UPPER AIRWAY VOLUMETRIC CHANGE FOLLOWING THE USE OF TWO CAD/CAM ORAL APPLIANCES FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Document Type : Original Article

Authors

1 Assistant lecturer of Removable Prosthodontics, Faculty of Dentistry, Alexandria University

2 Professor of Removable Prosthodontics, Faculty of Dentistry, Alexandria University

3 Professor of Chest Diseases, Faculty of Medicine, Alexandria University

4 Oral and Maxillofacial Surgery consultant, Faculty of Dentistry, Cairo University

Abstract

Introduction: Obstructive sleep apnea (OSA) is a condition in which there is repetitive and intermittent occlusion of the upper airway (UA) during sleep. OSA can be treated through; continuous positive airway pressure (CPAP), surgery, or oral appliances. Mandibular Advancement Appliance (MAA) is considered a valid alternative, which can be the first choice in simple snorers and mild-moderate OSA. MAA can be either custom-made or non-custom-made, one-piece or two-piece, titratable or non-titratable. While Monoblock designs permit no mouth opening, two-piece appliances vary in permissible lateral jaw movement and in the coupling mechanisms which attach the two plates together.
Objectives: measuring the change in UA volume after the use of two different designs of MAA (Monoblock and Biblock)
Materials and methods: Twenty patients with diagnosed OSA were divided randomly into two equal groups: Monoblock group ; received Monoblock MAA fabricated using CAD/CAM technique at different advancement levels; 50% then 75% of maximum advancement, Biblock group; received Biblock MAA fabricated using CAD/CAM technique at different advancement levels; 50% then 75% of maximum advancement. UA volume of all patients were evaluated after three months of acclimatization of each stage of advancement through Cone-Beam Computed Tomography (CBCT).
Results: Biblock group showed statistically significant increase in UA volume at 75% mandibular advancement level, compared to Monoblock group (p=.001). There was statistically significant increase in UA volume percentage change from baseline to 50% advancement (p=.016), and also from baseline to 75% advancement (p=.001) in favor to Biblock MAA.
Conclusions: Both Monoblock and Biblock MAA produced statistically significant increase in UA volume of OSA patients. Biblock MAA with elastics presented statistically significant favorable increase in UA volume in relation to Monoblock MAA.

