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Mandibular Advancement Appliance

Sylvan S Mintz, Reka Kovacs
PURPOSE: In 2005, the American Academy of Sleep Medicine stated, "Oral appliances are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA) who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP." However, this recommendation is based upon variable results from only six studies with more than 100 participants. These studies have assessed the effectiveness of mandibular advancement devices (MADs) in specific groups (military populations, academic institutions, or hospital settings) with no large study conducted in a fee-for-service private practice where the majority of patients receive MADs for OSA...
March 8, 2018: Sleep & Breathing, Schlaf & Atmung
Gero Stefan Michael Kinzinger, Jan Hourfar, Cornelia Kober, Jörg Alexander Lisson
OBJECTIVE: During therapy of distoclusion entailing a rigid, fixed orthodontic appliance, the mandibular fossa and condyle are ideally remodeled, while dentoalveolar effects occur through adaptive mechanisms. Adaptive processes, especially in the fossa region, have not been adequately investigated. Our magnetic resonance imaging (MRI) investigation aimed to assess the effects of therapy with a functional mandibular advancer (FMA) on mandibular fossa morphology. PATIENTS AND METHODS: We monitored via MRI the therapeutic course of 25 patients at three time points...
February 20, 2018: Journal of Orofacial Orthopedics, Fortschritte der Kieferorthopädie
Shadi Basyuni, Michal Barabas, Tim Quinnell
Continuous positive airway pressure (CPAP) remains the gold standard treatment for obstructive sleep apnoea hypopnoea syndrome (OSAHS). However, the high efficacy of CPAP is offset by intolerance and poor compliance, which can undermine effectiveness. This means that alternatives to CPAP are also necessary. In recent years, oral appliances have emerged as the leading alternative to CPAP. There is now a strong body of evidence supporting their use in OSAHS and clinical guidelines now recommend their use in mild OSAHS and in more severe cases when CPAP fails...
January 2018: Journal of Thoracic Disease
Ama Johal, Bahn Agha
Mandibular advancement appliances (MAAs) are an increasingly accepted treatment choice in obstructive sleep apnea management. The ready-made MAAs has questioned the need for a customised MAAs, given the former is more accessible and considerably cheaper. We conducted a systematic review and meta-analysis to evaluate both objective and patient-centred outcomes in relation to ready-made and custom-made MAAs s. Biomedical electronic databases, clinical trials registers and Grey literature were searched to January 2017, for randomised controlled trials...
February 6, 2018: Journal of Sleep Research
Kate Sutherland, Andrew S L Chan, Joachim Ngiam, M Ali Darendeliler, Peter A Cistulli
PURPOSE: Clinical methods to identify responders to oral appliance (OA) therapy for obstructive sleep apnoea (OSA) are needed. Awake nasopharyngoscopy during mandibular advancement, with image capture and subsequent processing and analysis, may predict treatment response. A qualitative assessment of awake nasopharyngoscopy would be simpler for clinical practice. We aimed to determine if a qualitative classification system of nasopharyngoscopic observations reflects treatment response...
January 23, 2018: Sleep & Breathing, Schlaf & Atmung
Ghassan Idris, Barbara Galland, Christopher John Robertson, Andrew Gray, Mauro Farella
OBJECTIVE: To test the short-term effectiveness of a mandibular advancement splint (MAS) for the management of sleep-disordered breathing (SDB) in children. METHODS: Eighteen SDB children were enrolled in a crossover randomized clinical trial and assigned to a treatment sequence starting either with an Active or a Sham MAS. Each appliance was worn for three weeks and treatment periods were separated by a two-week washout. Home-based polysomnographic data were collected before and after each treatment period...
January 29, 2018: Journal of Dentistry
C Pavoni, E Cretella Lombardo, R Lione, P Bollero, F Ottaviani, P Cozza
The purpose of this cephalometric study was to evaluate the craniofacial changes induced by functional treatment of mandibular advancement with special regard to pharyngeal sagittal airway dimensions, tongue and hyoid bone position in subjects with sleep-disordered breathing (SDB) and dentoskeletal Class II malocclusions compared with an untreated Class II control group. 51 subjects (24 female, 27 male; mean age 9.9 ± 1.3 years) with Class II malocclusion and SDB consecutively treated with a functional appliance (Modify Monobloc, MM) were compared with a control group of 31 subjects (15 males, 16 females; mean age 10...
December 2017: Acta Otorhinolaryngologica Italica
B Saglam-Aydinatay, T Taner
BACKGROUND: Despite the advances in the treatment of obstructive sleep apnea (OSA) with mandibular advancement appliances (MAA), their effectiveness is dependent on the patients compliance. Our aims were to evaluate the long-term adherence to MAA therapy and patients experiences of the treatment in OSA. MATERIAL AND METHODS: Sixty-nine patients (52 males, 17 females; Mean age: 54.4±10.8 years) were included in the study. The subjects were mild (56%) and moderate (44%) OSA patients who had been treated using MAA at least 4 years prior to the study...
December 23, 2017: Medicina Oral, Patología Oral y Cirugía Bucal
Gowri Sivaramakrishnan, Kannan Sridharan
Background: Mandibular advancement appliances are being tested for use in patients with obstructive sleep apnea (OSA). However, the effectiveness of titration of these appliances does not have conclusive evidence. Systematic reviews help us to compile all available clinical evidence using statistical principles. Hence, the aim of this systematic review is to identify the effectiveness of titratable over nontitratable mandibular advancement appliances in patients with mild to moderate OSA...
