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

Sato, Kazumichi; Nakajima, Tsuneya

doi:10.1016/j.jdsr.2019.10.002

Cited by 16 publications

(7 citation statements)

References 41 publications

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“…No obstante lo anterior, muchos profesionales desconocen los efectos adversos que éstos pueden tener en la oclusión. Los efectos son progresivos y significativos, observándose una mayor proinclinación de incisivos inferiores, reducción del overjet y overbite, mordida abierta posterior, y posible desarrollo de mordida invertida (41,42) . Estos efectos justifican una supervisión ortodóncica con controles al menos cada 6 meses, siendo el ortodoncista el profesional idóneo para ello (15) .…”

Section: Discussionunclassified

Apnea Obstructiva del Sueño y el Rol del Ortodoncista. Revisión bibliográfica.

Alvarado

Oyonarte

2021

Int. j interdiscip. dent.

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Introducción: La apnea obstructiva del sueño es un trastorno crónico, altamente prevalente, asociada a secuelas cardiovasculares y neurocognitivas, que afectan gravemente la calidad de vida de los individuos que la padecen. En aquel contexto, tanto el odontólogo general, como especialista, tienen un rol importante en el screening y potencial tratamiento interdisciplinario de esta patología. Revisión de la literatura actual: Se describen las causas y las secuelas asociadas a este trastorno, junto con los métodos de screening inicial que sirven para una derivación oportuna. Además, se plantean las alternativas de tratamiento y la evidencia actual disponible sobre sus efectos terapéuticos. Discusión y conclusión: Por ser la apnea obstructiva del sueño una patología compleja y de origen multifactorial, se aborda con un equipo interdisciplinario para determinar la mejor estrategia de tratamiento de acuerdo a las características de cada paciente, y entendiendo las repercusiones que cada terapia conlleva. En Ortodoncia, existen controversias respecto del efecto de los tratamientos con extracciones de premolares sobre las dimensiones de la vía aérea superior, donde es relevante analizar críticamente la evidencia científica disponible al respecto, y con ello, asegurar estrategias óptimas de tratamiento en la práctica clínica.

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Section: Discussionunclassified

Apnea Obstructiva del Sueño y el Rol del Ortodoncista. Revisión bibliográfica.

Alvarado

Oyonarte

2021

Int. j interdiscip. dent.

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“…Possible reasons for these inconsistent results might include open labelling, lack of randomization, selection of the appliance being determined by resource availability (in the retrospective study by Lettieri et al [5]), and variations in the duration of follow-up. In a review of systematic reviews of bibloc versus monobloc appliances, Sato and Nakajima [12] reported a high degree of heterogeneity between study results, which precluded a valid meta-analysis. When the results of our 1-year study are compared with those of the preceding 8-week follow-up of the same sample of patients [8], one must also include time factors when interpreting outcomes.…”

Section: Discussionmentioning

confidence: 99%

Respiratory outcomes after a 1-year treatment of obstructive sleep apnoea with bibloc versus monobloc oral appliances: a multicentre, randomized equivalence trial

Tegelberg

Nohlert

Bornefalk-Hermansson

et al. 2020

Acta Odontologica Scandinavica

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Objective: The benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that these types of appliances would be equally effective. Material and methods: In this multicentre, randomized equivalence trial, patients with OSA received one type of bibloc or one type of monobloc treatment. At baseline, a 1-night polygraphy study was done, and this was repeated after 1 year. The outcome was any change in the apnoea-hypopnoea index (AHI) and the limits of equivalence between the two devices were set at ±5 AHI units. Results: Of 302 patients, 146 were randomly assigned to bibloc and 156 to monobloc appliances. In 88 and 104 patients, respectively, there were significant reductions in the AHI (p < .001) with a mean change of À16.7 (95% CI À19.4 to À14.1) in the bibloc and À11.8 (À14.9 to À8.7) in the monobloc groups. The proportions of responders defined as having an AHI <10 were 68% and 65% for the bibloc and monobloc groups, respectively. Treatment-related adverse events were mild, transient and the dropouts were more frequent in the bibloc group. Conclusions: Both types of treatments positively and significantly reduced respiratory disturbances, but at the 1-year follow-up, they were not significantly different in treating OSA, with a numerically greater reduction of the AHI value with the bibloc appliance. However, the higher proportion of treatment-related adverse events and higher proportion of dropouts among bibloc users should be balanced against the advantage of a greater reduction in the AHI.

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“…39 There is a significant positive correlation between oropharyngeal airway volume and mandibular length. 23,40 Increase in mandibular length by functional appliances has been demonstrated by Baccetti et al 41 and Marsico et al 42 A study evaluating the effects of skeletally anchored Forsus fatigue-resistant device (FFRD) and Herbst appliance reported a significant increase in the lower pharyngeal dimension with the former. 43 Celikoglu reported significantly increased oropharyngeal area measurements with both Herbst appliance and skeletally anchored Forsus FRD.…”

Section: Role Of Functional Appliances In Sdbmentioning

confidence: 92%

“…Oral appliance therapy during adulthood has clear dental and skeletal side effects with long-term use. 23 Therefore, if the identification of high-risk individuals is made early, it will serve a dual purpose i.e. enlargement of upper airway space along with addressing the malocclusion, facial dysmorphism, trauma to protruding incisors, and so on.…”

mentioning

confidence: 99%

Late upper airway constriction and its prevention by interceptive functional appliance therapy- A review

2021

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Introduction: Sleep-disordered breathing (SDB) is one of the poorly diagnosed disorders which affects the quality of life of patients. The SDB is a spectrum of problems ranging from simple snoring to obstructive sleep apnoea (OSA) which involves complete collapse of the pharyngeal airway passage during sleep resulting in airflow cessation and consequent arousals. A noteworthy etiological factor of OSA is mandibular retrognathism. Imaging studies on craniofacial structures in OSA patients have shown decreased oropharyngeal and hypopharyngeal depth, elongated soft palate, altered tongue posture, and increased hyoid bone-to-mandible distance. The management modalities of OSA are positive airway pressure (PAP) and oral appliance therapy. The modus operandi of mandibular advancement devices (MADs) is the same as of myofunctional therapy instituted by orthodontists for the treatment of skeletal Class II malocclusions with mandibular retrusion in growing patients. By virtue of the increase in the mandibular length and advancement in mandibular position, pharyngeal airway space is enlarged along with favorable changes in the soft palate, tongue posture, and hyoid bone position. The focus of the present review is to consolidate the available literature on the long-term effects of functional appliance treatment. It is hypothesized that interceptive functional appliance therapy in the growing stage could be a viable strategy for the prevention of OSA development during adulthood. The review also highlights the importance of the need for more studies emphasizing the long-term impact of functional treatment to establish the role of the same in reducing the OSA treatment burden during adulthood.

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

Cited by 16 publications

References 41 publications

Apnea Obstructiva del Sueño y el Rol del Ortodoncista. Revisión bibliográfica.

Apnea Obstructiva del Sueño y el Rol del Ortodoncista. Revisión bibliográfica.

Respiratory outcomes after a 1-year treatment of obstructive sleep apnoea with bibloc versus monobloc oral appliances: a multicentre, randomized equivalence trial

Late upper airway constriction and its prevention by interceptive functional appliance therapy- A review

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