The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis

Bartolucci, Maria Lavinia; Bortolotti, Francesco; Raffaelli, Eugenia; D’Antò, Vincenzo; Michelotti, Ambrosina; Bonetti, Giulio Alessandri

doi:10.1007/s11325-015-1307-7

Cited by 74 publications

(83 citation statements)

References 46 publications

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“…MAD showed their efficacy in a number of studies [19], [20], [21], [22] but there are few specialists who are able to manage this therapeutic alternative. For this reason, there is not enough clinical evidence about their results in several populations [23].…”

Section: Introductionmentioning

confidence: 99%

Decrease of respiratory events in patients with obstructive sleep apnea-hypopnea syndrome using a mandibular advancement device assessed with split night polysomnography

et al. 2016

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IntroductionMandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients.ObjectiveThe aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP)MethodWe performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results.ResultsSNP show significant changes with use of MAD (p<0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points).ConclusionOur data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.

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Section: Introductionmentioning

confidence: 99%

Decrease of respiratory events in patients with obstructive sleep apnea-hypopnea syndrome using a mandibular advancement device assessed with split night polysomnography

et al. 2016

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“…5,15 Indeed, the advancement of the device is generally expressed in terms of percentage of the range of mandibular advancement rather than in millimetres. 5,15 Indeed, the advancement of the device is generally expressed in terms of percentage of the range of mandibular advancement rather than in millimetres.…”

Section: Discussionmentioning

confidence: 99%

“…Range of mandibular advancement varies greatly among individual subjects, and it is a key feature in MAD construction. 5,15 Indeed, the advancement of the device is generally expressed in terms of percentage of the range of mandibular advancement rather than in millimetres. Clark et al recommended that MADs should be constructed to position the mandible forward by 75% of the maximum range of protrusion.…”

Section: Discussionmentioning

confidence: 99%

Maximum voluntary retrusion or habitual bite position for mandibular advancement assessment in the treatment of obstructive sleep apnoea patients

Ippolito

Stipa

Cameli

et al. 2019

J of Oral Rehabilitation

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Background:There is no consensus on whether the range of mandibular advancement for the construction of mandibular advancement devices in obstructive sleep apnoea (OSA) patients should be measured from a starting position of maximum voluntary retrusion or habitual bite position.Objective: The purposes of this study were to investigate the differences in mandibular advancement registrations starting from maximum voluntary retrusion or from habitual bite position and to evaluate the reliability of these assessments. Methods:A retrospective cohort analysis of 126 patients with OSA was performed.All patients had their mandibular range of motion evaluated twice (starting from maximum voluntary retrusion and from habitual bite position) through the George Gauge before undergoing drug-induced sleep endoscopy. The Dahlberg formula and paired t test were used to calculate random and systematic errors of dental positions assessment. Test-retest reliability was quantified using the intra-class correlation coefficient (ICC). Results:The mean mandibular range starting from maximum voluntary retrusion and from habitual bite position were 12.49 ± 2.19 mm and 7.68 ± 2.29 mm, respectively, with a mean distance between the two starting positions of 4.81 ± 1.75 mm. No systematic error was found (P > .05), and random errors ranged from 0.30 to 0.95 mm. ICC values were excellent for maximum voluntary protrusion (ICC = 0.986) and maximum voluntary retrusion (ICC = 0.956), whereas habitual bite position showed a good value (ICC = 0.818). Conclusion: The difference between maximum voluntary retrusion and habitual bite position is potentially relevant. Maximum retrusion is advisable as starting point of the mandibular advancement registration since it provides a more reliable measure. K E Y W O R D S habitual bite, mandibular advancement device, mandibular range of motion, mandibular retruded position, obstructive sleep apnoea, reliability

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“…En ella se sugiere que los DAM, al forzar la mandíbula a una posición anterior, elongan las fibras de los músculos elevadores y el ligamento temporomandibular causando tensión en ellos y en los tejidos retrodiscales, produciendo dolor en las estructuras temporo-mandibulares (Bartolucci et al, 2016). Otra revisión clasificó las complicaciones en dos grupos, uno donde eran menores, transitorias y otro, donde eran más severas y permanentes.…”

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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The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis

Abstract: The AHI improvement resulted to be not proportional to the mandibular advancement increase. It is plausible that the success of the therapy is influenced by a combination of variables that need closer study.

Cited by 74 publications

References 46 publications

Decrease of respiratory events in patients with obstructive sleep apnea-hypopnea syndrome using a mandibular advancement device assessed with split night polysomnography

Decrease of respiratory events in patients with obstructive sleep apnea-hypopnea syndrome using a mandibular advancement device assessed with split night polysomnography

Maximum voluntary retrusion or habitual bite position for mandibular advancement assessment in the treatment of obstructive sleep apnoea patients

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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