American Journal of Orthodontics and Dentofacial Orthopedics
Original articleLong-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis
Section snippets
Material and methods
Patients who had worn OAs for at least 5 years were recruited to participate in this study.25 They came to the Sleep Apnea Dental Clinic at the University of British Columbia or to an author’s (A.A.L.) private practice for regular follow-up of their OAs and were currently using their OAs for 4 or more days a week and had been doing so for more than 5 years. All patients had been treated with a mandibular advancement device for snoring or OSA. Even though some patients started with a different
Results
The 71 patients had been wearing OAs for a minimum of 4 nights a week. Most wore this appliance every night because, without regular wear, morning headaches and excessive daytime sleepiness were reported. These patients had been using OAs for 7.3 ± 2.1 years when the follow-up evaluation was completed. A team of 5 orthodontists evaluated pretreatment and posttreatment models and reached consensus on the Angle classification39 of each patient. The mean cephalometric changes according to
Discussion
This study demonstrates that OAs used for a mean period of 7.3 years have a significant impact on occlusal and dental structures, eg, a 2.8 mm decrease in OB and a 2.6 mm decrease in OJ. Changes observed in craniofacial structures were mainly related to significant tooth movements. Although some changes might be undesirable in certain patients, we believe that the effective treatment of a life-threatening disease such as OSA supersedes the maintenance of baseline occlusion. Even if major tooth
Conclusions
Our results showed that craniofacial side effects occur after long-term OA use, and this might have clinical implications. With the use of mandibular advancement appliances over a mean duration of 7.3 years, we found significant and progressive changes in the dentition. Because OAs are a lifelong treatment approach for OSA, and the changes appeared to continue over time, the collection of cephalometric radiographs, study models, and intraoral photographs before and during treatment should be
References (48)
- et al.
Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS)
Am J Orthod Dentofacial Orthop
(1997) - et al.
An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome
Chest
(2002) - et al.
Obstructive sleep apnea subtypes by cluster analysis
Am J Orthod Dentofacial Orthop
(1992) Imaging for the snoring and sleep apnea patient
Dent Clin North Am
(2001)- et al.
Effects of an anteriorly titrated mandibular position on awake airway and obstructive sleep apnea severity
Am J Orthod Dentofacial Orthop
(2004) - et al.
Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoringtolerability and predictors of treatment success
Chest
(2004) - et al.
A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea
Chest
(1996) - et al.
Treating obstructive sleep apnea and snoringassessment of an anterior mandibular positioning device
J Am Dent Assoc
(2000) - et al.
The effects of oral appliance therapy on occlusal function in patients with obstructive sleep apneaa short-term prospective study
Am J Orthod Dentofacial Orthop
(2006) - et al.
Occlusal and skeletal effects of an oral appliance in the treatment of obstructive sleep apnea
Chest
(2002)
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?
Am J Orthod Dentofacial Orthop
Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring
Am J Orthod Dentofacial Orthop
A cephalometric and electromyographic study of upper airway structures in the upright and supine positions
Am J Orthod Dentofacial Orthop
Longitudinal dental arch changes in adults
Am J Orthod Dentofacial Orthop
Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement devicea prospective, randomized study
Am J Orthod Dentofacial Orthop
Cortical bone remodelling/tooth movement ratio during maxillary incisor retraction with tip versus torque movements
Am J Orthod Dentofacial Orthop
Cephalometric analysis in obese and non-obese patients with obstructive sleep apnea syndrome
Chest
Longitudinal changes in craniofacial factors among snoring and nonsnoring Bolton-Brush study participants
Am J Orthod Dentofacial Orthop
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years
Am J Respir Crit Care Med
MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome
Eur Respir J
Effect of mandibular and tongue protrusion on upper airway size
Am J Respir Crit Care Med
Oral appliance therapy improves symptoms in obstructive sleep apneaa randomized, controlled trial
Am J Respir Crit Care Med
A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea
Am J Respir Crit Care Med
Cited by (0)
The Klearway appliance was invented by Alan A. Lowe. International patents have been obtained by the University of British Columbia; specific licensees are assigned the rights to manufacture and distribute it worldwide. This study was supported by CNPq, an entity of the Brazilian government for scientific and technological development, as a scholarship to the first author.