@article{Bianchi2023h,

title = {Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway.},

author = {Gurgel M and Cevidanes L and Costa F and Pereira R and Cunali P and Bittencourt L and et al},

url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10314553/},

doi = {10.1186/s12903-023-03125-5},

year  = {2023},

date = {2023-06-30},

journal = {BMC Oral Health},

volume = {23},

issue = {436},

abstract = {Background

The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA.



Methods

The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation.



Results

Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and − 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region.



Conclusions

The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.},

keywords = {Cone-beam computed tomography (CBCT), mandibular advancement device, Maxillomandibular advancement, Obstructive sleep apnea, Three-dimensional assessment, Upper airway},

pubstate = {published},

tppubtype = {article}

}

@article{Bianchi2022,

title = {Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes},

author = {Gurgel M and Cevidanes L and Pereira R and Costa F and Ruellas A and Bianchi J adn Cunali P and Bittencourt L and Junior C.C},

url = {https://pubmed.ncbi.nlm.nih.gov/34273012/},

doi = {10.1007/s00784-021-04066-5},

year  = {2022},

date = {2022-01-01},

journal = {Clinical Oral Investigations},

volume = {26},

issue = {1},

pages = {875-887},

abstract = {Objectives: This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes.



Materials and methods: Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied.



Results: Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly.



Conclusions: The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment.



Clinical relevance: The craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.},

keywords = {Airway management, anatomy, Cone-beam computed tomography (CBCT), mandibular advancement device, obstructive, occlusal splints, sleep apnea},

pubstate = {published},

tppubtype = {article}

}