Does 2 years’ nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible?,☆☆,

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Abstract

The aim of this pilot study was to investigate the effects of 2 years’ nocturnal treatment with a mandibular advancement splint in adult patients with snoring and obstructive sleep apnea syndrome with respect to possible development of a forward position of the mandible or other dentofacial changes. Thirty snoring and sleep apnea patients, mean age 55.3 years (SD, 8.61; range, 46.5 to 79.8 years), referred from the Ear, Nose, and Throat Department, were treated with an acrylic splint with full tooth coverage that advanced the mandible 5 to 8 mm (70% of maximal protrusion) and used 5 mm opening vertically. The splint was used 6 to 8 hours per night and 5 to 7 nights per week. Two lateral head radiographs were taken in centric occlusion, 1 before and 1 after 2 years of treatment. A small but statistically significant forward and downward change in mandibular position was found after treatment; mean was 0.4 mm (SD, 0.53; range, 0.0 to 2.0 mm; P < .001) and 0.3 mm (SD, 0.43; range, 0.0 to 1.5 mm; P < .001), respectively. The forward and downward movement of the mandible was accomplished by a statistically significant increase in mandibular length—mean was 0.4 mm (SD, 0.62; range, 0.0 to 2.5 mm; P < .01)—and a significant decrease in overjet (P < .001) and overbite (P < .05). However, none of the patients reported any permanent sense of altered occlusion, and the anteroposterior distance between habitual occlusion (intercuspal position) and centric relation (retruded position) did not exceed 1.0 mm in any of the patients either before or after the treatment. The change in mandibular position might be a result of a condylar and/or glenoid fossa remodeling or condylar position changes within the fossa as a compensatory reaction to the advancement of the mandible (bite jumping). However, to visualize and analyze such possible changes in detail, additional studies using lateral tomography of the temporomandibular joints or magnetic resonance imaging are required. Furthermore, because the treatment of snoring and OSAS patients is considered to be lifelong, long-term studies are needed to analyze if the small change in mandibular position will continue with further treatment. (Am J Orthod Dentofacial Orthop 1999;116:621-8)

Section snippets

MATERIAL AND METHODS

Thirty patients with socially handicapping snoring and OSAS participated in this intraindividual pilot study. Twenty-one were male, 9 were female; they ranged in age from 46.5 to 79.8 years with a mean age of 55.3 years (SD, 8.61) at the start of treatment. All patients had been referred from the Ear, Nose, and Throat (ENT) Department for treatment with a mandibular advancement splint. The snoring and OSAS had been confirmed by somnography, and all patients were judged to benefit from

RESULTS

All patients declared that they had used the mandibular advancement splint 6 to 8 hours per night and 5 to 7 nights per week throughout the 2-year treatment period. During the first nights of use, 8 patients reported transient symptoms like slight tenderness in the teeth and/or increased salivary secretion. Two patients reported increased jaw stiffness during half an hour after removal of the splint in the morning. However, none of the patients reported any permanent sense of altered occlusion.

DISCUSSION

In the present pilot study, a control group matched with regard to age and sex could not be obtained for ethical reasons. Instead, a common approach with an intraindividual experimental protocol was used where the dentofacial morphology was intraindividually compared at the start and after 2 years of treatment. The most interesting finding of the study was that a significant forward and downward change in mandibular position had occurred after treatment (Table I). It was also found that the

CONCLUSIONS

The most interesting finding of this pilot study was that a statistically significant forward and downward change in mandibular posture had occurred after 2 years’ nocturnal treatment with a mandibular advancement splint in adult snoring and OSAS patients. It was also found that the forward and downward movement of the mandible was accomplished by a statistically significant increase in mandibular length. This might be a result of a condylar or glenoid fossa remodeling as a compensatory

Acknowledgements

This pilot study is dedicated to my father, Yngve Bondemark, who died during the time the study was accomplished.

References (36)

  • T Young et al.

    The occurrence of sleep-disordered breathing among middle-aged adults

    N Engl J Med

    (1993)
  • T Gislason et al.

    Snoring, hypertension, and the sleep apnea syndrome: an epidemiological survey of middle aged women

    Chest

    (1993)
  • GT Clark et al.

    Dental appliances for the treatment of obstructive sleep apnea

    J Am Dent Assoc

    (1989)
  • W Schmidt-Nowara et al.

    Oral appliances for the treatment of snoring and obstructive sleep apnea: a review

    Sleep

    (1995)
  • A. Lowe

    Dental appliances for the treatment of snoring and obstructive sleep apnea

  • RA O'Sullivan et al.

    Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea

    Am J Resp Crit Care Med

    (1995)
  • M Bernhold et al.

    A magnetic appliance for treatment of snoring patients with and without obstructive sleep apnea

    Am J Orthod Dentofacial Orthop

    (1998)
  • RJO Davies et al.

    The relationship between neck circumference, radiographic pharyngeal anatomy and obstructive sleep apnea syndrome

    Eur Resp J

    (1990)
  • AE Athanasiou et al.

    Cephalometric evaluation of pharynx, soft palate, adenoid tissue, tongue, and hyoid bone following the use of a mandibular repositioning appliance in obstructive sleep apnea patients

    Int J Orthod Orthognat Surg

    (1994)
  • G Mayer et al.

    Cephalometric predictors for orthopaedic mandibular advancement in obstructive sleep apnea

    Eur J Orthod

    (1995)
  • T Ono et al.

    A tongue retaining device and sleep-state genioglossus muscle activity in patients with obstructive sleep apnea

    Angle Orthod

    (1996)
  • JA McNamara et al.

    Histological studies of temporomandibular joint adaptations

  • H. Pancherz

    The mechanism of Class II correction in Herbst appliance treatment: a cephalometric investigation

    Am J Orthod

    (1982)
  • L. Wieslander

    Intensive treatment of severe Class II malocclusions with a headgear-Herbst appliance in the early mixed dentition

    Am J Orthod

    (1984)
  • H Pancherz et al.

    Class II correction in Herbst and Bass therapy

    Eur J Orthod

    (1989)
  • AD Vardimon et al.

    Functional orthopedic magnetic appliance (FOMA) II: Modus operandi

    Am J Orthod Dentofacial Orthop

    (1989)
  • JA McNamara et al.

    A comparison of the Herbst and Fränkel appliances in the treatment of Class II malocclusion

    Am J Orthod Dentofacial Orthop

    (1990)
  • MI Heather et al.

    A prospective evaluation of Bass, Bionator and Twin-block appliances. Part I - the hard tissues

    Eur J Orthod

    (1998)
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    The research was supported by the Swedish Dental Society and the University of Kristianstad, Sweden.

    ☆☆

    Reprint requests to: Dr Lars Bondemark, Orthodontic Clinic, Esplanadgatan 15, S-281 38 Hässleholm, Sweden; e-mail: [email protected]

    0889-5406/99/$8.00 + 0  8/1/100760

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