Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients

Abstract

Oral appliances (OAs) have been used to treat obstructive sleep apnea (OSA) patients for decades. However, detailed dental side effects in long-term OA cases analyzed with an accurate three-dimensional (3D) measurement tool have seldom been reported. The purpose of this study is to evaluate dental side effects in five OSA patients, who had used a tongue retaining device (TRD) (with occasional other OA wear) for an average of 6 years and 4 months. The baseline and follow-up orthodontic study models were measured with a newly developed MicroScribe-3DX analysis system. High compliance of TRD wear was confirmed in all cases and different patterns and amounts of dental changes were observed. The most common appliance-induced dental changes included anterior and/or unilateral posterior open-bites and reduced anterior overjets. It was hypothesized that there might be two possible mechanisms for the TRD side effects--one is the forward pressure of the tongue upon the anterior dental arch and the other is the lateral pressure of the tongue upon the posterior arch. Considerations to correct the TRD dental side effects should be guided by these different mechanisms of the tongue on the dental arch. Possible solutions to minimize occlusal changes and maximize the benefits for OSA patients are also discussed.

Connecting and Collaborating to Advance Dental Sleep Medicine

“…Ten edentulous OSA patients (8 male, 2 female, age 61 ± 4 years; BMI 22 ± 5; AHI [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], who volunteered and provided written informed consent were included in the study. A provisional selection of patients was based on subjective evaluation of symptoms, according to the Epworth Sleepiness Scale and the http://dx.doi.org/10.15331/jdsm.4134…”

“…24,25 In subjects who are edentulous, do not have at least eight teeth in both arches, have severe limitations in the anteroposterior position of the mandible, or who have significant periodontal disease, traditional OAs may be contraindicated. Instead an appliance such as a tongue repositioner/stabilizer 26 could be used, which delivers less force directly to the teeth and distributes the pressure over other intraoral sites. However, tongue retaining devices are generally contraindicated in obligate mouth breathers, since it may be difficult to breathe through the mouth with these appliances.…”

“…[26][27][28] Some 14% of OSA patients who had worn a mandibular repositioning appliance for five years or longer were found to have no change in their occlusion, 42% had a favorable change, and 44% had an unfavorable change. 27 Patients with larger overbites and overjets had the most favorable occlusal changes based on cephalometric and study model analyses.…”

Little known but important aspect of long term dental stability

“…5 As more and more people are diagnosed with sleep disturbances, 1,3 the incidence of dental changes taking place related to various CPAP wear, 2 tongue retaining (TR), 5 and mandibular advancement devices (MAD) 6,7 will need to be front and center in every dentist's risk factor assessment for tooth movement.…”

Dental changes associated with tongue retaining device wear

“…Dear Editors, The article "Dental changes evaluated with a 3D computerassisted model analysis after long-term tongue retaining device wear in OSA patients" by Chen et al [1] seems to leave many open questions.…”