ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Occlusal Appliances Used By Patients With Obstructive Sleep Apnea May Cause Occlusal Changes
Clinical Question Do occlusal appliances used to treat obstructive sleep apnea cause occlusal changes as measured by lateral cephalometric radiographs?
Clinical Bottom Line Chronic use of occlusal appliances to treat obstructive sleep apnea may cause occlusal changes, although generally small. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15187032Hoekema / 2004667 patients with obstructive sleep apnea or snoring in 13 studies reported through 2002Systematic Review of controlled trials and case series
Key resultsAuthors reported qualitatively from each article regarding “co-morbidity” outcomes of mandibular repositioning appliances, ranging from “no adverse effects on craniomandibular complex” to “few adverse effects on craniomandibular complex” to “mesial shift intermolar relationship” to “decreased over-jet/over-bite” to 26% of patients with posterior open bite.”
#2) 12938843Robertson / 2003100 adults with obstructive sleep apnea and/or snoringUncontrolled Prospective Clinical Study
Key resultsThere were “12 small but statistically significant increases and five reductions” in comparisons between the initial and ending (6 to 30 months, depending upon the group) cephalometric radiographs.
#3) 20831889Doff / 2010103 patients randomized to either adjustable oral appliance therapy or CPAPRandomized Controlled Triall
Key resultsAt mean follow-up of 2.3 (+/-0.2) years, patients in the oral appliance group had several small but statistically significant dental occlusal changes including decreased over-bite and over-jet, retroclination of the maxillary incisors and proclination of the mandibular incisors, and an increase in lower and total anterior facial height. There was no difference in skeletal variables.
Evidence Search ("Sleep Apnea, Obstructive"[Mesh]) AND ("Occlusal Splints/adverse effects"[Mesh] OR "Dental Occlusion, Centric"[Mesh]) ...view in PubMed
Comments on
The Evidence
Hoekema systematically reviewed the literature through 2002 using explicit review criteria. Follow-up period of the various studies ranged from 6 months through 30 months post-insertion of the repositioning appliance. Review included both case series of appliance therapy and controlled clinical trials of appliance therapy vs. another treatment. Robertson followed 100 patients, all treated with nonadjustable mandibular repositioning appliances. Groups of 20 of these patients were evaluated at either 6, 12, 18, 24, or 30 months. There was no control group.
Doff randomized his trial into two groups: occlusal appliance therapy and CPAP therapy. He lost 23 of 51 occlusal appliance patients and 17 of 52 CPAP patients to non-responsiveness/non-adherence to treatment, to upper airway surgery, or to crossover to the other group. Therefore only 63 patients were analyzed.
Applicability Patients recruited for these studies were adults with obstructive sleep apnea-hypopnea syndrome and/or snoring. Occlusal appliances provided in these studies are commonly prescribed to patients with OSA.
Specialty/Discipline (General Dentistry) (Orthodontics) (Prosthodontics)
Keywords mandibular repositioning, splint, occlusion, obstructive sleep apnea
ID# 898
Date of submission: 05/16/2011spacer
E-mail clcorrigan@gmail.com
Author Caroline Corrigan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail DEAHL@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the occlusal changes in obstructive sleep apnea patients using occlusal appliances was performed Oct 2015. A more recent publication was found: Chen 2008, PubMed: 18774087. This longitudinal study showed that a variety of occlusal changes occur with long-term OA treatment for OSA. The changes could be regarded as either adverse or beneficial depending upon the baseline characteristics.
by Michael Hosking, Brian Hill (San Antonio, TX) on 05/27/2013
Recent studies, the majority of which are lower levels of evidence, support the findings that oral appliances used to treat OSA cause craniofacial changes, specifically occlusal changes. These changes are usually small but should be continuously monitored and attempts should be made to minimize or prevent these changes.
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