Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions

Abstract

BackgroundPatients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long‐term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users.MethodsA comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB‐2 was used to evaluate the methodological quality of the included studies.ResultsA total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ‐related parameters from baseline to follow‐up intervals. Temporary increases in TMJ‐related pain or symptoms at the beginning of the follow‐up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs.ConclusionThe findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ‐related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.

Assessment of Cephalometric Parameters and Correlation With the Severity of the Obstructive Sleep Apnea Syndrome

“…The diagnosis of OSAS is established through cardiorespiratory monitoring and polysomnography [4]. Although some concerns exist [5], OSAS is classi ed for severity on the apnea-hypopnea index (AHI) as mild (AHI: 5-15), moderate (AHI: [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], or severe (AHI > 30) [6].…”

“…Maxillofacial surgery has proven to be quite effective [13]. I fact, OSAS patients are characterized by facial alterations that may bene t of surgical approaches, including improvements in associated symptoms like mandibular and cervical pain and bruxism [17][18]. Therefore, the treatment of OSA requires a holistic and multidisciplinary approach.…”

“…Cephalometric evaluation has been used to determine the typical facial shape of OSAS patients [20]. The cervical, hyoid, and mandibular positions may affect the severity of OSAS [21,[17][18]. Little is known about the use of the stabilizing platform used in OSAS, and it has not been widely applied [22][23][24].…”

Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome

“…Maxillofacial surgery has proven to be quite effective [ 13 ]. In fact, OSAS patients are characterized by facial alterations that may benefit of surgical approaches, including improvements in associated symptoms like mandibular and cervical pain and bruxism [ 17 , 18 ]. Therefore, the treatment of OSAS requires a holistic and multidisciplinary approach.…”

“…Cephalometric evaluation has been used to determine the typical facial shape of OSAS patients [ 20 ]. The cervical, hyoid, and mandibular positions may affect the severity of OSAS [ 17 , 18 , 21 ]. Little is known about the use of the stabilizing platform used in OSAS, and it has not been widely applied [ 22 – 24 ].…”