Dental and skeletal changes associated with long-term oral appliance use for obstructive sleep apnea: A systematic review and meta-analysis

Araie, Takafumi; Okuno, Kentaro; Minagi, Hitomi Ono; Sakai, Takayoshi

doi:10.1016/j.smrv.2018.02.006

Cited by 39 publications

(44 citation statements)

References 37 publications

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“…Some previous studies have reported that subjective feelings of bite changes decrease over time [6,9], while the degree of objectively assessed bite changes increases [1][2][3][4][5][6][7][8][9][10][11][12]16]. The patients included in the present study had used oral appliances for at least 3 years.…”

Section: Discussionmentioning

confidence: 98%

“…Occlusal changes are common during long-term treatment with oral appliances (OAs) for sleep apnea [1,2], but patients more seldom complain of any dental side effects [3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…The molars in the posterior parts of the dentition will reposition into a more class III relationship, and the changed inclinations of the front teeth will decrease the overjet and the overbite ( Fig. 1) [1,2]. The teeth may have more space [14][15][16][17] or become more crowded [18].…”

Section: Introductionmentioning

confidence: 99%

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Subjective versus objective dental side effects from oral sleep apnea appliances

Marklund

2019

Sleep Breath

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Purpose Occlusal changes are common during long-term treatment with oral appliances (OAs) for sleep apnea. The aim of the present study was to compare subjectively reported bite changes with objective findings. Methods Consecutive adherent treated patients were asked to participate in this study. The patients responded to two questionnaires using numeric visual analogue scales (VAS), ranging from 0 (not at all) to 10 (very much). The first questionnaire included open questions and the second questionnaire comprised specific questions about side effects. Measurements of overjet, overbite, and space for the teeth were made on plaster casts taken before treatment start and at follow-up. Results Thirty-eight (12 women) patients with a median age of 64 years (interquartile range (IQR) 57 to 69 years) and a median treatment time of 9.5 years (IQR 5.8 to 14.3 years) were included. Overjet, overbite, the molar relationship, and the irregularity of the lower front teeth had changed significantly during treatment. There were no associations between any of the patients' responses and the objectively measured bite changes. Younger patients, those with a small baseline overjet or overbite and those who developed an anterior crossbite were more likely to report bite changes. Conclusions Patients who choose to continue long-term treatment with oral appliances for sleep apnea are unaware of various types of bite changes. Such changes will, however, progressively increase in magnitude and be more difficult to take care of, if needed. It is therefore important continuously to follow up patients in regard to bite changes.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Subjective versus objective dental side effects from oral sleep apnea appliances

Marklund

2019

Sleep Breath

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“…A meta-analysis of skeletal changes from MAD use reported no significant skeletal changes. 53 Other investigators, however, report significant increase in lower and total anterior facial height from longterm MAD use of more than 2 years. 60,61 Temporomandibular Joint Disorders Transient muscle soreness and temporomandibular joint (TMJ) discomfort have been reported after MAD use, especially during the initial titration period.…”

Section: Craniofacial Changesmentioning

confidence: 95%

“…There was no significant change in the upper incisor inclination or interincisal angle. 53 Due to the lower incisor inclination change and attendant decrease in OJ and OB, there was significant increase in anterior crossbites, 54 increase in mandibular arch width, and reduction in lower arch crowding. 54,55 Maxillary arch width increase and upper arch decrowding also have been reported.…”

Section: Dental Effectsmentioning

confidence: 99%

Oral Appliances in the Management of Obstructive Sleep Apnea

Yow

2019

Sleep Medicine Clinics

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Airway imaging with cone-beam computed tomography, magnetic resonance imaging and nasal endoscopy showed anteroposterior (AP) mandibular protrusion predominantly increases the caliber of the airway at the retropalatal area via lateral expansion and displacement of parapharyngeal fat pads 2,6-13 while the tongue and tongue-base muscles shift forward. 2,9,13 The lateral widening from AP movement is attributed to stretching of soft tissue connections KEYWORDS OSA Oral appliance Mandibular advancement Tongue stabilizer KEY POINTSThe concept in oral appliances for obstructive sleep apnea (OSA) management is protrusion of the mandible and/or tongue for structural effects on the upper airway. The upper airway is a muscular tube and its dimensions are enlarged with mandibular and tongue advancement. Protrusion of the mandible and tongue stretches the muscles, thereby reducing upper airway collapsibility with airway shape change and increase in muscle tone. Oral appliances are effective and evidence-based options in managing OSA.

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

116

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Dental and skeletal changes associated with long-term oral appliance use for obstructive sleep apnea: A systematic review and meta-analysis

Cited by 39 publications

References 37 publications

Subjective versus objective dental side effects from oral sleep apnea appliances

Subjective versus objective dental side effects from oral sleep apnea appliances

Oral Appliances in the Management of Obstructive Sleep Apnea

International Consensus Statement on Obstructive Sleep Apnea

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