Patients with obstructive sleep apnea (OSA) are usually treated with either mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) therapy. The objective of this study is to evaluate changes in dental occlusion associated with long-term MAD and CPAP therapy.
Materials and methods
Data from 14 OSA patients using MAD and 17 OSA patients using CPAP therapy were evaluated at baseline, 2-year and 10-year follow-up. Changes in dental occlusion were analyzed from dental plaster casts with a digital sliding caliper.
At 2-year follow-up, MAD therapy resulted in significant dental changes when compared with baseline values. In MAD therapy, overjet and overbite decreased with 1.1 ± 1.8 mm and 1.1 ± 1.2 mm respectively. With CPAP therapy overjet and overbite decreased significantly with 0.2 ± 0.5 mm and 0.3 ± 0.5 mm, respectively. Both groups also showed significant changes in molar occlusion. After a 10-year follow-up, significant and more pronounced changes were seen in overjet and overbite. In MAD therapy, overjet and overbite decreased with 3.5 ± 1.5 mm and 2.9 ± 1.5 mm respectively when compared with baseline values. In CPAP therapy, overjet and overbite decreased with 0.7 ± 1.5 mm and 0.8 ± 1.4 mm respectively when compared with baseline values.
This study demonstrates that MAD and CPAP therapy result in significant changes in dental occlusion. These changes appear progressive and more pronounced with MAD compared to CPAP therapy.
Long-term OSA treatment results in significant dental side effects that may progress over time. Informed consent is fundamental before starting MAD treatment and individualized long-term follow-up is of eminent importance.
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Jenkinson C, Davies RJ, Mullins R, Stradling JR (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353(9170):2100–2105
Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053
Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet (London, England) 383(9918):736–747
Ramar K, Dort LC, Katz SG et al (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 11(7):773–827
Hoekema A, Stegenga B, Wijkstra PJ et al (2008) Obstructive sleep apnea therapy. J Dent Res 87(9):882–887
Doff MH, Hoekema A, Wijkstra PJ et al (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 36(9):1289–1296
Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29(2):244–262
Chan AS, Lee RW, Cistulli PA (2007) Dental appliance treatment for obstructive sleep apnea. Chest. 132(2):693–699
Sawyer AM, Gooneratne NS, Marcus CL et al (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15(6):343–356
Doff MH, Veldhuis SK, Hoekema A, Slater JJ, Wijkstra PJ, de Bont LG, Stegenga B (2012) Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects. Clin Oral Investig 16(3):689–697
Gong X, Zhang J, Zhao Y, Gao X (2013) Long-term therapeutic efficacy of oral appliances in treatment of obstructive sleep apnea-hypopnea syndrome. Angle Orthod 83(4):653–658
Giannasi LC, Almeida FR, Magini M, Costa MS, de Oliveira CS, de Oliveira JC et al (2009) Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation. Sleep Breath 13(4):375–381
Almeida FR, Lowe AA, Sung JO, Tsuiki S, Otsuka R (2006) Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: part 1. Cephalometric analysis. Am J Orthod Dentofac Orthop 129(2):195–204
Doff MH, Hoekema A, Pruim GJ, Huddleston Slater JJ, Stegenga B (2010) Long-term oral-appliance therapy in obstructive sleep apnea: a cephalometric study of craniofacial changes. J Dent 38(12):1010–1018
Marklund M, Franklin KA (2015) Treatment of elderly patients with snoring and obstructive sleep apnea using a mandibular advancement device. Sleep Breath 19(1):403–405
Li W, Xiao L, Hu J (2013) The comparison of CPAP and oral appliances in treatment of patients with OSA: a systematic review and meta-analysis. Respir Care 58(7):1184–1195
Martinez-Gomis J, Willaert E, Nogues L, Pascual M, Somoza M, Monasterio C (2010) Five years of sleep apnea treatment with a mandibular advancement device: side effects and technical complications. Angle Orthod 80(1):30–36
Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S (2006) Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: part 2. Study-model analysis. Am J Orthod Dentofac Orthop 129(2):205–213
Doff MH, Finnema KJ, Hoekema A, Wijkstra PJ, de Bont LG, Stegenga B (2013) Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 17(2):475–482
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA (2010) Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea. Chest 138(4):870–874
Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR (2014) Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 10(12):1285–1291
Ueda H, Almeida FR, Lowe AA, Ruse ND (2008) Changes in occlusal contact area during oral appliance therapy assessed on study models. Angle Orthod 78(5):866–872
Ghazal A, Jonas IE, Rose EC (2008) Dental side effects of mandibular advancement appliances - a 2-year follow-up. J Orofac Orthop 69(6):437–447
Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, Cistulli PA (2014) Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 10(2):215–227
Tsiopas N, Nilner M, Bondemark L, Bjerklin K (2013) A 40 years follow-up of dental arch dimensions and incisor irregularity in adults. Eur J Orthod 35(2):230–235
Marklund M, Franklin KA, Persson M (2001) Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea. Eur J Orthod 23(2):135–144
Petit FX, Pepin JL, Bettega G, Sadek H, Raphael B, Levy P (2002) Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J Respir Crit Care Med 166(3):274–278
This is not an industry supported study. Aarnoud Hoekema is a medical advisor for Airway Management Inc., Somnomed and Zephyr Sleep Technologies.
Conflict of interest
Aarnoud Hoekema is a medical advisor for Airway Management Inc., Somnomed and Zephyr Sleep Technologies. All other authors do not have any conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Boudewijn Stegenga deceased.
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Uniken Venema, J.A.M., Doff, M.H.J., Joffe-Sokolova, D.S. et al. Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study. Clin Oral Invest 24, 3069–3076 (2020). https://doi.org/10.1007/s00784-019-03175-6
- Obstructive sleep apnea
- Mandibular advancement device
- Continuous positive airway pressure
- Treatment outcome
- Dental side effects