Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review

Abstract

Introduction: Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. Objective: This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. Methods: An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. Results: A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. Conclusion: The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.

Obstructive sleep apnea in adults

“…The irreversible adverse effect that occurs in practically every individual who wear a MAD for a prolonged period of time is tooth movement. 26 , 27 The movements of the teeth tend to decrease the overjet and overbite of the patients (Figs 2C and 2D). This movement may even be positive in cases where the patient has a Class II dental relationship with excessive overbite.…”

Review of systematic reviews on mandibular advancement oral appliance for obstructive sleep apnea: The importance of long-term follow-up

“…Liu et al [3] did not describe the types of OA, and hence those SRs were excluded. Ultimately, 27 articles were included [1,[4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]]. Descriptions of the included SRs are shown in Table 1.…”

“…Breakdown of the content of the 27 SRs is as follows: there were 10 articles on comparison with other treatments [1,9,12,13,[18], [19], [20],22,24,27], five articles on the types of OAm [5,6,14,16,21], and six articles on the effect of OAm and the associated side effects [4,8,23,26,28,29]. There were also three articles on predicting the therapeutic effect of OAm [10,11,15], two articles on changes in the upper respiratory tract caused by this therapy [7,25], and one article on a remotely controlled mandibular positioner [17].…”

“…There has been an increase in the number of studies with longer study periods. An SR on long-term side effects has recently been published [26,28,29]. There were differences in the number of studies included in the three SRs.…”

“…There were differences in the number of studies included in the three SRs. The reason for this is that Martins et al [28] included RCTs only. There were differences in the studies included by Araie et al [26] and Bartolucci et al [29] because of the search date, and Bartolucci et al [29] only targeted studies where OAm was used for two or more years.…”