Non-apneic snoring and the orthodontist: the effectiveness of mandibular advancement splints.
(33/135)
OBJECTIVE: Non-apneic snoring is a very common problem, which impacts on all family members. Oral appliances have been used in the management of snoring. These posture the mandible forward during sleep, opening the airway and so reducing the potential for noise generation. This articles aims to objectively evaluate the effectiveness of mandibular advancement splints (MAS) in non-apneic snorers. DESIGN: Prospective clinical trial. SETTING: University Dental Hospital and School. SUBJECTS AND METHODS: 35 consecutively referred adults with proven non-apneic snoring. INTERVENTIONS: Subjects were fitted with a removable, adjustable Herbst MAS. MAIN OUTCOME MEASURES: Questionnaires determined changes in snoring incidence, daytime tiredness, any side effects and their duration. Eleven subjects completed overnight domiciliary sleep recordings of oxygen saturations, pulse rates and sound profile, before and 1 month after fitting the MAS. RESULTS: The questionnaires and sleep recordings suggested that the MAS significantly reduced snoring incidence (p<0.05) and improved sleep quality. Daytime tiredness, as assessed by the Epworth Sleepiness Scale, was significantly reduced (p<0.001). Initial side effects of muscular and TMJ discomforts were mostly resolved after 1 month of appliance wear. CONCLUSIONS: Use of a MAS improves snoring incidence and sleep quality in most patients with non-apneic snoring. (+info)
Non-apneic snoring and the orthodontist: radiographic pharyngeal dimension changes with supine posture and mandibular protrusion.
(34/135)
OBJECTIVE: To evaluate the radiographic changes that occur in the pharynx and surrounding structures with alteration of posture from the upright to the supine position and the effect that mandibular protrusion whilst supine has on these dimensions. DESIGN: Prospective cephalometric study. SETTING: University Dental Hospital and School. SUBJECTS AND METHOD: This prospective study involved 35 consecutively referred adults with proven non-apneic snoring. Lateral skull radiographs were obtained with the subjects upright in occlusion, supine in occlusion and supine with the mandible protruded to the maximum comfortable position. Radiographs were traced and digitized, and the pharyngeal dimensional changes and hyoid position were examined. Males and females were examined separately. RESULTS: Radiographic pharyngeal dimensions were changed with altered posture, resulting in significant reductions in the minimum post-palatal (p<0.01) and post-lingual (p<0.05) airway measurements in the supine position. Mandibular protrusion whilst in the supine position produced increases in the functioning space for the tongue. CONCLUSION: A supine posture results in significant reductions in pharyngeal airway measurements of non-apneic snorers. Mandibular protrusion whilst in the supine position produces an increase in the functioning space for the tongue. (+info)
Dentoskeletal effects and facial profile changes during activator therapy.
(35/135)
The aim of this retrospective study was to investigate cephalometrically the skeletal, dental, and soft tissue modifications induced by activator treatment in patients with Class II malocclusions caused by mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 40 patients treated with an incisor double capping activator (20 girls, 20 boys with a mean age of 10 years) and a control group of 30 subjects (15 girls, 15 boys with a mean age of 10 years). The dentoskeletal and aesthetic changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 18-24 months, when the activator was removed (T1). In the control group the radiographs were obtained before (T0) and after (T1) 21 months (standard deviation +/- 3 months). Activator treatment in these growing patients resulted in a correction of the Class II relationship (ANB -2.14 degrees), a restriction of maxillary growth (SNA -0.5 degrees), an advancement of the mandibular structures (SNB +1.64 degrees, FH--NPg +3.39 degrees; OLp-B +5.17 mm, OLp-Pg +5.14 mm, OLp-Go +2.44 mm), a correction of the overjet (-5.03 mm), an improvement in overbite (-1.17 mm) and uprighting of the maxillary incisors (1--FH -5.64 degrees). The activator appliance was effective in treating growing patients with mandibular deficiency: activator therapy corrected Class II malocclusions by a combination of skeletal and dental changes and improved the soft tissue facial profile. (+info)
How predictable is orthognathic surgery?
(36/135)
There are a number of increasingly sophisticated techniques available for orthognathic treatment planning. All are based on the determination of the skeletal pattern and the position of the dentition. However, they all suffer from difficulties associated with predicting the soft tissue profile. The aim of this retrospective cephalometric investigation was, therefore, to compare the ability to predict accurately the outcome of orthognathic treatment using the 'hand planning' technique and the orthognathic planning and analysis (OPAL) computer program, with an emphasis on the soft tissue profile. Seventy adult subjects were divided into two groups not specific for gender or age: the Class III patients had undergone bimaxillary surgery and the Class II patients sagittal split mandibular advancement. In each group, the pre-treatment and post-debond lateral cephalograms were utilized to calculate the actual orthodontic and surgical movements. These values were then used to produce a prediction using both the hand planning technique and the OPAL program. The resultant predictions were digitized using a customized computer program and compared with the actual outcome. The results show that there was marked individual variation when planning by hand and using the OPAL program. In the mandibular surgery group, hand planning and OPAL were of similar accuracy and few points differed significantly between prediction and outcome. However, for the bimaxillary group, a number of points showed bias and the hand planning technique appeared to be more accurate than the OPAL program, particularly in the region of the lips. Although the usefulness of predictions is acknowledged, these results suggest that they should be used with a certain amount of caution. (+info)
Forward mandibular positioning enhances condylar adaptation in adult rats.
