Skip to main content
SpringerLink
Log in

Influence of oral appliances for mandibular advancement on occlusal function

A preliminary study

  • original article
  • Published:
international journal of stomatology & occlusion medicine

Abstract

Introduction

Oral appliances (OAs) that aim to enlarge the upper airway by repositioning the mandible forward have been established as a lifelong treatment tool for primary snoring and mild-to-moderate obstructive sleep apnea (OSA). Recent OSA studies have reported that the use of OAs produces jaw discomfort with difficulty in chewing immediately after waking. The aim of this study was to evaluate the influence of nocturnal OA use on occlusal function.

Materials and methods

The subjects consisted of 10 adults (mean age 26.2 ± 5.8 years) selected from volunteers in the Department of Orthodontics at Hiroshima University Hospital. Occlusal contact area (OCA), maximum bite force (MBF) and centre of occlusal load (COL) were measured using a Dental Prescale Occluzer immediately after nocturnal OA use. Tooth mobility was measured using the Periotest and tooth pain was evaluated with the visual analogue scale. Recordings were obtained 6 times immediately after OA removal (0 min) with an interval of 5, 10, 15, 30 and 60 min between each respective measurement, resulting in a total period of 120 min.

Results

Significant differences in OCA, MBF and COL were found between the readings obtained after the 0 min and 30 min intervals. Although some subjects achieved 80 % of the baseline OCA and MBF values, these values remained at 50 % of the baseline for several subjects after 120 min. Only the lower incisors showed significantly high mobility between 0 min and baseline. The degree of tooth pain significantly decreased in most cases after the 15 min interval.

Conclusions

Although OA side effects may be mild, acceptable and transient close attention must be paid to the use of OAs for the treatment of OSA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Ryan CF, Love LL, Peat D, Fleetham JA, Lowe AA. Mandibular advancement oral appliance therapy for obstructive sleep apnoea: effect on awake caliber of the velopharynx. Thorax. 1999;54:972–7.

    Article  PubMed  CAS  Google Scholar 

  2. Kato J, Isono S, Tanaka A, Watanabe T, Araki D, Tanzawa H, et al. Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest. 2000;117:1065–72.

    Article  PubMed  CAS  Google Scholar 

  3. Tsuiki S, Hiyama S, Ono T, Imamura N, Ishiwata Y, Kuroda T, et al. Effects of a titratable oral appliance therapy on supine airway size in awake non-apneic individuals. Sleep. 2001;24:554–60.

    PubMed  CAS  Google Scholar 

  4. Strohl KP, Redline S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med. 1996;154:279–89.

    PubMed  CAS  Google Scholar 

  5. He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest. 1988;94:9–14.

    Article  PubMed  CAS  Google Scholar 

  6. American Sleep Disorders Association. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. An American Sleep Disorders Association report. Sleep. 1995;18:511–3.

    Google Scholar 

  7. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med. 2001;163:1457–61.

    PubMed  CAS  Google Scholar 

  8. Pantin CC, Hillman DR, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep. 1999;22:237–40.

    PubMed  CAS  Google Scholar 

  9. Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest. 1999;116:1511–8.

    Article  PubMed  CAS  Google Scholar 

  10. Bloch KE, Iseli A, Zhang JN, Xie X, Kaplan V, Stoeckli PW, et al. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med. 2000;162:246–51.

    PubMed  CAS  Google Scholar 

  11. Fritsch KM, Iseli A, Russi EW, Bloch KE. Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med. 2001;164:813–8.

    PubMed  CAS  Google Scholar 

  12. Fransson AMC, Isacsson G, Leissner LC, Nasman AB, Alton MK. Treatment of snoring and obstructive sleep apnea with a mandibular protruding device: an open-label study. Sleep Breath. 2001;5:23–33.

    Article  PubMed  CAS  Google Scholar 

  13. Ringqvist M, Walker-Engstrom ML, Tegelberg A, Ringqvist I. Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study. Am J Orthod Dentofacial Orthop. 2003;124:53–60.

    Article  PubMed  Google Scholar 

  14. Marklund M, Franklin KA, Persson M. Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea. Eur J Orthod. 2001;23:135–44.

    Article  PubMed  CAS  Google Scholar 

  15. Robertson C, Herbison P, Harkness M. Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients. Eur J Orthod. 2003;25:371–6.

    Article  PubMed  Google Scholar 

  16. Bondemark L. Does 2 years nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible? Am J Orthod Dentofac Orthop. 1999;116:621–8.

    Article  CAS  Google Scholar 

  17. Almeida FR, Lowe AA, Sung JO, Tsuiki S, Otsuka R. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients. Part 1. Cephalometric analysis. Am J Orthod Dentofac Orthop. 2006;129:195–204.

    Article  Google Scholar 

  18. Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients. Part 2. Study-model analysis. Am J Orthod Dentofac Orthop. 2006;129:205–13.

    Article  Google Scholar 

  19. Rose EC, Schnegelsberg C, Staats R, Jonas IE. Occlusal side effects caused by a mandibular advancement appliance in patients with obstructive sleep apnea. Angle Orthod. 2001;71:452–60.

