Original article
Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis

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Introduction: Oral appliances (OAs) have been widely used to treat snoring and sleep apnea, but their effects on craniofacial structures in patients after 5 years or more of wear have not yet been quantified. Methods: Seventy-one patients who had worn adjustable mandibular repositioners to treat snoring or sleep apnea were evaluated. Upright lateral cephalometric radiographs in centric occlusion taken before treatment and after a mean of 7.3 ± 2.1 years of OA use were compared. Baseline sleep studies and patient demographic data were included in the analysis. Results: Cephalometric analyses after long term OA use showed significant (P < .01) changes in many variables, including increases in mandibular plane and ANB angles; decreases in overbite and overjet; retroclined maxillary incisors; proclined mandibular incisors; increased lower facial height; and distally tipped maxillary molars with mesially tipped and erupted mandibular molars. The initial deep overbite group had a significantly greater decrease in overbite. Duration of OA use correlated positively with variables such as decreased overbite and increased mandibular plane angle; changes in the dentition appeared to be progressive over time. Conclusions: After long-term use, OAs appear to cause changes in tooth positions that also might affect mandibular posture.

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

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  • 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.

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