Abstract
Oral appliances (OAs) have been used to treat obstructive sleep apnea (OSA) patients for decades. However, detailed dental side effects in long-term OA cases analyzed with an accurate three-dimensional (3D) measurement tool have seldom been reported. The purpose of this study is to evaluate dental side effects in five OSA patients, who had used a tongue retaining device (TRD) (with occasional other OA wear) for an average of 6 years and 4 months. The baseline and follow-up orthodontic study models were measured with a newly developed MicroScribe-3DX analysis system. High compliance of TRD wear was confirmed in all cases and different patterns and amounts of dental changes were observed. The most common appliance-induced dental changes included anterior and/or unilateral posterior openbites and reduced anterior overjets. It was hypothesized that there might be two possible mechanisms for the TRD side effects—one is the forward pressure of the tongue upon the anterior dental arch and the other is the lateral pressure of the tongue upon the posterior arch. Considerations to correct the TRD dental side effects should be guided by these different mechanisms of the tongue on the dental arch. Possible solutions to minimize occlusal changes and maximize the benefits for OSA patients are also discussed.
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References
Hoekema A, Stegenga B, De Bont LG (2004) Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea–hypopnea: a systematic review. Crit Rev Oral Biol Med 15:137–155
Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev CD004435
Cartwright RD, Samelson CF (1982) The effects of a nonsurgical treatment for obstructive sleep apnea. The tongue-retaining device. JAMA 248:705–709
Ono T, Lowe AA, Ferguson KA, Pae EK, Fleetham JA (1996) The effect of the tongue retaining device on awake genioglossus muscle activity in patients with obstructive sleep apnea. Am J Orthod Dentofac Orthop 110:28–35
Higurashi N, Kikuchi M, Miyazaki S, Itasaka Y (2002) Effectiveness of a tongue-retaining device. Psychiatry Clin Neurosci 56:331–332
Hoffstein V (2006) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 29(2):244–262
Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262
Marklund M (2006) Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofac Orthop 129:214–221
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 129:205–213
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 129:195–204
Chen H, Lowe AA, Almeida FR, Wong M, Fleetham JA, Wang BK (2007) 3D computer-assisted study model analysis of long term oral appliance wear—Part I: methodology. Am J Orthod Dentofac Orthop, in press
Liu Y, Lowe AA, Fleetham JA, Park YC (2001) Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofac Orthop 120:639–647
Warunek SP (2004) Oral appliance therapy in sleep apnea syndromes: a review. Semin Orthod 10:73–89
Battagel JM, Johal A, L’Estrange PR, Croft CB, Kotecha B (1999) Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod 21:363–376
Fransson AM, Tegelberg A, Svenson BA, Lennartsson B, Isacsson G (2002) Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring. Am J Orthod Dentofac Orthop 122:371–379
Fritsch KM, Iseli A, Russi EW, Bloch KE (2001) Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med 164:813–818
Chen H, Lowe AA, Almeida FR, Fleetham JA, Wang BK 3D computer-assisted study model analysis of long term oral appliance wear—Part II: side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod Dentofac Orthop, in press
Takahashi S, Kuribayashi G, Ono T, Ishiwata Y, Kuroda T (2005) Modulation of masticatory muscle activity by tongue position. Angle Orthod 75:35–39
Robertson C, Herbison P, Harkness M (2003) Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients. Eur J Orthod 25:371–376
Rose EC, Schnegelsberg C, Staats R, Jonas IE (2001) Occlusal side effects caused by a mandibular advancement appliance in patients with obstructive sleep apnea. Angle Orthod 71:452–460
Barthlen GM, Brown LK, Wiland MR, Sadeh JS, Patwari J, Zimmerman M (2000) Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome. Sleep Med 1:299–305
Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163:1457–1461
Acknowledgements
The authors wish to thank Dr. Alan G. Hannam for his technical support of the MicroScribe-3DX system and Mrs. Ingrid Ellis for her editorial assistance in the final preparation of the manuscript. The study models from Dr. A. Strauss were duplicated by Davis Laboratory, Wyoming, Michigan, USA. The present study was supported by the China Scholarship Council (CSC) to the first author (H.C.) and by royalties paid to the University of British Columbia from Klearway™ sales worldwide.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s11325-008-0229-z
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Chen, H., Lowe, A.A., Strauss, A.M. et al. Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients. Sleep Breath 12, 169–178 (2008). https://doi.org/10.1007/s11325-007-0141-y
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DOI: https://doi.org/10.1007/s11325-007-0141-y