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Eur J Orthod. 2017 Oct 1;39(5):482-488. doi: 10.1093/ejo/cjw078.

Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients.

Author information

1
Department of Orthodontics, School of Dentistry, University of Bologna.
2
Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.
3
Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.

Abstract

Objectives:

To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients.

Methods:

Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05.

Results:

At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011).

Limitations:

A larger sample size could increase the generalizability of the findings.

Conclusion:

MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.

PMID:
27932405
DOI:
10.1093/ejo/cjw078
[Indexed for MEDLINE]

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