, Brazil
| | - Cosimo Galletti
- Comprehensive Dentistry Department, Faculty of Dentistry, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain
| | - Francesco Gazia
- Department of Adult and Development Age Human Pathology "Gaetano Barresi," Unit of Otorhinolaryngology, University of Messina Via Consolare Valeria 1, Messina, Italy
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi," Unit of Otorhinolaryngology, University of Messina Via Consolare Valeria 1, Messina, Italy
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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.
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Vásquez-Cárdenas J, Zapata-Noreña Ó, Carvajal-Flórez Á, Barbosa-Liz DM, Giannakopoulos NN, Faggion CM. Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting. Am J Orthod Dentofacial Orthop 2019; 156:442-452.e12. [PMID: 31582116 DOI: 10.1016/j.ajodo.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A). METHODS Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores. RESULTS Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting. CONCLUSIONS The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.
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Affiliation(s)
- Jenny Vásquez-Cárdenas
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Óscar Zapata-Noreña
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Álvaro Carvajal-Flórez
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana María Barbosa-Liz
- Orthodontic Postgraduate Program, Gionorto Research Group, Faculty of Dentistry, University of Antioquia, Medellín, Colombia.
| | | | - Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University of Münster, Münster, Germany
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García NM, Blaya F, Urquijo EL, Heras ES, D’Amato R. Oral appliance for Obstructive Sleep Apnea: Prototyping and Optimization of the Mandibular Protrusion Device. J Med Syst 2019; 43:107. [DOI: 10.1007/s10916-019-1235-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
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Abstract
Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA compared with CPAP therapy. Measures can be taken to improve predictability of oral appliance treatment.
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Lee JS, Choi HI, Lee H, Ahn SJ, Noh G. Biomechanical effect of mandibular advancement device with different protrusion positions for treatment of obstructive sleep apnoea on tooth and facial bone: A finite element study. J Oral Rehabil 2018; 45:948-958. [DOI: 10.1111/joor.12709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/30/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Ji-Soo Lee
- Department of Dentistry; Graduate School; Kyung Hee University; Seoul Korea
| | - Hye-In Choi
- Center for Bionics; Korea Institute of Science and Technology (KIST); Seoul Korea
| | - Hyeonjong Lee
- Division of Fixed Prosthodontics and Biomaterials; Clinique of Universitaire Medicine Dentaire; University of Geneva; Geneva Switzerland
| | - Su-Jin Ahn
- Department of Biomaterials & Prosthodontics; Kyung Hee University Hospital at Gangdong; School of Dentistry; Kyung Hee University; Seoul Korea
| | - Gunwoo Noh
- School of Mechanical Engineering; Kyungpook National University; Daegu Korea
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Sampol Rubio G, Macías Escalada E, Montserrat Canal JM, Terán Santos J. Los dispositivos de avance mandibular en el tratamiento de la apnea obstructiva del sueño. Una opción necesaria y eficaz. Med Clin (Barc) 2018; 151:34-38. [DOI: 10.1016/j.medcli.2017.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022]
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Kim HJ, Hong SN, Lee WH, Ahn JC, Cha MS, Rhee CS, Kim JW. Soft palate cephalometric changes with a mandibular advancement device may be associated with polysomnographic improvement in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2018; 275:1811-1817. [PMID: 29796743 DOI: 10.1007/s00405-018-5007-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE It is unclear whether soft palate-associated changes in cephalometry associated with a mandibular advancement device (MAD) are independently associated with improvements in polysomnography (PSG) respiratory parameters in obstructive sleep apnea (OSA). METHODS This retrospective review aimed to identify the association between soft palate-associated changes in cephalometry and PSG changes after application of an MAD. Korean patients diagnosed with OSA who underwent cephalometry with or without an MAD were enrolled. All the patients were evaluated after undergoing full-night PSG twice: once with an MAD and once without. Cephalometric findings were measured using an image analyzer. RESULTS Mean apnea-hypopnea index significantly decreased with an MAD from 36.4/h to 14.7/h (p < 0.001). Retropalatal airway space significantly increased with an MAD from 6.6 to 7.3 mm (p = 0.013). Soft palate length also significantly decreased with an MAD from 43.6 to 42.3 mm (p = 0.02). Although these findings were shown by responders (patients with a reduction of apnea-hypopnea index by more than 50%), there were no significant changes in non-responders. However, retroglossal airway space did not significantly increase with an MAD even in responders. CONCLUSIONS Improvement of OSA with an MAD can be predicted with soft palate-associated upper airway changes shown in cephalometry.
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Affiliation(s)
- Hong Joong Kim
- Department of Otorhinolaryngology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, South Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Woo Hyun Lee
- Department of Otolaryngology, College of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Jae-Cheul Ahn
- Department of Otorhinolaryngology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea
| | - Min-Sang Cha
- Department of Dentistry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
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Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med Rev 2016; 35:113-123. [PMID: 27815038 DOI: 10.1016/j.smrv.2016.10.002] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/23/2016] [Accepted: 10/05/2016] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is a complex and heterogeneous disorder and the apnea hypopnea index alone can not capture the diverse spectrum of the condition. Enhanced phenotyping can improve prognostication, patient selection for clinical trials, understanding of mechanisms, and personalized treatments. In OSA, multiple condition characteristics have been termed "phenotypes." To help classify patients into relevant prognostic and therapeutic categories, an OSA phenotype can be operationally defined as: "A category of patients with OSA distinguished from others by a single or combination of disease features, in relation to clinically meaningful attributes (symptoms, response to therapy, health outcomes, quality of life)." We review approaches to clinical phenotyping in OSA, citing examples of increasing analytic complexity. Although clinical feature based OSA phenotypes with significant prognostic and treatment implications have been identified (e.g., excessive daytime sleepiness OSA), many current categorizations lack association with meaningful outcomes. Recent work focused on pathophysiologic risk factors for OSA (e.g., arousal threshold, craniofacial morphology, chemoreflex sensitivity) appears to capture heterogeneity in OSA, but requires clinical validation. Lastly, we discuss the use of machine learning as a promising phenotyping strategy that can integrate multiple types of data (genomic, molecular, cellular, clinical) to identify unique, meaningful OSA phenotypes.
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Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing. J Clin Sleep Med 2016; 12:1175-83. [PMID: 27397656 PMCID: PMC4957196 DOI: 10.5664/jcsm.6062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). METHODS SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. RESULTS Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. CONCLUSIONS Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB.
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Affiliation(s)
- Thikriat S. Al-Jewair
- Clinical Assistant Professor and Program Director, Department of Orthodontics, State University of New York at Buffalo, Buffalo, NY
| | - Balgis O. Gaffar
- Lecturer, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Saudi Arabia
| | - Carlos Flores-Mir
- Professor, Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta Canada
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