    PubMed  CAS  Google Scholar 

  20. Ueda H, Almeida FR, Lowe AA, Ruse ND. Changes in occlusal contact area during oral appliance therapy assessed on study models. Angle Orthod. 2008;78:866–72.

    Article  PubMed  Google Scholar 

  21. Tanaka E, Ueki K, Kikuzaki M, Yamada E, Takeuchi M, Dalla-Bona D, et al. Longitudinal measurements of tooth mobility during orthodontic treatment using a periotest. Angle Orthod. 2005;75:101–5.

    PubMed  Google Scholar 

  22. Fransson AMC, Tegelberg A, Johansson A, Wenneberg B. Influence of the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: a 2-year follow-up. Am J Orthod Dentofacial Orthop. 2004;126:687–93.

    Article  PubMed  Google Scholar 

  23. Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, et al. Long term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005;1:143–52.

    PubMed  Google Scholar 

  24. Otsuka R, Almeida FR, Lowe AA. The effects of oral appliance therapy on occlusal function in patients with obstructive sleep apnea: a short-term prospective study. Am J Orthod Dentofac Orthop. 2006;129:222–9.

    Article  Google Scholar 

  25. Ueda H, Almeida FR, Chen H, Lowe AA. The effect of two jaw exercises on occlusal function in obstructive sleep apnea patients during oral appliance therapy—a randomized controlled trial. Am J Orthod Dentofac Orthop. 2009;135:430–1.

    Article  Google Scholar 

  26. Matsui Y, Ohno K, Michi K, Suzuki Y, Hirose K, Yamagata K. A computerized method for evaluating balance of occlusal load. J Oral Rehabil. 1996;23:530–5.

    Article  PubMed  CAS  Google Scholar 

  27. Miura H, Araki Y, Hirai T, Isogai E, Hirose K, Umenai T. Evaluation of chewing activity in the elderly person. J Oral Rehabil. 1998;25:190–3.

    Article  PubMed  CAS  Google Scholar 

  28. Hidaka O, Iwasaki M, Saito M, Morimoto T. Influence of clenching intensity on bite force balance, occlusal contact area, and average bite pressure. J Dent Res. 1999;78:1336–44.

    Article  PubMed  CAS  Google Scholar 

  29. Miura H, Watanabe S, Isogai E, Miura K. Comparison of maximum bite force and dentate status between healthy and frail elderly persons. J Oral Rehabil. 2001;28:592–5.

    Article  PubMed  CAS  Google Scholar 

  30. Sultana MH, Yamada K, Hanada K. Changes in occlusal force and occlusal contact area after active orthodontic treatment: a pilot study using pressure-sensitive sheets. J Oral Rehabil. 2002;29:484–91.

    Article  PubMed  CAS  Google Scholar 

  31. Gibbs CH, Mahan PE, Mauderli A, Lundeen HC, Walsh EK. Limits of human bite strength. J Prosthet Dent. 1986;56:226–9.

    Article  PubMed  CAS  Google Scholar 

  32. Kikuchi M, Korioth TWP, Hannam AG. The association among occlusal contacts, clenching effort, and bite force distribution in man. J Dent Res. 1997;76:1316–25.

    Article  PubMed  CAS  Google Scholar 

  33. Raadsheer MC, Van Eijden TMGJ, Van Ginkel FC, Prahl-Andersen B. Contribution of jaw muscle size and craniofacial morphology to human bite force magnitude. J Dent Res. 1999;78:31–42.

    Article  PubMed  CAS  Google Scholar 

  34. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996;109:1269–75.

    Article  PubMed  CAS  Google Scholar 

  35. Rose EC, Staats R, Virchow Jr C, Jonas IE. Occlusal and skeletal effects of an oral appliance in the treatment of obstructive apnea. Chest. 2002;122:871–7.

    Article  PubMed  Google Scholar 

  36. Tanne K, Yoshida S, Kawata T, Sasaki A, Knox J, Jones ML. An evaluation of the biomechanical response of the tooth and periodontium to orthodontic forces in adolescent and adult subjects. Br J Orthod. 1998;25:109–15.

    Article  PubMed  CAS  Google Scholar 

  37. Aitken RCV. Measurement of feelings using visual analogue scales. Proc R Soc Med. 1969;62:989–93.

    PubMed  CAS  Google Scholar 

  38. Scott J. Huskisson EC. Graphic representation of pain. Pain 2. 1976;2(2)175–86.

    Article  CAS  Google Scholar 

  39. George PT. Is adjustability advantageous in mandibular advancement appliance in the treatment of sleep-disordered breathing? Sleep Breath. 2001;5:139–47.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi Minami-ku, 734–8553, Hiroshima, Japan

    Genki Watanabe DDS, Hiroshi Ueda DDS, PhD, Atushi Horihata DDS, PhD, Myongsun Koh DDS, PhD & Kazuo Tanne DDS, PhD

Authors
  1. Genki Watanabe DDS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Ueda DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atushi Horihata DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Myongsun Koh DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuo Tanne DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Ueda DDS, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Watanabe, G., Ueda, H., Horihata, A. et al. Influence of oral appliances for mandibular advancement on occlusal function. J. Stomat. Occ. Med. 5, 57–63 (2012). https://doi.org/10.1007/s12548-012-0044-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12548-012-0044-9

Keywords

Search

Navigation