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.
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.
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.
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.
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The authors are greatly indebted to Carole Boudet, Mylène Gandubert, and Karine Robin for data collection. Our thanks also go to Jean-Marc Lebas for radiological acquisitions. We thank Jean-Louis Racineux from the Institut de Recherche en Santé Respiratoire des Pays de la Loire.
This study was supported by a grant from the Pays de la Loire Respiratory Health Research Institute (IRSRPL).
Conflict of interest
FG reports grants and personal fees from RESMED, personal fees and non-financial support from SEFAM, personal fees from CIDELEC, personal fees and non-financial support from NOVARTIS, personal fees from ACTELION, non-financial support from BOEHRINGER INGELHEIM, personal fees and non-financial support from AIR LIQUIDE SANTE, non-financial support from ASTEN, personal fees and non-financial support from NYXOAH, personal fees and non-financial support from JAZZ Pharmaceutical, outside the submitted work.
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Baldini, N., Gagnadoux, F., Trzepizur, W. et al. Long-term dentoskeletal side effects of mandibular advancement therapy in patients with obstructive sleep apnea: data from the Pays de la Loire sleep cohort. Clin Oral Invest (2021). https://doi.org/10.1007/s00784-021-04064-7
- Obstructive sleep apnea
- Mandibular advancement device
- Oral appliance
- Dentoskeletal side effects
- Subjective assessment of side effects