Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects

• Published in: Clinical oral investigations Vol. 17; no. 2; pp. 475 - 482
• Main Authors: Doff, M. H. J., Finnema, K. J., Hoekema, A., Wijkstra, P. J., de Bont, L. G. M., Stegenga, B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2013; Springer Nature B.V
• Subjects: Bicuspid - pathology; Continuous Positive Airway Pressure; Cuspid - pathology; Dental Models; Dental Occlusion; Dentistry; Female; Follow-Up Studies; Humans; Jaw Relation Record - methods; Longitudinal Studies; Male; Malocclusion - classification; Malocclusion - etiology; Mandible - pathology; Mandibular Advancement - instrumentation; Medicine; Middle Aged; Original; Original Article; Orthodontic Appliances - adverse effects; Overbite - classification; Overbite - pathology; Prospective Studies; Sleep Apnea, Obstructive - therapy; Sleep Stages - physiology; Snoring - therapy; Obstructive sleep apnea syndrome; Therapy; Side effects; CPAP; Oral appliance; Study models
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-012-0737-x

Objectives This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. Materials and methods As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. Results Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior–posterior change in the occlusion (−1.3 ± 1.5 mm) in the oral appliance group compared to the CPAP group (−0.1 ± 0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient ( β ) = −0.02, 95 % confidence interval (−0.04 to −0.00)]. Conclusions Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. Clinical relevance Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.