The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

Sakamoto, Yuki; Furuhashi, Akifumi; Komori, Eri; Ishiyama, Hiroyuki; Hasebe, Daichi; Sato, Kazumichi; Yuasa, Hidemichi

doi:10.3390/ijerph16183248

Cited by 12 publications

(17 citation statements)

References 16 publications

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“…Few other studies which supported our results were the systematic reviews by Kannan et al [24] and Sakamoto et al [25], who found significant increase in pharyngeal airway dimensions with the use of functional appliances.…”

Section: Discussionsupporting

confidence: 88%

Airway changes in patients with sleep apnea using AdvanSync2 Class II correctors – a case series

Keerthana

Negi

Chitra

2021

Medicine and Pharmacy Reports

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Background. Obstructive sleep apnea (OSA) is a condition that affects a patient’s ability to sleep normally, predisposing them to many risks and reduced quality of life. Myofunctional therapy has been proven to increase the airway space according to literature. Aim. To report the effects of AdvanSync2 Class II corrector in the management of 3 orthodontic patients who reported sleeping difficulties due to breathing problems and retrognathic mandible. Case presentation. Three patients reported to Department of Orthodontics and Dentofacial Orthopaedics with Class II malocclusion associated with sleep apnea requiring treatment. Clinical examination revealed a retrognathic mandible with airway constriction in all subjects. A non-extraction approach using an AdvanSync2 Class II corrector (Ormco Corp, Glendora, Calif) with fixed appliances was considered. Lateral cephalometric records were obtained at three stages: pre-treatment, post functional and prefinishing/post treatment. The airway was divided into 3 parts in the lateral cephalogram: velopharynx, hypopharynx and glossopharynx. The most constricted part of the airway was noted. Pre and post treatment lateral cephalograms were compared to assess the changes in airway dimensions after using AdvanSync2. Significant enhancement in airway dimensions was noted in all three parts (velopharynx, glossopharynx and hypopharynx) in all patients. Conclusion. Airway assessment is an important aspect in orthodontic diagnosis. Use of the AdvanSync2 Class II corrector in combination with fixed orthodontic appliances enhanced quality of life in Class II patients by improving airway dimensions. This approach can be recommended in the management of mild to moderate Class II malocclusions associated with mandibular retrognathism and airway constriction.

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Section: Discussionsupporting

confidence: 88%

Airway changes in patients with sleep apnea using AdvanSync2 Class II correctors – a case series

Keerthana

Negi

Chitra

2021

Medicine and Pharmacy Reports

View full text Add to dashboard Cite

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“…In the study by Ringvist et al that used the appliance that provided only posterior occlusal coverage and protruded the mandible, only 50% showed no change in overjet and overbite. On the other hand, a systematic review and meta-analysis found no significant difference between the side effects caused by 50% and 75% of maximum protrusion [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Dental and Skeletal Side Effects of Oral Appliances Used for the Treatment of Obstructive Sleep Apnea and Snoring in Adult Patients—A Systematic Review and Meta-Analysis

Tsolakis

Palomo

Matthaios

et al. 2022

JPM

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Background: Mandibular advancement devices for obstructive sleep apnea treatment are becoming increasingly popular among patients who do not prefer CPAP devices or surgery. Our study aims to evaluate the literature regarding potential dental and skeletal side effects caused by mandibular advancement appliances used for adult OSA treatment. Methods: Electronic databases were searched for published and unpublished literature along with the reference lists of the eligible studies. Randomized clinical trials and non-randomized trials assessing dental and skeletal changes by comparing cephalometric radiographs were selected. Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Fourteen articles were finally selected (two randomized clinical trials and 12 non-randomized trials). Results: The results suggest that mandibular advancement devices used for OSA treatment increase the lower incisor proclination by 1.54 ± 0.16°, decrease overjet by 0.89 ± 0.04 mm and overbite by 0.68 ± 0.04 mm, rotate the mandible downward and forward, and increase the SNA angle by to 0.06 ± 0.03°. The meta-analysis revealed high statistical heterogeneity. Conclusions: The MADs affect the lower incisor proclination, overjet, overbite, the rotation of the mandible and the SNA angle. More randomized clinical trials providing high-quality evidence are needed to support those findings.

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“…The AP protocol aims for individualisation of OA treatment. Standard protocol OA treatment suggests ‘maximal comfortable protrusion’, which often results in 50%‐80% of maximal protrusive range as the target OA position for optimal treatment effect 40,41 . A systematic review investigating clinical practice in OA titration found that all included studies describing percentage of maximal protrusion reported a mean protrusion exceeding 85% 10 .…”

Section: Discussionmentioning

confidence: 99%

Acoustic pharyngometry ‐ A new method to facilitate oral appliance therapy

Opsahl

Berge

Lehmann

et al. 2020

J of Oral Rehabilitation

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Background There is lack of reliable and accurate methods to predict treatment outcomes of oral appliance (OA) treatment. Acoustic pharyngometry (AP) is a non‐invasive technique to evaluate the volume and minimal cross‐sectional area of the upper airway, which may prove useful to locate the optimal position of OAs. Objective This retrospective study aimed to evaluate the effect of applying AP to OA treatment of patients with obstructive sleep apnoea (OSA). Methods All patients (n = 244) treated with OAs following an AP protocol at two dental clinics between 2013 and 2018 were invited to participate. A total of 129 patients accepted the invitation, and 120 patients (75 men, 45 women) were included in the analyses. Mean baseline age, BMI and apnoea hypopnea index (AHI) were 59.1 ± 0.9 years, 27.8 ± 0.4 and 21.9 ± 1.1, respectively. Mean follow‐up time was 318 ± 24 days. Results AHI at follow‐up was 6.4 ± 0.7, resulting in a treatment success rate of 86.7% (≥50% reduction of baseline AHI). The number of failures (<50% reduction of baseline AHI) did not differ significantly among patients with mild, moderate and severe OSA. 87.6% of the patients reported OA usage every night, and 95.5% reported > 5 hours usage per night, when worn. Conclusion The AP protocol applied seems to contribute to the excellent effect of OA treatment in this study. Further research on the application of AP in OA treatment is necessary in order to clarify its possible beneficial contribution to improving OA therapy.

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The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

Cited by 12 publications

References 16 publications

Airway changes in patients with sleep apnea using AdvanSync2 Class II correctors – a case series

Airway changes in patients with sleep apnea using AdvanSync2 Class II correctors – a case series

Dental and Skeletal Side Effects of Oral Appliances Used for the Treatment of Obstructive Sleep Apnea and Snoring in Adult Patients—A Systematic Review and Meta-Analysis

Acoustic pharyngometry ‐ A new method to facilitate oral appliance therapy

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