Forces created by mandibular advancement devices in OSAS patients

Cohen-Lévy, Julia; Pételle, Boris; Pinguet, Jérémy; Limerat, E.; Fleury, Bernard

doi:10.1007/s11325-012-0765-4

Cited by 47 publications

(26 citation statements)

References 45 publications

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“…29 It has been previously shown that the relationship between the force applied to the arches and amount of mandibular advancement is almost linear, with the force increasing with increasing mandibular advancement. 24 In the present study, patients with a greater amount of initial overjet tended to see larger total reductions to both overjet and overbite. This may be due to the greater amount of clearance for the forward movement of the lower dentition that occurs in these patients, before the lower anterior teeth would contact the corresponding upper anterior teeth.…”

Section: Discussionsupporting

confidence: 44%

“…The force required to suspended the mandible and associated soft tissues thus is transmitted to the dental arches and likely results in the occlusal changes reported. 24 It should be understood then that the dental side effects of MAS treatment are a product of protruding the mandible to achieve a therapeutic effect rather than specific appliance design. 25 This is likely why studies examining side effects comparing different appliance designs have found very little difference in terms of magnitude of these secondary effects of dental movement.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

Pliska

Nam

Chen

et al. 2014

Journal of Clinical Sleep Medicine

107

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However, some of these studies are limited by a relatively short observation period, considering that MAS treatment may continue indefi nitely through a patient's lifetime.Previous studies examining effects over at least a 5-year treatment period have shown signifi cant decreases in overbite (OB)-the vertical overlap of the anterior teeth, and overjet (OJ)-the horizontal overlap of the anterior teeth, ranging from 0.6-1.91 mm and 0.6-1.24 mm, respectively, after long-term appliance use. [16][17][18] These studies also report various BRIEF SUMMARYCurrent Knowledge/Study Rationale: Mandibular advancement splints are an effective treatment option for OSA patients, with changes to the dental occlusion as a common side effect. Due to the indefi nite nature of OSA treatment a clear understanding of the magnitude and progression of long-term occlusal changes is needed. Study Impact: With the longest observation period yet to be reported, the results from this study confi rm that long-term MAS treatment leads to signifi cant changes in occlusion for the majority of patients. These dental changes were found to be progressive in nature, and continue with ongoing MAS use.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

Pliska

Nam

Chen

et al. 2014

Journal of Clinical Sleep Medicine

107

View full text Add to dashboard Cite

show abstract

“…In a recent in vivo study [30] an almost linear relationship between recorded force and mandibular advancement was found, reaching up to 13.6 N. Forces in this order of magnitude may not only cause potentially irreversible changes of occlusion [30] but may also increase the risk of loss of retention of the MAD. Further research is needed to translate the in vitro forces measured in the present test into clinically relevant indicators and to determine the key design features of MADs explaining the differences in retention characteristics measured.…”

Section: Discussionmentioning

confidence: 99%

Retention of mandibular advancement devices in the treatment of obstructive sleep apnea: an in vitro pilot study

2013

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PurposeIn order for a mandibular advancement device (MAD) to be efficacious, it must remain seated on the teeth during sleep. Quantitative data on the retentive characteristics of MADs are currently unavailable. The present pilot study is the first to describe an in vitro setup testing the retentive characteristics of different monobloc MADs.MethodsA hydraulic cyclic test machine was used with MADs seated on dental casts to measure retention forces upon removal of the MADs. A custom-made monobloc (CM-mono), a thermoplastic monobloc (TP-mono), and a thermoplastic duobloc (TP-duo) configured as a monobloc were tested. Two protrusions were investigated, representing 25 and 65 % of the maximal protrusion. The effects of the type of MAD, duration of the test, and amount of protrusion on removal forces were measured.ResultsThe measured removal forces of all three MADs tested differed significantly, with the TP-duo showing the highest values (P < 0.0001). The effects of wear due to the repetitive cyclic loading became obvious by the production of wear particles in all MADs tested. However, only the TP-duo showed a significant reduction in time in removal forces for both protrusion positions (P < 0.0001; P = 0.0011). The effect of the amount of protrusion on the removal forces differed significantly between all three MADs tested (P = 0.0074).ConclusionsThis in vitro pilot study reveals significant differences in retention forces for the MADs tested. The findings are consistent with clinical effects of nightly loss of MADs as reported in the literature and are within the range of reported physiological mouth-opening forces. Future research is needed to determine the key design features of MADs that explain these differences.

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“…Cohen-Levy et al used a pressure transducer system with OA in OSA patients and measured forces created by progressive mandibular advancement for each step of 1 mm. They found that the mean force was 1.18 N/mm, which exhibited an almost linear evolution [21]. …”

Section: Discussionmentioning

confidence: 99%

Influence of Oral Appliances for Mandibular Advancement on Dentitions Using a Strain Gauge Analysis: A Pilot Study

et al. 2017

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Introduction. This study aimed to evaluate the influence of oral appliances (OAs) on dentition using a strain gauge analysis. Materials/Methods. Eight volunteers, who were mild snorers, participated in this study. OAs were individually constructed, and advancement was defined as two-thirds of the maximum mandibular advancement. Strain gauges were mounted on the right first molar and central incisor of both the upper and lower arches. After OA use, two measurement sessions (short- and long-term) were performed. Results. Compressive strain on the labial surface was significantly larger than the stretching strain on the lingual surface on U1. On L1, the stretching strain on the labial surface was significantly larger than the compressive strain on the lingual surface. Comparing the upper and lower teeth, the stretching strain was significantly greater on L1 than on U1 in both test sessions. Moreover, the stretching strain was significantly larger on U6 than on L6. Conclusion. OA side effects, such as forcing on the incisors, might be repeated every night. In this way, permanent occlusal changes, such as labial tipping of L1, may occur, followed by lingual tipping of U1 and buccal and lingual movements of the U6 and L6, respectively.

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Forces created by mandibular advancement devices in OSAS patients

Abstract: The force values recorded in this study may explain the occlusal and skeletal side effects associated with long-term use of these oral appliances. They illustrate the influence of the extent of mandibular advancement, and indicate a possible dose-dependent effect.

Cited by 47 publications

References 45 publications

Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

Retention of mandibular advancement devices in the treatment of obstructive sleep apnea: an in vitro pilot study

Influence of Oral Appliances for Mandibular Advancement on Dentitions Using a Strain Gauge Analysis: A Pilot Study

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