October 2017: Journal of Indian Prosthodontic Society
Hitomi Ono Minagi, Kentaro Okuno, Kanji Nohara, Takayoshi Sakai
STUDY OBJECTIVES: The aim of this study was to investigate the predictors of dental changes associated with long-term treatment with oral appliances (OAs) in patients with obstructive sleep apnea (OSA). METHODS: This was a retrospective study to investigate Japanese patients with OSA receiving long-term treatment with OAs. Comparisons of cephalometric analysis were carried out between the initial and follow-up assessments of dental and skeletal changes. Based on dental changes, predictors that may cause side effects were investigated...
January 15, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Gustavo Tirado Rodrigues
Obtaining long term stability allied to functional and aesthetic balance is the main goal of any orthodontic-orthopedic therapy. This case report describes the orthodontic therapy applied to a 7-year-9-month old child, who presented a Class II, division 1 malocclusion associated to skeletal open bite. Functional and skeletal corrections (sagittally and vertically) were obtained by means of mandible advancement achieved with a closed Balter's bionator appliance followed by a fixed appliance. This approach showed to be efficient in accomplishing both functional and aesthetic goals, that were kept stable five years after the treatment was finished...
September 2017: Dental Press Journal of Orthodontics
Enrique Fernández-Julián, Tomás Pérez-Carbonell, Rocío Marco, Verónica Pellicer, Enrique Rodriguez-Borja, Jaime Marco
OBJECTIVE/HYPOTHESIS: To investigate outcomes including efficacy, quality of life, and levels of inflammatory markers of a mandibular advancement device (MAD) for moderate-to-severe obstructive sleep apnea (OSA). STUDY DESIGN: Case-control study. METHODS: Patients with apnea-hypopnea index (AHI) ≥ 15/hr who only accepted MAD therapy (study group) or who refused any treatment (control group) were recruited. At baseline and at 6 months, polysomnography, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), C-reactive protein (CRP), interleukin 1β, interleukin 6, and tumor necrosis factor α (TNF-α) were assessed in both groups...
November 20, 2017: Laryngoscope
Martha Schwartz, Luis Acosta, Yuan-Lung Hung, Mariela Padilla, Reyes Enciso
The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias...
November 11, 2017: Sleep & Breathing, Schlaf & Atmung
K Gjerde, S Lehmann, I F Naterstad, M E Berge, A Johansson
The aim of this study was to test if digitally registered use of a Mandibular Advancement Device (MAD) by a built-in thermal sensor was reliable compared to a self-reported diary of MAD use. Eighty consecutive patients referred to a specialist outpatient sleep medicine clinic (HUS) were recruited. Patients of both genders aged from 25 to 70 years with a diagnosis of mild to moderate or severe OSA, were included. All participants signed a written informed consent when they received the MAD. For the purpose of this reliability study, we found it sufficient to include the first 30 nights of MAD use in the reliability analysis...
November 1, 2017: Journal of Oral Rehabilitation
Katherine Forde, Madeleine Storey, Simon J Littlewood, Paul Scott, Friedy Luther, Jing Kang
Background: There is a shortage of evidence on the best type of retainer. Objectives: Evaluate upper and lower bonded retainers (BRs) versus upper and lower vacuum-formed retainers (VFRs) over 12 months, in terms of stability, retainer survival, and patient satisfaction. Trial design: Two-arm parallel group multi-centre randomized controlled clinical trial. Methods: Sixty consecutive patients completing fixed appliance therapy and requiring retainers were recruited from 3 hospital departments...
October 20, 2017: European Journal of Orthodontics
Luciana B M Godoy, Luciana Palombini, Dalva Poyares, Cibele Dal-Fabbro, Thaís Moura Guimarães, Priscila Calixto Klichouvicz, Sergio Tufik, Sonia Maria Togeiro
Objectives: To evaluate the long term effects of an oral appliance on clinical symptoms, respiratory sleep parameters, sleep quality and sustained attention in patients with Upper Airway Resistance Syndrome (UARS) compared with placebo. Methods: This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time...
October 17, 2017: Sleep
Kim Rogers, Phillip M Campbell, Larry Tadlock, Emet Schneiderman, Peter H Buschang
OBJECTIVES: To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients. MATERIALS AND METHODS: The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA)...
October 10, 2017: Angle Orthodontist
L Jokubauskas, A Baltrušaitytė, G Pileičikienė
The review focuses on the last decade of research regarding the use of various oral appliances (OAs) in the management of sleep bruxism (SB) in adults. Sixteen (n = 16) papers of 641 identified citations involving 398 participants were included in the review. Of them, seven were randomised controlled trials (RCTs), seven were uncontrolled before-after studies and two were crossover trials. Analysis of the included articles revealed a high variability of study designs and findings. Generally, the risk of bias was low-to-unclear for RCTs and high for crossover studies, whilst the before-after studies exhibited several structural limitations...
January 2018: Journal of Oral Rehabilitation
Y Y Ma, J J Zhang, X M Gao
OBJECTIVE: To evaluate the polysomnology results along with mandibular titrated advancement using oral appliance to treat obstructive sleep apnea and hyponea syndrome (OSAHS). METHODS: Several electronic databases (PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang) were systematically searched up to September 2015. There was no restriction of language or source of information. All randomized clinical trials (RCT) and before-after trials (BAT) comparing at least two different mandibular advancements were included...
August 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Nancy R Foldvary-Schaefer, Tina E Waters
PURPOSE OF REVIEW: Sleep-disordered breathing encompasses a broad spectrum of sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea, as well as sleep-related hypoventilation and hypoxemia. Diagnostic criteria have been updated in the International Classification of Sleep Disorders, Third Edition and the American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events. Neurologic providers should have basic knowledge and skills to identify at-risk patients, as these disorders are associated with substantial morbidity, the treatment of which is largely reversible...
August 2017: Continuum: Lifelong Learning in Neurology
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