Prospective Assessment of Maximum Protrusion in Patients Wearing a Mandibular Advancement Device

Abstract

Study Objectives: Obstructive sleep apnea (OSA) is a sleep-related disorder with high prevalence in our society. The gold standard for the treatment of sleep apnea is continuous positive airway pressure (CPAP). Given the low adherence rate of patients on CPAP treatment, interest has turned toward dental appliances, commonly called mandibular advancement devices (MAD). The aim of this study was to determine whether patients' maximum protrusion could be increased after wearing a MAD for 3 months, such that patients with weak protrusion (who could at first be withdrawn from treatment) could be eligible for this treatment. Methods:The experimental group included 30 patients in whom OSA was diagnosed by polysomnography. Patients were matched with 30 healthy control patients without OSA. The experimental group wore a MAD for 90 days whereas the control group received no treatment. Both groups underwent two assessments of mandibular borderline movements (protrusion, maximum opening, and left and right lateral movement) at baseline and after 90 days with computerized mandibular scanning.Results: Results showed that wearing the MAD did not cause greater changes in mandibular movements compared to controls. However, in the MAD group, maximum opening decreased, lateral movement increased, and maximum protrusion increased. Patients with weak maximum protrusion at baseline showed increased maximum protrusion.Conclusions: Further studies are needed to assess changes in maximum protrusion in patients with weak maximum protrusion. Nevertheless, the findings provide a deeper understanding of the effects of MAD wear on jaw movements, and indicate the potential of the MAD as an effective therapy for patients with maximum protrusion less than 5 mm.

Effect of mandibular advancement device on the stomatognathic system in patients with mild‐to‐moderate obstructive sleep apnoea‐hypopnoea syndrome

“…A study determining the pressure pain thresholds (PPTs) of masticatory and neck muscles change after the application of MAD in patients with OSA showed no significant difference in the physiological functions of the masticatory muscle and neck muscles after 6 months of MAD treatment 40 . Similar to our study findings, another study also reported no greater changes in mandibular movements compared to control group after wearing MAD 41 . However, in our study changes in mandibular movement were evaluated using EMG.…”

Antero-Posterior Mandibular Excursion in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Device: A Retrospective Cohort Study

“…Although the titration procedure relies on the capacity of antero-posterior mandibular excursion, few studies have investigated the potential changes in the antero-posterior mandibular movement due to MAD therapy with conflicting outcomes [ 17 , 18 , 19 , 20 , 21 , 22 ]. No difference in mandibular protrusion capacity was found at the 2-year follow-up in a prospective cohort study investigating the craniomandibular status and function in patients with habitual snoring and OSA after nocturnal treatment with the MAD [ 17 ].…”

“…The majority of previous studies have not consistently indicated the method of mandibular protrusion measurement [ 17 , 18 , 19 , 20 , 21 , 22 ]. The study by Tegelberg et al [ 21 ] reported that the mandibular range of motion was measured with a steel ruler to the nearest millimeter.…”

“…There is still considerable variation across studies on the recommended initial mandibular position, but the subsequent titration allows one to determine for each patient the minimal protrusion needed to achieve the highest reduction in the AHI while reducing patient discomfort and potential side effects [ 14 , 15 , 16 ]. Most of the previous studies analyzing the change in the range of antero-posterior mandibular excursion during treatment with the MAD did not indicate the method of excursion measurement, failed to indicate whether the maximal voluntary retrusion or the habitual bite position were used as posterior references and, also, used unreliable dental reference points [ 17 , 18 , 19 , 20 , 21 , 22 ].…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…Another study explored whether patients' maximum protrusion could be increased after wearing a MAD for 3 months, such that individuals with weak protrusion (who could at first be ineligible for effective treatment) could become candidates for the therapy. 299 The treatment group consisted of 30 patients with PSG-diagnosed OSA; 30 healthy participants without OSA were matched controls. MAD was worn for 90 days while the control group received no treatment.…”