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Wiener RC, Hnat M, Ngan P. Sleep disruption and premolar absence, NHANES, 2017-2020: A cross-sectional study. Community Dent Oral Epidemiol 2024; 52:809-816. [PMID: 38825699 PMCID: PMC11563929 DOI: 10.1111/cdoe.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars. METHODS A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data on participants, aged 18-65 years (n = 4742). Variables of interest included self-reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test. RESULTS There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants. CONCLUSION Concerns of the impact of first premolar extractions on SDB were not supported with this study.
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Affiliation(s)
- R. Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Michael Hnat
- Department of Restorative Dentistry, School of Dentistry, 1073 Health Sciences Center North, West Virginia University, Morgantown, West Virginia, USA
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, 1073 Health Sciences Center North, West Virginia University, Morgantown, West Virginia, USA
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Sivarajkumar S, Tam TYC, Mohammad HA, Viggiano S, Oniani D, Visweswaran S, Wang Y. Extraction of sleep information from clinical notes of Alzheimer's disease patients using natural language processing. J Am Med Inform Assoc 2024; 31:2217-2227. [PMID: 39001795 DOI: 10.1093/jamia/ocae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVES Alzheimer's disease (AD) is the most common form of dementia in the United States. Sleep is one of the lifestyle-related factors that has been shown critical for optimal cognitive function in old age. However, there is a lack of research studying the association between sleep and AD incidence. A major bottleneck for conducting such research is that the traditional way to acquire sleep information is time-consuming, inefficient, non-scalable, and limited to patients' subjective experience. We aim to automate the extraction of specific sleep-related patterns, such as snoring, napping, poor sleep quality, daytime sleepiness, night wakings, other sleep problems, and sleep duration, from clinical notes of AD patients. These sleep patterns are hypothesized to play a role in the incidence of AD, providing insight into the relationship between sleep and AD onset and progression. MATERIALS AND METHODS A gold standard dataset is created from manual annotation of 570 randomly sampled clinical note documents from the adSLEEP, a corpus of 192 000 de-identified clinical notes of 7266 AD patients retrieved from the University of Pittsburgh Medical Center (UPMC). We developed a rule-based natural language processing (NLP) algorithm, machine learning models, and large language model (LLM)-based NLP algorithms to automate the extraction of sleep-related concepts, including snoring, napping, sleep problem, bad sleep quality, daytime sleepiness, night wakings, and sleep duration, from the gold standard dataset. RESULTS The annotated dataset of 482 patients comprised a predominantly White (89.2%), older adult population with an average age of 84.7 years, where females represented 64.1%, and a vast majority were non-Hispanic or Latino (94.6%). Rule-based NLP algorithm achieved the best performance of F1 across all sleep-related concepts. In terms of positive predictive value (PPV), the rule-based NLP algorithm achieved the highest PPV scores for daytime sleepiness (1.00) and sleep duration (1.00), while the machine learning models had the highest PPV for napping (0.95) and bad sleep quality (0.86), and LLAMA2 with finetuning had the highest PPV for night wakings (0.93) and sleep problem (0.89). DISCUSSION Although sleep information is infrequently documented in the clinical notes, the proposed rule-based NLP algorithm and LLM-based NLP algorithms still achieved promising results. In comparison, the machine learning-based approaches did not achieve good results, which is due to the small size of sleep information in the training data. CONCLUSION The results show that the rule-based NLP algorithm consistently achieved the best performance for all sleep concepts. This study focused on the clinical notes of patients with AD but could be extended to general sleep information extraction for other diseases.
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Affiliation(s)
- Sonish Sivarajkumar
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Thomas Yu Chow Tam
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Haneef Ahamed Mohammad
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Samuel Viggiano
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - David Oniani
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Shyam Visweswaran
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA 15260, United States
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Yanshan Wang
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA 15260, United States
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA 15260, United States
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15260, United States
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15260, United States
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Kazmierski RH. Obstructive sleep apnea: What is an orthodontist's role? Prog Orthod 2024; 25:21. [PMID: 38945976 PMCID: PMC11214936 DOI: 10.1186/s40510-024-00524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. RESULTS Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. CONCLUSIONS Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.
