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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie

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01.01.2015 | Original article

Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects

verfasst von: B. Piskin, PhD, O. Karakoc, MD, H. Genc, MD, S. Akay, MD, C. Sipahi, PhD, M. Erdem, MD, B. Karaman, MD, S. Gorgulu, PhD, S. Yetkin, MD, S. Ayyildiz, PhD

Erschienen in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie | Ausgabe 1/2015

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Abstract

Introduction

Despite numerous studies investigating the dimensional and therapeutic effects of mandibular advancement splints (MASs), data regarding the effects of differently designed individual and non-adjustable MASs on the upper airway in fully dentate apneic subjects in the sagittal plane including comparison of these effects with a placebo device are sparse. The present study aimed to determine the dimensional changes in the sagittal plane created by differently designed MASs in the upper airway in fully dentate apneic subjects and to compare these changes with the effects of a placebo device.

Materials and methods

Magnetic resonance (MR) images of 9 dentate apneic subjects with 5 differently designed MASs and without a MAS were obtained. We measured the area of the entire pharynx (velopharynx, oropharynx, hypopharynx) on these MR images and compared the dimensional changes.

Results

The dimensional changes triggered by two specific MASs (75 % of the maximum mandibular protrusion with 5 mm vertical opening, and 75 % of the maximum mandibular protrusion with 10 mm of vertical opening) in the entire pharynx in the sagittal plane were statistically significant compared to the other MASs (p < 0.05). The MAS effecting 75 % of the maximum mandibular protrusion and 10 mm of vertical opening created a significant dimensional increase only in the velopharyngeal area among the three pharyngeal sites (p ≤ 0.003).

Conclusion

While the degree of mandibular protrusion created by the MAS affects the dimensions of the upper airway, the degree of the vertical opening exerts no significant dimensional effect in the sagittal plane in fully dentate apneic patients. The mandibular protrusion effect is comparatively larger in the velopharyngeal region.

Aarab G, Lobbezoo F, Hamburger HL, Naeije M (2010) Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig 14(3):339–345PubMedCrossRef

Ahrens A, McGrath C, Hagg U (2011) A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnea. Eur J Orthod 33(3):318–324PubMedCrossRef

Arisaka H, Sakuraba S, Tamaki K et al (2009) Effects of wearing complete dentures during sleep on the apnea/hypopnea index. Int J Prosthodont 22(2):173–177PubMed

Ash SP, Smith AM (2004) Chrome cobalt mandibular advancement appliances for managing snoring and obstructive sleep apnea. J Orthod 31(4):295–299PubMedCrossRef

Baik UB, Suzuki M, Ikeda K et al (2002) Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea syndrome. Angle Orthod 72(2):124–134PubMed

Barthlen GM, Brown LK, Wiland MR et al (2000) Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome. Sleep Med 1(4):299–305PubMedCrossRef

Boudewyns A, Marklund M, Hochban W (2007) Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances. Eur Respir Rev 16(106):132–145CrossRef

Campbell AJ, Reynolds G, Trengrove H, Neill AM (2009) Mandibular advancement splint titration in obstructive sleep apnoea. Sleep Breath 13(2):157–162PubMedCrossRef

Chan AS, Lee RW, Cistulli PA (2007) Dental appliance treatment for obstructive sleep apnea. Chest 132(2):693–699PubMedCrossRef

10.

Chan AS, Lee RW, Srinivasan VK et al (2010) Nasopharyngoscopic evaluation of oral appliance therapy for obstructive sleep apnoea. Eur Respir J 35(4):836–842PubMedCrossRef

11.

Chan AS, Sutherland K, Schwab RJ et al (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65(8):726–732PubMedCrossRef

12.

Choi JK, Goldman M, Koyal S, Clark G (2000) Effect of jaw and head position on airway resistance in obstructive sleep apnea. Sleep Breath 4(4):163–168PubMedCrossRef

13.

Choi JK, Hur YK, Lee JM, Clark GT (2010) Effects of mandibular advancement on upper airway dimension and collapsibility in patients with obstructive sleep apnea using dynamic upper airway imaging during sleep. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109(5):712–719PubMedCrossRef

14.

Choi JK, Kee WC, Lee JM, Ye MK (2001) Variable site of oropharyngeal narrowing and regional variations of oropharyngeal collapsibility among snoring patients during wakefulness and sleep. Cranio 19(4):252–259PubMed

15.

