Nicolas Baldini1, Frédéric Gagnadoux2,3, Wojciech Trzepizur2,3, Nicole Meslier2,3, Julien Dugas4, Chloé Gerves-Pinquie4, Frédérique Chouet-Girard5, Jean-Daniel Kün-Darbois6,2. 1. Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France. nicolasbaldini.maxillofacial@laposte.net. 2. Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France. 3. Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France. 4. Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France. 5. Department of Maxillofacial Surgery, Le Mans Hospital, 194 avenue Rubillard, 72037, Le Mans Cedex, France. 6. Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.
Abstract
OBJECTIVES: Mandibular advancement devices (MADs) are the main therapeutic alternative to continuous positive airway pressure for obstructive sleep apnea. Our aim was to evaluate the long-term dentoskeletal side effects of MADs and to identify the predictive factors for these side effects. MATERIALS AND METHODS: Patients from the Pays de la Loire cohort treated with a custom-made MAD for at least 1 year were included in this retrospective study. Digital cephalometric analyses were performed at baseline and at follow-up. RESULTS: We included a total of 117 patients, treated with a MAD for a median [interquartile range] of 4.6 [2.6-6.6] years. The main significant side effects were a decrease in overbite (- 0.5 ± 1 mm), overjet (- 0.7 ± 1 mm) and maxillary incisor inclination (- 2.5 ± 2.8°) and an increase in mandibular incisor inclination (+ 2.2 ± 2.7°). Subjective side effects were not linked to the observed dentoskeletal changes. Current smokers were at higher risk of overjet modifications. A pre-existing anterior open-bite was associated with a greater decrease in overbite. Treatment duration was associated with a more pronounced mandibular incisor proclination. Propulsion was negatively associated with maxillary incisor retroclination. CONCLUSIONS: Long-term dentoskeletal side effects were mainly moderate dental side effects. Some predictive factors were shown to be associated with more pronounced changes. Subjective side effects did not appear to be reliable tools to detect dentoskeletal side effects. CLINICAL RELEVANCE: Regular follow-up with clinical examination and regular radiographs is mandatory. The predictive factors could be of interest for a better selection of patients and to individualize follow-up.
OBJECTIVES: Mandibular advancement devices (MADs) are the main therapeutic alternative to continuous positive airway pressure for obstructive sleep apnea. Our aim was to evaluate the long-term dentoskeletal side effects of MADs and to identify the predictive factors for these side effects. MATERIALS AND METHODS: Patients from the Pays de la Loire cohort treated with a custom-made MAD for at least 1 year were included in this retrospective study. Digital cephalometric analyses were performed at baseline and at follow-up. RESULTS: We included a total of 117 patients, treated with a MAD for a median [interquartile range] of 4.6 [2.6-6.6] years. The main significant side effects were a decrease in overbite (- 0.5 ± 1 mm), overjet (- 0.7 ± 1 mm) and maxillary incisor inclination (- 2.5 ± 2.8°) and an increase in mandibular incisor inclination (+ 2.2 ± 2.7°). Subjective side effects were not linked to the observed dentoskeletal changes. Current smokers were at higher risk of overjet modifications. A pre-existing anterior open-bite was associated with a greater decrease in overbite. Treatment duration was associated with a more pronounced mandibular incisor proclination. Propulsion was negatively associated with maxillary incisor retroclination. CONCLUSIONS: Long-term dentoskeletal side effects were mainly moderate dental side effects. Some predictive factors were shown to be associated with more pronounced changes. Subjective side effects did not appear to be reliable tools to detect dentoskeletal side effects. CLINICAL RELEVANCE: Regular follow-up with clinical examination and regular radiographs is mandatory. The predictive factors could be of interest for a better selection of patients and to individualize follow-up.
Authors: G Vigié du Cayla; J M Collet; V Attali; J B Kerbrat; L Benslama; P Goudot Journal: J Stomatol Oral Maxillofac Surg Date: 2018-10-27 Impact factor: 1.569
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