Original article
A follow-up study of dental and skeletal changes associated with mandibular advancement splint use in obstructive sleep apnea

https://doi.org/10.1016/j.ajodo.2005.08.047Get rights and content

Introduction: Mandibular advancement splints (MAS) are a recognized therapeutic option in the treatment of obstructive sleep apnea (OSA). This study aimed to investigate side effects and possible changes in the dentofacial complex associated with long term use of MAS. Methods: The sample included 64 patients with OSA who had been using MAS on average for 25.1 ± 11.8 months (range, 10.7-64.5 months). A specifically designed questionnaire was used to investigate the patients’ self-assessment of the side effects of wearing MAS; cephalometric analyses and dental cast measurements were conducted to identify objectively dental and skeletal changes caused by MAS over time. Results: The most commonly reported side effects were jaw discomfort, tooth tenderness, excessive salivation, and dry mouth. Subjectively, snoring improved in 56 patients (88%), and daytime sleepiness (Epworth sleepiness scale) scores significantly decreased from pretreatment to follow-up (11.4-7.1, P <.001). Small subjective occlusal changes were experienced by 8 patients (12.5%). Reductions in overbite (−0.3 ± 0.08 mm, P <.01) and overjet (−0.2 ± 0.06 mm, P <.05) were found, and cephalometric analysis showed statistically significant but clinically insignificant changes limited to anterior movement of the mandibular incisors (0.5 ± 0.12 mm, P <.001). Conclusions: Side effects of MAS use over long periods are common but mild and well tolerated by most patients, and dentofacial changes are negligible.

Section snippets

Material and methods

The sample included 64 patients (50 men, 14 women) recruited from the patient data bank at a multidisciplinary sleep disorders clinic in St George University Hospital. All patients had been assessed by a respiratory physician and an orthodontist associated with the sleep disorders clinic and had been prescribed MAS for their OSA. A selection criterion for this follow-up study was the issue of a MAS at least 6 months before the study. Overnight polysomnography was undertaken before treatment

Results

All 64 patients completed the questionnaire, and 57 patients (89%) underwent a clinical examination. Sufficient records at T1 and T3 were available to complete the dental study model analysis in 45 patients (70%) and radiographic analysis in 46 patients (71%).

The results from the questionnaires are summarized in Fig 4, Fig 5 and Table I. Eight patients (12.5%; 6 men) had no side effects. Bed partners assisted in answering the questionnaire in 46 patients (72%). Nine patients (14%) were not

Discussion

In this study, we found that MAS therapy is subjectively effective and well tolerated despite the side effects reported by many (87.5%) patients. Most patients (97%) found control of OSA symptoms to be satisfactory or better after an average of 25.1 ± 11.8 months. Sleep quality was reported as moderately or very refreshing in 83% of patients, and the subjective improvements in snoring and daytime sleepiness agree with data from other studies.5, 10, 21 Although the questionnaire was not

Conclusions

MAS therapy in the treatment of OSA has been found to provide subjective and objective benefits with minimal dental and skeletal side effects. Compliance levels in this study attest to patients’ satisfaction with MAS therapy in spite of some minor side effects associated with its use by most of the sample. The extent to which this is influenced by design features of the MAS remains to be determined. Management by a multidisciplinary team, consisting of orthodontic, OSA, and prosthetic

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