Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation

Giannasi, Lílian Chrystiane; Almeida, Fernanda R.; Magini, Marcio; Costa, Maricília Silva; Oliveira, Cláudia Santos; Oliveira, Júlio César Mendes de; Bussadori, Sandra Kalil; Oliveira, Luís Vicente Franco de

doi:10.1007/s11325-009-0257-3

Cited by 42 publications

(50 citation statements)

References 32 publications

(54 reference statements)

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“…46,91,103,107 However, in an MRI study, translation of the condyle with OA therapy was equal or less than that observed with maximum jaw opening with no significant TMJ morphological alterations observed. 91 Nonetheless, when compared with CPAP therapy, more subjects were found to experience TMD related pain in the initial stages of treatment.…”

Section: Temporomandibular Disordersmentioning

confidence: 83%

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Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

et al. 2013

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The purpose of this review is to provide guidelines for the use of oral appliances (OAs) for the treatment of snoring and obstructive sleep apnoea (OSA) in Australia. A review of the scientific literature up to June 2012 regarding the clinical use of OAs in the treatment of snoring and OSA was undertaken by a dental and medical sleep specialists team consisting of respiratory sleep physicians, an otolaryngologist, orthodontist, oral and maxillofacial surgeon and an oral medicine specialist. The recommendations are based on the most recent evidence from studies obtained from peer reviewed literature. Oral appliances can be an effective therapeutic option for the treatment of snoring and OSA across a broad range of disease severity. However, the response to therapy is variable. While a significant proportion of subjects have a near complete control of the apnoea and snoring when using an OA, a significant proportion do not respond, and others show a partial response. Measurements of baseline and treatment success should ideally be undertaken. A coordinated team approach between medical practitioner and dentist should be fostered to enhance treatment outcomes. Ongoing patient follow-up to monitor treatment efficacy, OA comfort and side effects are cardinal to long-term treatment success and OA compliance.Keywords: Mandibular advancement splint, obstructive sleep apnoea, oral appliance, review, snoring.Abbreviations and acronyms: AASM = American Academy of Sleep Medicine; ADA = Australian Dental Association; AHI = apnoeahypopnoea index; ASA = Australasian Sleep Association; BMI = body mass index; CBCT = cone beam computed tomography; CT = computed tomography; ESS = Epworth Sleepiness Scale; MAS = mandibular advancement splints; OA = oral appliances; OSA = obstructive sleep apnoea; PSG = polysomnogram; SDB = sleep disordered breathing; TMD = temporomandibular disorder; TMJ = temporomandibular joint; TRD = tongue retaining device; TSD = tongue stabilizing device; UARS = upper airway resistance syndrome; UPPP = uvulopalatopharyngoplasty.

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Section: Temporomandibular Disordersmentioning

confidence: 83%

“…102 Overall, there appears to be a decrease in intensity of TMD pain with continued OA use. 90,100,102,106,107 To date, only two studies have addressed the issue of TMD related pain and occlusal function associated with OA use. 108,109 Both these studies advocated the use of mandibular jaw exercises to manage side effects.…”

Section: Temporomandibular Disordersmentioning

confidence: 99%

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

et al. 2013

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“…However, most studies reported that these adverse symptoms that appear in the initial phase of treatment are transient in a large number of affected patients, and there appears to be a trend of symptoms to decrease over time in the majority of patients. One study reported an improvement in TMD signs and symptoms in some patients undergoing MAD therapy for OSA (Giannasi et al, 2009). In another study, the prevalence of orofacial pain increased with the use of MAD; however this study was based on a single question broad questionnaire and hence the results should be interpreted with caution (Vuorjoki-Ranta, 2014).…”

Section: Discussionmentioning

confidence: 95%

“…Two different devices were used: the Monobloc and the Herbst. Giannasi et al, 2009 Treatment adherence could not be objectively verified. Patients reported wearing the appliance at least 4 nights a week.…”

Section: 5%mentioning

confidence: 99%

Temporomandibular Disorders in Patients Undergoing Mandibular Advancement Device Therapy for Obstructive Sleep Apnea: A Systematic Review

Nguyen¹,

Balasubramaniam²

2016

AJOM

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Background: Mandibular advancement device (MAD) therapy is a popular and effective treatment for snoring and obstructive sleep apnea (OSA). However, there have been several reports in the literature of patients developing temporomandibular disorders (TMDs). Objective:The objective of this review is to evaluate the prevalence of TMD, both in the initial phase of therapy and at follow up appointments, amongst patients wearing a MAD for OSA. Methods:The authors conducted a systematic review of published articles in which the presence of TMDs in patients undergoing MAD therapy for OSA was investigated. Eligible studies met the following criteria: a diagnosis of TMD following mandibular advancement using a custom-made and titratable MAD using either the Diagnostic Criteria for TMD (DC/TMD), Helkimo Anamnestic Dysfunction Index or reproducible clinical signs/symptoms. Of the thirty-six articles published in this area, eleven were included in this review. These were assessed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results:The average prevalence of TMD during the initial phase of MAD therapy was found to be 25%. The prevalence of TMD reduced in the follow up periods. The adherence to MAD, especially long term, appears to be variable and from our results, it appears an average of 20% of patients discontinue MAD therapy over six to one hundred and twenty months, and this number has been reported to be as high as 62.5% (over 58 months). Conclusions:There was some difficulty in comparing the studies due to the differences in follow up time, methodology, sample size and diagnostic criteria. Longer clinical follow-up studies, with an objective method of monitoring patient adherence such as home monitoring devices, and preferably with a larger sample size Amanda Phoon Nguyen and Ramesh Balasubramaniam / American Journal of Oral Medicine (2016) Vol. 2 No. 1 pp. 26-42 27 are needed to evaluate the long-term effects of MADs on the TMD. The authors consider it prudent for clinicians to counsel patients that a small number will experience signs and symptoms of TMD with MAD use. However TMD is usually transient and the long-term risk appears small. In patients who develop TMD during MAD therapy, treatment of their TMD is recommended to prevent discontinuation of MAD therapy. In a few patients, persistent TMD may result in discontinuation of MAD therapy. Patients should be cautioned of this possibility and subsequently referred to consider other treatment options for their OSA.