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Affiliation(s)
- Robert H Kazmierski
- Solo Private Orthodontic Practice, 110 Marter Ave., Suite 404, Moorestown, NJ, 08057, USA.
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Vejwarakul W, Ko EWC, Lin CH. Evaluation of pharyngeal airway space after orthodontic extraction treatment in class II malocclusion integrating with the subjective sleep quality assessment. Sci Rep 2023; 13:9210. [PMID: 37280305 PMCID: PMC10244355 DOI: 10.1038/s41598-023-36467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/04/2023] [Indexed: 06/08/2023] Open
Abstract
Orthodontic treatment with premolar extractions is typically used to relieve dental crowding and retract anterior teeth for lip profile improvement. The aim of the study is to compare the changes in regional pharyngeal airway space (PAS) after orthodontic treatment with Class II malocclusion and to identify the correlations between questionnaire results and PAS dimensions after orthodontic treatment. In this retrospective cohort study, 79 consecutive patients were divided into normodivergent nonextraction, normodivergent extraction, and hyperdivergent extraction groups. Serial lateral cephalograms were used to evaluate the patients' PASs and hyoid bone positions. The Pittsburgh Sleep Quality Index and STOP-Bang questionnaire were used for sleep quality evaluation and obstructive sleep apnea (OSA) risk assessment, respectively, after treatment. The greatest airway reduction was observed in hyperdivergent extraction group. However, the changes in PAS and hyoid positions did not differ significantly among three groups. According to questionnaire results, all three groups had high sleep quality and low risk of OSA, with no significant intergroup differences. Moreover, pretreatment-to-posttreatment changes in PAS were not correlated with sleep quality or risk of OSA. Orthodontic retraction with premolar extractions nither exhibit significant reduction in airway dimensions nor increase their risk of OSA.
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Affiliation(s)
- Weerayuth Vejwarakul
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Ellen Wen-Ching Ko
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 6F, 199, Tung Hwa North Road, Taipei, 105, Taiwan.
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
| | - Cheng-Hui Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Ho ACH, Savoldi F, Wong RWK, Fung SC, Li SKY, Yang Y, Gu M. Prevalence and Risk Factors for Obstructive Sleep Apnea Syndrome Among Children and Adolescents with Cleft lip and Palate: A Survey Study in Hong Kong. Cleft Palate Craniofac J 2023; 60:421-429. [PMID: 34939456 DOI: 10.1177/10556656211068306] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) risk and related risk factors among children and adolescents of Hong Kong with cleft lip and/or palate (CL/P). DESIGN Retrospective survey study adopting three questionnaires, obstructive sleep apnea-18 (OSA-18), pediatric sleep questionnaire-22 (PSQ-22), and modified Epworth Sleepiness Scale (ESS). SETTINGS Multicenter study in two public hospitals. PATIENTS A total of 351 Chinese children and adolescents with non-syndromic CL/P (6-18-year-old, 57% males) visited between September 2017 and November 2019, with primary palatal repair surgery done before 3-year-old. MAIN OUTCOME MEASURE Positive OSAS risk was determined based on cut-off ≥60 for OSA-18, ≥8 for PSQ-22, and >8 for ESS. Age, sex, overweight presence, cleft type, embryonic secondary palate involvement, palatal repair surgery, palatal revision surgery, and orthodontic treatment were analyzed as possible risk factors. RESULTS A total of 9.5% of patients had positive OSAS risk based on OSA-18, 13.6% based on PSQ-22, and 13.2% according to ESS. A higher prevalence of patients with positive OSAS risk was of younger age (OSA-18, p = .034), had cleft involving embryonic secondary palate (PSQ-22, p = .009), and history of fixed orthodontic treatment (ESS, p = .002). The regression model identified only involvement of embryonic secondary palate as a risk factor (PSQ-22, odds ratio = 3.7, p = .015). CONCLUSIONS OSAS risk among children and adolescents of Hong Kong with CL/P was 9.5% to 13.6%. Patients at higher risk were those with cleft involving embryonic secondary palate. OSAS risk assessment may be influenced by different aspects of the disease spectrum, and a multimodal approach should be considered for such assessment.