Keywords

Main Subjects

References

  1. American Academy of Sleep Medicine (AASM) AASM. ICSD-3 Online Version [Last accessed on 2019 Jan 27]. Available from: http://www.aasmnet.org/store/product.aspx?pid=849.
  2. Rodríguez-Lozano FJ, Sáez-Yuguero RM, Linares ET, Bermejo AF. Sleep apnea and mandibular advancement device. Revision of the literature. Med Oral Patol Oral Cir Bucal. 2008;13: E549–54.
  3. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006 ;3:CD001106.
  4. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:1108-14.
  5. Yetkin O, Kunter E, Gunen H. CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath. 2008;12:365-7.
  6. Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman Jr J, et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006; 29:240-3.
  7. Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11:773-827.
  8. Cobo JM, de Carlos F, Suarez AA. “Mandibular advancement device (MAD®) to treat sleep apnoea – Hypopnoea syndrome and chonic snoring”: 25th Southern Biomedical Engineering Conference 2009, Miami, Florida, USA. IFMBE Proc. 2009;24:349-54.
  9. Scherr SC, Dort LC, Almeida FR, Bennett KM, Blumenstock NT, Demko BG, et al. Definition of an effective oral appliance for the treatment of obstructive sleep apnea and snoring: a report of the American Academy of Dental Sleep Medicine. J Dent Sleep Med. 2014;1:39-50.
  10. Ahrens A, McGrath C, Hägg U. A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod. 2011;33:318- 24.
  11. Jayesh SR, Bhat WM. Mandibular advancement device for obstructive sleep apnea: An overview. J Pharm Bioallied Sci. 2015; 7: S223-5.
  12. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014 ;10:215-27.
  13. 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. 
  14. AbdElmoniem AA. Fixed position versus adjustable mandibular advancement prostheses for treatment of obstructive sleep apnea. Master thesis, Faculty of Dentistry, Alexandria University, 2006.
  15. Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R et al. Consensus and evidencebased Indian initiative on obstructive sleep apnea guidelines 2014. Lung India. 2015;32:422-34.
  16. Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig. 2010;14:339-45.
  17. Kim J, Shin W. How to do random allocation (randomization). Clin Orthop Surg. 2014;6:103-9.
  18. Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of STOP-Bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med. 2014;10:951-8.
  19. Chang Y, Koenig LJ, Pruszynski JE, Bradley TG, Bosio JA, Liu D. Dimensional changes of upper airway after rapid maxillary expansion: a prospective conebeam computed tomography study. Am J Orthod Dentofac. 2013;143:462-70.
  20. Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. Am J Orthod Dentofac. 2013;143:235-45.
  21. Abdallah RM, Rashad HA, Kashef NA, El‑Sheikh MN. The effect of changes in the intermaxillary distance in mandibular advancement splints as a treatment of obstructive sleep apnea. Tanta Dent J. 2016; 13: 193-8.
  22. Chiang CC, Jeffres MN, Miller A, Hatcher DC. Threedimensional airway evaluation in 387 subjects from one university orthodontic clinic using cone beam computed tomography. Angle Orthod. 2012;82:985-92.
  23. Lenza MG, De Lenza MM, Dalstra M, Melsen B, Cattaneo PM. An analysis of different approaches to the assessment of upper airway morphology: a CBCT study. Orthod Craniofac Res. 2010;13:96-105.
  24. IBM Corp. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.; Released 2012.
  25. Field A. Discovering Statistics Using IBM SPSS Statistics. 4th ed. London, California, New Delhi: SAGE Publications Ltd, 2013. 
  26. Nickerson CA. A note on" A concordance correlation coefficient to evaluate reproducibility". Biometrics. 1997: 1503-7.
  27. Mann HB, Whitney DR. On a test of whether one of two random variables is stochastically larger than the other. The annals of mathematical statistics. 1947;1: 50-60.
  28. Friedman M. The use of ranks to avoid the assumption of normality implicit in the analysis of variance. Journal of the american statistical association. 1937; 32: 675-701.
  29. Al‐Dwairi Z, Tahboub KY, Baba NZ, Goodacre CJ, Özcan M. A Comparison of the Surface Properties of CAD/CAM and Conventional Polymethylmethacrylate (PMMA). J Prosthodont. 2019;2:1-6.
  30. Tasaka A, Matsunaga S, Odaka K, Ishizaki K, Ueda T, Abe S, et al. Accuracy and retention of denture base fabricated by heat curing and additive manufacturing. J Prosthodont Res. 2019;63:85-9.
  31. Soltanzadeh P, Suprono MS, Kattadiyil MT, Goodacre C, Gregorius W. An In Vitro Investigation of Accuracy and Fit of Conventional and CAD/CAM Removable Partial Denture Frameworks. J Prosthodont. 2018; 8;1- 9.
  32. https://nextdent.com/#materials-op.
  33. Kavand G, Lagravère M, Kula K, Stewart K, Ghoneima A. Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion. Angle Orthod. 2019;15:1-9.
  34. Dos Santos Trento G, Moura LB, Spin-Neto R, Jürgens PC, Gabrielli MA, Pereira-Filho VA. Comparison of Imaging Softwares for Upper Airway Evaluation: Preliminary Study. Craniomaxillofac Trauma Reconstr. 2018;11:273-7.
  35. Tsuiki S, Lowe AA, Almeida FR, et al. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir J. 2004; 23:263-8.
  36. Shi H, Scarfe WC, Farman AG. Upper airway segmentation and dimensions estimation from conebeam CT image datasets. Int J Cars. 2006; 1:177-86.
  37. Ogawa T, Enciso R, Memon A, et al. Evaluation of 3D airway imaging of obstructive sleep apnea with conebeam computed tomography. Stud Health Technol Inform. 2005: 111:365-8.
  38. Johal A, Battagel JM. Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances. Br Dent J. 2001;190:532-6.
  39. Nacher M, Serrano-Mollar A, Farre R, Panes J, Segui J, Montserrat JM. Recurrent obstructive apneas trigger early systemic inflammation in a rat model of sleep apnea. Respir Physiol Neurobiol. 2007; 155: 93-6.
  40. Haskell JA, McCrillis J, Haskell BS, Scheetz JP, Scarfe WC, Farman AG. Effects of mandibular advancement device (MAD) on airway dimensions assessed with cone-beam computed tomography. Semin Orthod. 2009; 15: 132-8. 

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