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“…En otra publicación de series de casos de Giannasi et al (2009), se usó el método diagnóstico de Helkimo (Anamnestic Dysfunction Index) y se concluyó que el uso a largo plazo de DAM para pacientes con bruxismo y SHAOS no agravan los síntomas de TTMS, por el contrario, los alivió en los casos que los pacientes presentaban TTMs moderados.…”

Section: Discussionunclassified

Repercusiones del uso de Dispositivos de Avance Mandibular como Terapia para el Síndrome de Apnea Obstructiva del Sueño en el Complejo Temporomandibular. Revisión Narrativa

Valenzuela-Chaigneau

Field-Seisdedos

Ugarte-Sánchez

et al. 2018

Int. J. Odontostomat.

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A. B. Repercusiones del uso de dispositivos de avance mandibular como terapia para el síndrome de apnea obstructiva del sueño en el complejo temporomandibular. Revisión narrativa. Int. J. Odontostomat., 12(1):7-14, 2018. RESUMEN:El objetivo de este trabajo fue escribir, según la literatura científica disponible más actual, los efectos que inducen el uso de dispositivos de avance mandibular, como terapia para el SAHOS, en el sistema temporomandibular de los pacientes. Se realizó una revisión de la literatura más actual (últimos 10 años; 2006-2016) a partir de la búsqueda electrónica en las bases de datos PubMed, TripData Base, Epistemonikos, The Cochrane Library y las revistas especializadas Journal of Clinical Sleep Medicine y SLEEP. Con el uso de las palabras clave: "Mandibular advancement device", "orthodonthic appliances", "sleep apnea syndroms", "sleep apnea obstructive", "Temporomandibular joints disorder", los operadores booleanos AND y OR. Se realizó un análisis crítico de la literatura evaluando nivel de evidencia, grado de recomendación y riesgo de sesgo de cada publicación. La búsqueda en las distintas bases de datos arrojó un total de 242 documentos, de los cuales 60 fueron seleccionados por título y abstract. Luego 8 estudios fueron descartados por estar repetidos. Se aplicaron los criterios de inclusión y exclusión quedando un total de 20 artículos; se eliminaron 8 por no responder a la pregunta de investigación y se añadió 1 título mediante la búsqueda manual. Finalmente, se analizaron 13 artículos; 2 revisiones sistemáticas, 2 ensayos clínicos aleatorizados y 6 series de casos. La mayoría de los documentos incluidos concuerda en que los efectos inducidos por los DAM, sobre el complejo temporomandibular son mínimos y reversibles, sin explicitar ningún diagnóstico de TTM en particular. Sin embargo, esta evidencia viene en su mayoría de estudios recomendables, pero no concluyentes. Se necesitan más y mejores estudios para realizar un análisis y abstraer conclusiones más certeras. Estos deben ser homogéneos a la hora de clasificar TTM y definir un protocolo óptimo de avance mandibular.PALABRAS CLAVE: dispositivo de avance mandibular,aparatos ortodóncicos, síndrome de apnea durante el sueñom apnea del sueño obstructiva, trastornos de las articulaciones temporomandibulares. INTRODUCCIÓNEl síndrome de apnea/hipoapnea obstructiva del sueño (SAHOS) es un desorden respiratorio del sueño caracterizado por la sucesión de múltiples eventos en dónde existe cese o disminución del flujo aéreo durante el sueño, con persistencia de esfuerzo ventilatorio (Quan & Gillin, 1999). Se caracteriza por ronquidos a repetición, pausas respiratorias, y aumento del esfuerzo respiratorio, asociado a múltiples microdespertares en el transcurso del sueño.Anatómicamente, se explica por un colapso de las vías aéreas superiores durante el sueño, que puede suceder distintos niveles, comprometiendo diferentes estructuras (Lee-Chiong, 2006). Su prevalencia, en la población adulta, se distingue por sexo, afectando a un 2 % de las mujere...

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Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation

Cited by 42 publications

References 32 publications

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

Temporomandibular Disorders in Patients Undergoing Mandibular Advancement Device Therapy for Obstructive Sleep Apnea: A Systematic Review

Repercusiones del uso de Dispositivos de Avance Mandibular como Terapia para el Síndrome de Apnea Obstructiva del Sueño en el Complejo Temporomandibular. Revisión Narrativa

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