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Affiliation(s)
- A C H Ho
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - F Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - R W K Wong
- 36621Department of Dentistry & Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR
| | - S C Fung
- 36621Department of Dentistry & Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR
| | - S K Y Li
- Clinical Research Center, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Y Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - M Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
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Karaman A, Güdük Z, Genc E. Evaluation of pharyngeal airway dimensions and cephalometric changes after premolar extraction and nonextraction orthodontic treatment in adolescent and adult patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101275. [PMID: 36064145 DOI: 10.1016/j.jormas.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/24/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of premolar extraction and non-extraction for orthodontic treatment on the skeletal, dentoalveolar and pharyngeal airway. MATERIAL AND METHOD The study was carried out with the radiographs of a total of 130 patients at the ages of 14 to 25, including 59 male and 71 female patients. The cases were divided into two groups as the "extraction" group(2 upper premolar teeth) (n = 66) and the "non extraction" group (n = 64). RESULTS Extraction Group:In both age groups, there was a statistically significant increase in the mean interincisal angle (U1xL1) and lower anterior facial height (ANS-Me) values(p < 0.05). In the 14-18 age group, there was a significant increase in the mean upper airway thickness, inferior airway space, hyoid position, soft palate length(PNSP) and upper pharynx values(p < 0.05). In both sexes, while the mean U1xL1 and ANS-Me values significantly increased, the mean upper incisors inclination values decreased significantly(p < 0.05). Non Extraction Group:In both age groups, the mean ANS-Me values increased significantly from T0 to T1(p < 0.05). In the 14-18 age group, the increase in the mean upper adenoid thickness, tongue length,PNSP, softpalate thickness and vertical airway length values was significant(p < 0.05). In the male patients, the mean U1xL1 value decreased significantly(p < 0.05). CONCLUSION The premolar teeth extraction performed in the patients receiving orthodontic treatment did not affect airway dimensions to a high extent.It was determined that the position of the hyoid bone and tongue length was not affected in the patients with premolar extraction and non extraction.
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Affiliation(s)
- Ahmet Karaman
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydın University, Istanbul, Turkey.
| | - Zekeriya Güdük
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydın University, Istanbul, Turkey
| | - Esra Genc
- Orthodontic private practice, Kayseri, Turkey
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Extraction vs. Nonextraction on Soft-Tissue Profile Change in Patients with Malocclusion: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7751516. [PMID: 34589550 PMCID: PMC8476252 DOI: 10.1155/2021/7751516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022]
Abstract
Objectives We aimed to summarize the current evidence regarding the impact of extraction vs. nonextraction in orthodontic treatment on patients' soft-tissue profile with malocclusion. Methods Between April 30th and November 30th, 2020, we searched PubMed and SCOPUS for published papers from inception to November 2020 using "orthodontic," "extraction," "nonextraction," and "Malocclusion." Included studies were summarized, and relevant data were extracted and analyzed using Review Manager 5.4. Results Pooled data from four controlled trials demonstrated a nonsignificant difference between extraction and nonextraction in terms of SNA (MD = 0.50, 95% CI: -0.37, 1.38; p = 0.26), SNB (MD = 0.11, 95% CI: -1.23, 1.44; p = 0.88), FMA (MD = 1.82, 95% CI: -2.39, 6.02; p = 0.40), IMPA (MD = 0.06, 95% CI: -8.83, -8.94; p = 0.99), overjet (MD = -1.47, 95% CI: -6.21, 3.26; p = 0.54), and overbite (MD = 0.50, 95% CI: -1.40, 2.40; p = 0.60). On the other hand, the extraction method significantly increased the ANB compared with the nonextraction group (MD = 0.78, 95% CI: 0.25, 1.31; p = 0.004). Conclusion The current evidence demonstrated that nonextraction protocols for orthodontic treatment are a safe and effective alternative to extraction protocols; individually tailored treatment strategies should be applied. More randomized controlled trials are critically needed to safely make an evidence-based treatment conclusion.
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Singh GD, Kherani S. Changes in sleep parameters following biomimetic oral appliance therapy: A case report. World J Clin Cases 2021; 9:2312-2319. [PMID: 33869608 PMCID: PMC8026823 DOI: 10.12998/wjcc.v9.i10.2312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/04/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA.
