Mandibular Torus as a New Index of Success for Mandibular Advancement Devices

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.

Can treatment with statins have a negative influence on the tolerance of mandibular advancement devices?

BACKGROUND

Statins are considered the most effective drugs used in the treatment of dyslipidemias. Some of their adverse effects are related to muscle problems. Myalgias produced by statins appear more often during exercise. Mandibular advancement devices (MAD) force the propulsory and elevatory musculature of the mandible to exercise by making the jaw move forward. The aim of this study is to evaluate the incidence of muscular side effects (referred, spontaneous, or under palpation pain, myofascial pain, mandibular rigidity and fatigue, tension and sensitivity of the masticatory muscles) in a group of patients with a diagnosis of obstructive sleep apnea being treated with MAD.

METHODS

This was a prospective study, involving consecutively 104 patients with a diagnosis of OSAS, and who had begun treatment with a custom made oral device. Muscular side effects were collected by anamnesis (verbal request and questionnaires), psychological status and clinical assessment (manual muscle palpation in the masticatory and cervical muscle groups), before and during MAD treatment.

RESULTS

Of the total sample, 22.1 % presented muscular side effects with the oral device. However, in patients taking statins, this percentage was 57.1 %, as opposed to 16.7 % of the non-statins patients (p < 0.001). The risk of suffering muscular alterations during oral device treatment is higher in statin patients (odds ratio 6.67, p = 0.002).

CONCLUSION

Treatment with statins can give rise to the appearance of undesirable side effects among patients being treated with oral devices.

Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review

INTRODUCTION

Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed.

OBJECTIVES

The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage.

METHODS

The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed.

RESULTS

Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs).

CONCLUSIONS

Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements.

Orthodontic tooth movement after different coxib therapies

Anti-inflammatory substances used for treatment of pain and discomfort related to orthodontic treatment (OT) could slow down tooth movement. Selective cyclooxygenase-2 inhibitors are an alternative to conventional non-steroidal anti-inflammatory drugs. The aim of this study was to compare different coxibs on dental movement in the rat. Twenty-eight Wistar male rats (3 months old) divided into four experimental groups were studied: (1) Five rats underwent a 50 g coil spring implantation and received three injections of 0.5 mg/kg body weight (bw) of Rofecoxib in the maxillary gingiva, close to the first molar, on the day of implantation and after 3 and 5 days. Similar procedures were carried out (2) on six animals receiving 8 mg/kg bw of Celecoxib and (3) on five animals receiving 25 mg/kg bw of Parecoxib. (4) For the controls, 12 rats received the same OT but only equivolumetric 0.9 per cent saline solution injections. Tooth movement was measured on lateral cranial teleradiographs after 10 days of treatment. Non-parametric standard techniques (Wilcoxon, H, and Mann-Whitney, U) were used for statistical analysis. Mesial tooth displacement in the control animals was 0.33 +/- 0.07 mm. While no movement was found in rats treated with Rofecoxib, the Celecoxib- and Parecoxib-treated rats showed tooth movement of 0.42 +/- 0.09 mm and 0.22 +/- 0.04 mm, respectively. The differences were statistically significant (H = 13.07; P < 0.004). Celecoxib and Parecoxib, but not Rofecoxib, seem appropriate for discomfort and pain relief while avoiding interference during tooth movement.

Hay-Wells syndrome (AEC): a case report

We would like to present a case of the rare genetic skin disorder catalogued as AEC syndrome. This rare disorder was described in 1976 by Hay and Wells in seven individuals from four families, and it entails a complex polymalformative syndrome with an autosomal-dominant inheritance pattern and variable penetration. Descriptive explanation and facial and intraoral images of this rare disorder constituted the study design. The neonatal report outlines dysplastic phenotype, micrognathia, hypoplasia of the hard and soft palate, cleft palate, small nose, mammary hypoplasia with ectopic mammary nodules, hypoplastic external genitalia with clitoral hypertrophy, hypoplasia of the nails, a tendency towards dorsiflexion of the big toe on both feet, ankyloblepharon filiforme, low positioning of the auricles and faulty development of the left auricle, scaly exanthema with eritrodermatitis and hyperkeratosis, good lung ventilation, normal heart rhythm and normal neurological examination. Although only a few cases published are available, clinical variability is one of the hallmarks of AEC syndrome. The majority of authors consider ankyloblepharon, ectodermal dysplasia and orofacial clefting as cardinal signs. They are all are present in the case reported.

Orthodontic tooth movement after inhibition of cyclooxygenase-2

INTRODUCTION

The purpose of this study was to compare the effects of a conventional nonsteroidal anti-inflammatory drug, diclofenac (Voltaren [Novartis, Barcelona, Spain]), and a specific cyclooxygenase-2 (COX-2) inhibitor, rofecoxib (Vioxx [MSD, Madrid, Spain]), on the inhibition of dental movement induced with a coil-spring orthodontic apparatus in rats.

METHODS

Tooth movement was measured on the lateral cranial teleradiographs of 42 male Wistar rats in 6 experimental groups: (1) 50-g coil spring and 2 rofecoxib injections of 1 mg per kilogram of body weight; (2) similar orthodontic procedure and 2 diclofenac injections of 10 mg per kilogram of body weight; (3) the same orthodontic treatment and 0.9% saline-solution injections; and (4), (5), and (6) 100-g coil appliance and the same pharmacological treatment as 1, 2, and 3, respectively.

RESULTS

The difference in tooth movement, measured in the control animals after 10 days of 50 or 100 g of orthodontic force application, was not statistically significant. Reduction in tooth movement in 50-g traction groups reached statistically significant differences; both rofecoxib or diclofenac were effective in inhibiting dental movement. The comparison of the 3 groups treated with 100 g of force also reached statistical significance. Both rofecoxib and diclofenac significantly inhibited dental movement, partially in the case of rofecoxib and totally in the case of diclofenac. Nevertheless, no statistically significant difference was found between the effects of rofecoxib and diclofenac.

CONCLUSIONS

There is no substantial advantage in using selective COX-2 inhibitors compared with nonspecific COX inhibitors to avoid interference with tooth movement during orthodontic treatment in rats.