Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial

Idris, Ghassan; Galland, Barbara; Robertson, Christopher J.; Gray, Andrew; Farella, Mauro

doi:10.1016/j.jdent.2018.01.006

Cited by 21 publications

(15 citation statements)

References 55 publications

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“…The reactivation of this tool is relatively easy. 23 Research conducted by Idris et al, 2018 andBignotti et al, 2019 indicates that this device is an option for OSA therapy in children by reducing AHI. 13,15 Research conducted by Danut Rădescu et al, 2017 showed a negative correlation with the use of twin blocks.…”

Section: Discussionmentioning

confidence: 99%

Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases

Narmada¹,

Winoto

Hakim

2022

IJDM

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Background: Obstructive sleep apnea (OSA) is a breathing disorder that occurs during sleep and results in decreased or complete cessation of airflow despite attempts to breathe. Specific populations, such as children with certain craniofacial or other genetic syndromes and who are obese have a higher prevalence of OSA than the general population. Craniofacial abnormalities are one of the causes of OSA in the upper airway. Craniofacial morphologies that may predispose to OSA include retrognathia, anterior open bite, midface deficiency, and lower hyoid position. Therefore, interceptive orthodontic treatment in children is needed as one of the treatment options that can be chosen. Purpose: this study aimed to describe the interceptive orthodontic treatments and their effects on OSA cases in children. Review: Interceptive orthodontic treatment has various types depending on how the dentocraniofacial abnormality occurs. Orthodontic treatment aims to reduce the severity of OSA through maxillary and mandibular expansion, thereby increasing air space and airflow. Conclusion: Interceptive orthodontic treatment in pediatric OSA cases include; Rapid Maxillary Expansion, Twin-block, Propulsor Universal Light appliance, Planas appliance modified, Fränkel-II appliance, and BioAJustax oral appliance.

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Section: Discussionmentioning

confidence: 99%

Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases

Narmada¹,

Winoto

Hakim

2022

IJDM

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“…Compliance with twin-block appliance therapy for OSA treatment was good, as no patient abandoned the treatment except in Idris et al's study [ 21 ] where three patients abandoned the treatment. The high success rate in the included study might be because the subjects were selected from otherwise healthy OSA children with retrognathia mainly.…”

Section: Discussionmentioning

confidence: 99%

“…The amount of reduction would be considered clinically significant according to one of the common definitions of successful OSA treatment (a reduction of ≥50% in AHI) and another criterion for complete resolution of OSA symptoms (AHI reduction to less than one event/h) [ 28 , 29 ]. Except the study by Idris et al, [ 21 ] which reported successful OSA treatment and complete resolution of OSA symptoms, other studies did not report on these indicators. Thus, future studies should report the indicators of successful OSA treatment and complete resolution of OSA symptoms.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Twin-Block Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis

Duan

Xia

Yang

et al. 2022

BioMed Research International

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Objective. To evaluate the efficacy of twin-block appliance in the treatment of children with obstructive sleep apnea (OSA). Methods. Two independent reviewers conducted a systematic review of seven databases from database establishment until October 16, 2021. There were no language restrictions. The outcomes were changes in apnea-hypopnea index (AHI), oxyhemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (lowest SaO2). National Institute for Health and Clinical Excellence (NICE) tool was used to assess the quality of the studies included. Results. A total of 207 articles were screened for relevance, and 6 of them met the inclusion criteria for our meta-analysis. Four of the studies were case series, 1 was nonrandomized control trial, and 1 was a randomized crossover clinical trial. After twin-block therapy, there was a significant decrease in AHI (4.35 events/hour, 95% CI: 4.04, 4.66, p ≤ 0.001 ). The lowest SaO2 significantly increased by 9.17% (95% CI: 12.05, 6.28, p ≤ 0.001 ). Sensitivity analysis by excluding studies one by one showed stable and favorable results in lowest SaO2 and AHI. Conclusions. Results from the meta-analysis showed that the use of twin-block appliance significantly decreased AHI and significantly increased lowest SaO2. Hence, twin-block appliance therapy may be an effective method for the treatment of pediatric OSA. Further large sample size randomized controlled trials are needed to assess this treatment efficacy in children with obstructive sleep apnea.

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“…Nevertheless, in these studies, a significant reduction in the AHI index, but not complete OSA resolution, was observed after treatment in mild to moderate pediatric OSA cases. No differences in the oxygen desaturation index were reported when MARA appliances were compared to placebo appliances 53 or no treatment 54 . These appliances also seem to contribute to an improvement in the oral‐health related quality of life, and a decrease in OSA signs and symptoms, including a reduction of snoring, sleepiness, irritability, tiredness, and mouth breathing 7,52 …”

Section: Pediatric Osa Management In a Dental Officementioning

confidence: 99%

“…The inconsistent daily wearing time of the removable MARA appliances may influence the magnitude of OSA signs and symptoms to improve. The continuous use of fixed MARA appliances (24 h/day) may result in faster treatment and more significant improvement in the AHI index than an overnight protocol 53,54,57 . However, it is worth highlighting that intrinsic facial features, such as the malocclusion characteristics, may determine the desired wearing protocol for these appliances.…”

Section: Pediatric Osa Management In a Dental Officementioning

confidence: 99%

Pediatric obstructive sleep apnea—Dental professionals can play a crucial role

Fagundes

Flores-Mir

2021

Pediatric Pulmonology

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The significant contribution of dental professionals to the management of selected adult obstructive sleep apnea (OSA) cases is understood. Among children, it has also been suggested that dental professionals may also help screen and manage this morbidity in selected cases. It has also been noted that our understanding of pediatric OSA lags significantly behind adult OSA. During the screening process for potential pediatric OSA cases, dental professionals may be quite helpful as specific craniofacial abnormalities have been previously associated with pediatric OSA, including Class II malocclusion, vertical facial growth and maxillary transversal deficiency. As dental professionals assess children more frequently than physicians, they can help screen sleep‐disordered breathing signs and symptoms using validated questionnaires. In more advanced cases, orthodontists may be leading contributors to the management of selected cases where a craniofacial involvement is suspected. Rapid maxillary expansion and mandibular or maxillary anterior repositioning devices have been proposed as managing alternatives. So far, there is no substantial evidence if these approaches can be adopted to treat OSA fully or if the reported OSA signs and symptoms improvements observed in a selected group of patients are stable long‐term. Nevertheless, dentists and orthodontists' integration into a transdisciplinary team should be encouraged to play a significant role. This review discusses dentists or orthodontists' potential contribution to screen and manage selective pediatric OSA patients as part of a transdisciplinary team.

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Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial

Cited by 21 publications

References 55 publications

Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases

Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases

The Efficacy of Twin-Block Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis

Pediatric obstructive sleep apnea—Dental professionals can play a crucial role

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