CASE SUMMARY An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance®, Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient’s mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions.
CONCLUSION In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Long-term follow up studies are required to verify these novel findings.
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Affiliation(s)
- G Dave Singh
- Institute of Craniofacial Sleep Medicine, Vivos Therapeutics, Inc., Highlands Ranch, CO 80129, United States
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Amat P. [Obstructive sleep disordered breathing and orthodontics: primum non nocere]. Orthod Fr 2019; 90:247-262. [PMID: 34643513 DOI: 10.1051/orthodfr/2019039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Obstructive sleep apnoea syndrome is a widespread and under-diagnosed condition, making it a major public health and safety issue. The objective of this article was to clarify some of the evidence-based elements of therapeutic decision-making and the information provided to the patient and family on the benefit-cost-security ratio of several of his therapeutic options. Published data on the effectiveness of oral appliances and functional orthopaedic appliances for obstructive sleep apnea (OSA) in children, the durability of their effects, the therapeutic possibilities of maxillary or bimaxillary expansion, and the interrelationships between permanent teeth extractions and obstructive sleep disordered breathing, were researched and analyzed. Based on available evidence, in growing patients with Class II malocclusion, treatment with functional orthopedic devices can increase the volume of the pharyngeal airway and thus hopefully reduce the risk of developing OSA. An improvement in the apnea-hypopnea index and lower oxygen saturation was observed in children treated with rapid maxillary expansion. Permanent teeth extractions prescribed for the treatment of teeth crowding in an orthodontic age patient do not result in any significant change in the upper airway. The role of the orthodontist in the multidisciplinary team in the screening and management of Obstructive Sleep Disordered Breathing (OSDB) is essential. By combining clinical experience with published data on various therapeutic approaches, the orthodontist helps the patient to benefit from better adapted care and a more sustainable outcome, while taking into account his or her preferences.
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Affiliation(s)
- Philippe Amat
- 19, Place des Comtes du Maine, 72000 Le Mans, France
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11
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Moskowitz E. Modern orthodontics at the crossroads. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ng JH, Song YL, Yap AUJ. Effects of bicuspid extractions and incisor retraction on upper airway of Asian adults and late adolescents: A systematic review. J Oral Rehabil 2019; 46:1071-1087. [PMID: 31281971 PMCID: PMC6851666 DOI: 10.1111/joor.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/23/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This systematic review aimed to assess the effects of bicuspid extractions and incisor retraction on airway dimension, hyoid position and breathing of adults and late adolescents. METHODS The review was conducted according to PRISMA guidelines. Eight databases including PubMed, EMBASE, Web of Science and Scopus were searched to August 2018. Minimum age of participants was 16 years. The intervention was dual-arch bicuspid extractions with incisor retraction. Outcomes were airway dimension, hyoid position and breathing assessment. RESULTS All nine publications meeting inclusion criteria were from Asia. They were divided into three Asian subregions. All East Asian lateral cephalometric studies reported anteroposterior airway narrowing at the oropharynx and sometimes the hypopharynx. However, the narrowing was small, comparable to measurement errors, and highly variable. Two out of three East Asian computed tomography (CT) studies described reductions in airway dimensions. The single functional breathing study showed increased simulated flow resistance after incisor retraction in East Asians. South Asian studies had mixed findings, with some reporting significant airway narrowing. The single study from West Asia found no significant airway or hyoid changes. CONCLUSIONS Airway response to bicuspid extractions and incisor retraction varied substantially when assessed with cephalometry. CT measurements present larger effect sizes and smaller variations, providing stronger evidence of airway narrowing. Orthodontic extractions for incisor retraction may be more frequently indicated in Asia, and East Asians seem particularly susceptible to airway narrowing and postero-inferior hyoid movement with incisor retraction. Better designed CT studies are needed for confirmation due to small effect size and large variability.