Cistulli PA, Gotsopoulos H, Marklund M, Lowe AA (2004) Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances. Sleep Med Rev 8(6):443–457PubMedCrossRef

16.

De Almeida FR, Bittencourt LR, Almeida CI de et al (2002) Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance. Sleep 25(5):505–511

17.

Douglass JB, Meader L, Kaplan A, Ellinger CW (1993) Cephalometric evaluation of the changes in patients wearing complete dentures: a 20-year study. J Prosthet Dent 69(3):270–275PubMedCrossRef

18.

Epstein LJ, Kristo D, Strollo PJ Jr et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276PubMed

19.

Eveloff SE, Rosenberg CL, Carlisle CC, Millman RP (1994) Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med 149(4 Pt 1):905–909PubMedCrossRef

20.

Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29(2):244–262PubMed

21.

Ferguson KA, Fleetham JA (1995) Consequences of sleep disordered breathing. Thorax 50(9):998–1004PubMedCentralPubMedCrossRef

22.

Ferguson KA, Love LL, Ryan CF (1997) Effect of mandibular and tongue protrusion on upper airway size during wakefulness. Am J Respir Crit Care Med 155(5):1748–1754PubMedCrossRef

23.

Gao X, Otsuka R, Ono T et al (2004) Effect of titrated mandibular advancement and jaw opening on the upper airway in nonapneic men. A magnetic resonance imaging and cephalometric study. Am J Orthod Dentofacial Orthop 125(5):191–199PubMedCrossRef

24.

George PT (2001) Selecting sleep disordered – breathing appliances. Biomechanical considerations. J Am Dent Assoc 132(3):339–347PubMedCrossRef

25.

Gotsopoulos H, Chen C, Qian J, Cistulli PA (2002) Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. Am J Respir Crit Care Med 166(5):743–748PubMedCrossRef

26.

Hans MG, Nelson S, Luks VG et al (1997) Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS). Am J Orthod Dentofacial Orthop 111(5):562–570PubMedCrossRef

27.

Haskell JA, McCrillis J, Haskell BS et al (2009) Effects of mandibular advancement device (MAD) on airway dimensions assessed with cone-beam computed tomography. Semin Orthod 15:132–158CrossRef

28.

Henke KG, Frantz DE, Kuna ST (2000) An oral elastic mandibular advancement device for obstructive sleep apnea. Am J Respir Crit Care Med 161:420–425PubMedCrossRef

29.

Hiyama S, Tsuiki S, Ono T et al (2003) Effects of mandibular advancement on supine airway size in normal subjects during sleep. Sleep 26(4):440–445PubMed

30.

Hudgel DW (1996) Treatment of obstructive sleep apnea. A review. Chest 109(5):1346–1358PubMedCrossRef

31.

Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

32.

Isono S, Tanaka A, Tagaito Y et al (1997) Pharyngeal patency in response to advancement of the mandible in obese anesthetized persons. Anesthesiology 87(5):1055–1062PubMedCrossRef

33.

Karakoc O, Akcam T, Gerek M et al (2012) The upper airway evaluation of habitual snorers and obstructive sleep apnea patients. ORL J Otorhinolaryngol Relat Spec 74(3):136–140PubMedCrossRef

34.

Kochel J, Meyer-Marcotty P, Sickel F et al (2013) Short-term pharyngeal airway changes after mandibular advancement surgery in adult Class-II-Patients-a three dimensional retrospective study. J Orofac Orthop 74(2):137–152PubMedCrossRef

35.

Kuna ST, Remmers JE (1985) Neural and anatomic factors related to upper airway occlusion during sleep. Med Clin North Am 69(6):1221–1242PubMed

36.

Kyung SH, Park YC, Pae EK (2005) Obstructive sleep apnea patients with the oral appliance experience pharyngeal size and shape changes in three dimensions. Angle Orthod 75(1):15–22PubMed

37.

L’Estrange PR, Battagel JM, Harkness B et al (1996) A method of studying adaptive changes of the oropharynx to variation in mandibular position in patients with obstructive sleep apnoea. J Oral Rehabil 23(10):699–711CrossRef

38.

Lamont J, Baldwin DR, Hay KD, Veale AG (1998) Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea. Eur J Orthod 20(3):293–297PubMedCrossRef

39.

Lee CH, Kim JW, Lee HJ et al (2009) An investigation of upper airway changes associated with mandibular advancement device using sleep videofluoroscopy in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 135(9):910–914PubMedCrossRef

40.