(37/135)
The aim of this investigation was to assess quantitatively the adaptive changes in the condyles of adult rats to forward mandibular positioning. The level of types II and X collagen expressed in the condyles of adult rats was compared with that formed in response to forward mandibular positioning and the levels of expression were correlated to the amount of bone formed in response to mandibular advancement. Seventy-eight 120-day-old female Sprague-Dawley rats were included in this study. The rats were randomly allocated to six groups. Each group consisted of nine rats with bite-jumping devices and four untreated controls. The animals in each group were sacrificed on days 3, 7, 14, 21, 30, and 60. Immunostaining was used for the detection of types II and X collagen, while Alcian blue-PAS was used to observe the extracellular matrix and new bone formation. The results showed that new cartilage was formed in the posterior condyle. The highest level of expression of types II and X collagen were present on day 21, the amount of increase was 247.99 and 540.08 per cent, respectively. The highest level of new bone formation was measured at day 30 of advancement when the amount of increase in new bone formation was 318.91 per cent. These findings indicate that forward mandibular positioning causes changes in the biophysical environment of the temporomandibular joint (TMJ) of adult rats that leads to condylar adaptation. (+info)
Chrome cobalt mandibular advancement appliances for managing snoring and obstructive sleep apnea.
(38/135)
Snoring and sleep apnea are chronic conditions. This article describes the use of cobalt chrome mandibular advancement appliances as a long-term, robust addition to the appliances used to treat these conditions. The clinical indications, appliance design, construction stages and special features of using cast alloy bases are described. (+info)
Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint.
(39/135)
Snoring and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are often treated with mandibular repositioning splints (MRS), but the efficacy and satisfaction of them has not been comprehensively addressed. A survey on the use of and satisfaction with MRS was posted to 177 patients referred by a hospital orthodontic department for custom-fitting of a MRS. Data were analysed using non-parametric techniques. The response rate was 81% (n=144). Responders (30F, 114M) had mean (SD) age of 51 (11) years, apnoea+hypopnoea index (AHI) of 24 (21) per hr and Epworth Score of 10 (5) at diagnosis, and had been supplied with their MRS a median 7 (IQR 5-11) months previously. Fifty of the 144 patients (35%) had been offered continuous positive airway pressure (CPAP) treatment but had declined or abandoned this. Self-reported MRS use was 5 (2) h/night, with 74 of the 144 patients (51%) continuing to use MRS at least occasionally at a median 7 months after fitting. Survival analysis showed 12% still using MRS at 12 months. Epworth score fell slightly with MRS therapy [-2.4 (3.5); P=0.005] and 7 daytime and 2 nocturnal symptoms improved in MRS users (all P<0.05). Marital satisfaction did not change with MRS. Problems preventing MRS use in 70 non-users included: non-retention (n=12), sore mouth (n=13) or jaw (n=7), difficulties falling asleep (n=10) or breathing (n=7), excessive salivation (n=4), dental damage (n=4) and other problems (n=3). Continued use of MRS therapy was associated with a higher number of teeth, low marital satisfaction perceived by partners and greater improvement in symptoms reported by patients and partners. Continuance with MRS may be low and linked to tolerance problems. (+info)
A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study.
(40/135)
This prospective, randomized, crossover study of 16 patients with obstructive sleep apnoea (OSA) [12 males, four females; median body mass index (BMI) 29.2 kg/m(2) (range 23.8-51.1); median age 44.8 years (range 24.0-68.4)] analysed the efficacy of the Twin Block (TB) in relation to the Herbst appliance as a mandibular advancement splint (MAS). Each subject was fitted with a TB and Herbst MAS in a random order with a washout period of 2 weeks between appliances. Once each patient was subjectively happy with the performance of each appliance, questionnaires and a visual analogue scale (VAS) were used to determine differences in snoring, daytime sleepiness, quality of life, side-effects of the appliances and patient preference. All patients underwent overnight domiciliary sleep recordings prior to and after fitting each appliance in order to objectively assess sleep quality in terms of the apnoea-hypopnoea index (AHI), snoring frequency and arterial oxygen saturation. The results suggested that there was no difference in the treatment performance of the TB and Herbst MAS for AHI (P = 0.71), snoring frequency (P = 0.49), arterial blood oxygen saturation (P = 0.97), quality of life and side-effects. The Herbst MAS proved to be the more effective appliance for reducing daytime sleepiness (P = 0.04) and was the more popular appliance among the patients. Side-effects with both appliances were minor and improved in the longer term. The TB MAS represents a viable alternative to the Herbst MAS in the treatment of patients with OSA. (+info)