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Affiliation(s)
- Jing Hao Ng
- National Dental Centre SingaporeSingaporeSingapore
| | - Yi Lin Song
- National Dental Centre SingaporeSingaporeSingapore
| | - Adrian U. J. Yap
- National Dental Centre SingaporeSingaporeSingapore
- Department of Dentistry, Ng Teng Fong General HospitalNational University Health SystemSingaporeSingapore
- Faculty of DentistryNational University of SingaporeSingaporeSingapore
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Behrents RG, Shelgikar AV, Conley RS, Flores-Mir C, Hans M, Levine M, McNamara JA, Palomo JM, Pliska B, Stockstill JW, Wise J, Murphy S, Nagel NJ, Hittner J. Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper. Am J Orthod Dentofacial Orthop 2019; 156:13-28.e1. [DOI: 10.1016/j.ajodo.2019.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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Brecher E, Stark TR, Christensen JR, Sheats RD, Fields H. Examination, Diagnosis, and Treatment Planning for General and Orthodontic Problems. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stark TR, Pozo-Alonso M, Daniels R, Camacho M. Pediatric Considerations for Dental Sleep Medicine. Sleep Med Clin 2018; 13:531-548. [DOI: 10.1016/j.jsmc.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Park JH, Kim S, Lee YJ, Bayome M, Kook YA, Hong M, Kim Y. Three-dimensional evaluation of maxillary dentoalveolar changes and airway space after distalization in adults. Angle Orthod 2018; 88:187-194. [PMID: 29337633 DOI: 10.2319/121116-889.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate the changes in position of the maxillary dentition and the airway space after distalization using a modified C-palatal plate (MCPP) in adult patients through CBCT images and to analyze the relationship between the amount of distalization and the changes in the airway space. MATERIALS AND METHODS CBCT images of 33 adult Class II patients (22.2 ± 4.0 years old; 27 women and 6 men) treated by total maxillary arch distalization using the MCPP were evaluated before and after distalization. The patients were divided into nonextraction and extraction groups. The changes in the airway space as well as the changes in the positions of the maxillary dentition were evaluated. The distalization effects were calculated and assessed using paired t-tests. RESULTS After distalization, the first molar showed significant distalization and intrusion ( P < .001) with no significant rotation of the crown and no significant buccal displacement of its root in the transverse dimension. There were no significant changes in the airway volume or the minimum cross-sectional area of the oropharynx. CONCLUSIONS The application of the MCPP resulted in significant total arch distalization without a significant effect on the transverse dimensions or changes in the oropharynx airway space. The MCPP can be considered a viable treatment option for patients with Class II malocclusion.
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Mulimani PS. Evidence-based practice and the evidence pyramid: A 21st century orthodontic odyssey. Am J Orthod Dentofacial Orthop 2017; 152:1-8. [DOI: 10.1016/j.ajodo.2017.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
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Haddad S, Kerbrat JB, Schouman T, Goudot P. [Effect of dental arch length decrease during orthodontic treatment in the upper airway development. A review]. Orthod Fr 2017; 88:25-33. [PMID: 28229850 DOI: 10.1051/orthodfr/2016041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A possible relation between an upper airway space decrease and the development of obstructive sleep apnea syndrom explains the importance to know the effect of the modification of dental arch length on the upper airway during orthodontic treatment. OBJECTIVES The aim of this article is to expose recent knowledge about upper airway development and dental arch length decrease factors, to determine the influence of this decrease on upper airway development. METHODS A review was done to determine the upper airway normal development, to define dental arch to specify if an ideal position of dental arch on apical base exists. All of the length dental arch decrease factors during orthodontic treatment (dental extraction, dental agenesis and dental malpositions) and their upper airway resounding were searched. RESULTS Some authors found a diminution of upper airway space after premolars extractions while others didn't found this diminution after extractions premolars when incisor retraction is finished. A decrease of transversal maxillary diameter and nasal cavity may be due to absence of permanent teeth. CONCLUSION The effect of dental arch length decrease during orthodontic treatment in the upper airway development was not scientifically proved. However we had to be vigilant and adapt our orthodontic treatment case by case to avoid an upper airway modification.
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Affiliation(s)
| | | | - Thomas Schouman
- Service de chirurgie maxillo-faciale et stomatologie, Hôpital universitaire Pitié Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Patrick Goudot
- Service de chirurgie maxillo-faciale et stomatologie, Hôpital universitaire Pitié Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France
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