Liu Y, Zeng X, Fu M et al (2000) Effects of a mandibular repositioner on obstructive sleep apnea. Am J Orthod Dentofacial Orthop 118(3):248–256PubMedCrossRef

41.

Lowe AA, Santamaria JD, Fleetham JA, Price C (1986) Facial morphology and obstructive sleep apnea. Am J Orthod Dentofacial Orthop 90(6):484–491PubMedCrossRef

42.

Mehta A, Qian J, Petocz P et al (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163(6):1457–1461PubMedCrossRef

43.

Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163(2):540–577PubMedCrossRef

44.

Mostafiz W, Dalci O, Sutherland K et al (2011) Influence of oral and craniofacial dimensions on mandibular advancement splint treatment outcome in patients with obstructive sleep apnea. Chest 139(6):1331–1339PubMedCrossRef

45.

Pitsis AJ, Darendeliler MA, Gotsopoulos H (2002) Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 166(6):860–864PubMedCrossRef

46.

Poon KH, Chay SH, Chiong KF (2008) Airway and craniofacial changes with mandibular advancement device in Chinese with obstructive sleep apnoea. Ann Acad Med Singapore 37(8):637–644PubMed

47.

Rose E, Staats R, Virchow C, Jonas IE (2002) A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod 24(2):191–198PubMedCrossRef

48.

Ryan CF, Love LL, Peat D et al (1999) Mandibular advancement oral appliance therapy for obstructive sleep apnoea: effect on awakecalibre of the velopharynx. Thorax 54(11):972–977PubMedCentralPubMedCrossRef

49.

Sam K, Lam B, Ooi CG et al (2006) Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea. Respir Med 100(5):897–902PubMedCrossRef

50.

Sanner B, Heise M, Knoben B et al (2002) MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome. Eur Respir J 20(1):143–150PubMedCrossRef

51.

Schwab RJ, Pasirstein M, Pierson R et al (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168(5):522–530PubMedCrossRef

52.

Stepnowsky CJ, Moore PJ (2003) Nasal CPAP treatment for obstructive sleep apnea developing a new perspective on dosing strategies and compliance. J Psychosom Res 54(6):599–605PubMedCrossRef

53.

Tsuiki S, Almeida FR, Lowe AA et al (2005) The interaction between changes in upright mandibular position and supine airway size in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 128(4):504–512PubMedCrossRef

54.

Tsuiki S, Hiyama S, Ono T et al (2001) Effects of a titrable oral appliance on supine airway size in awake non-apneic individuals. Sleep 24(5):554–560PubMed

55.

Unger JW (1990) Comparison of vertical morphologic measurements on dentulous and edentulous patients. J Prosthet Dent 64(2):232–234PubMedCrossRef

56.

Vroegop AV, Vanderveken OM, Van de Heyning PH, Braem MJ (2012) Effects of vertical opening on pharyngeal dimensions in patients with obstructive sleep apnoea. Sleep Med 13(3):314–316PubMedCrossRef

57.

Walker-Engström ML, Ringqvist I, Vestling O et al (2003) A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea. Sleep Breath 7(3):119–130PubMedCrossRef

58.

Warunek SP (2004) Oral appliance therapy in sleep apnea syndromes: a review. Semin Orthod 10:73–89CrossRef

59.

Zhang W, Song X, Masumi SI et al (2011) Effects of head and body positions on 2- and 3-dimensional configuration of the oropharynx with jaw protruded: a magnetic resonance imaging study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111(6):778–784PubMedCrossRef

60.

Zhao X, Liu Y, Gao Y (2008) Three-dimensional upper-airway changes associated with various amounts of mandibular advancement in awake apnea patients. Am J Orthod Dentofacial Orthop 133(5):661–668PubMedCrossRef

Titel: Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects
verfasst von: B. Piskin, PhD
O. Karakoc, MD
H. Genc, MD
S. Akay, MD
C. Sipahi, PhD
M. Erdem, MD
B. Karaman, MD
S. Gorgulu, PhD
S. Yetkin, MD
S. Ayyildiz, PhD
Publikationsdatum: 01.01.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie / Ausgabe 1/2015
Print ISSN: 1434-5293
Elektronische ISSN: 1615-6714
DOI: https://doi.org/10.1007/s00056-014-0259-z

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Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects

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