Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications.
OBJECTIVE
To determine the variation in prevalence of temporomandibular disorders (TMD), other side effects, and technical complications during 5 years of sleep apnea treatment with a mandibular advancement device.


METHODS
Forty patients diagnosed with obstructive sleep apnea received an adjustable appliance at 70% of the maximum protrusion. The protrusion was then progressively increased. TMD (diagnosed according to the Research Diagnostic Criteria for TMD), overjet, overbite, occlusal contacts, subjective side effects, and technical complications were recorded before and a mean of 14, 21, and 58 months after treatment and analyzed by the Wilcoxon test (P < .05).


RESULTS
Fifteen patients still used the oral appliance at the 5-year follow-up, and no significant variation in TMD prevalence was observed. Subjective side effects were common, and a significant reduction was found in overjet, overbite, and in the number of occlusal contacts. Furthermore, the patients made a mean of 2.5 unscheduled dental visits per year and a mean of 0.8 appliance repairs/relines per year by a dental technician. The most frequent unscheduled visits were needed during the first year and were a result of acrylic breakage on the lateral telescopic attachment, poor retention, and other adjustments to improve comfort.


CONCLUSIONS
Five-year oral appliance treatment does not affect TMD prevalence but is associated with permanent occlusal changes in most sleep apnea patients during the first 2 years. Patients seek several unscheduled visits, mainly because of technical complications.
Department of Prosthodontics, Faculty of Dentistry, University of Barcelona, Campus de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. jmartinezgomis@ub.edu
Jordi
J
Martínez-Gomis
Eva
E
Willaert
Lluis
L
Nogues
Maribel
M
Pascual
Maria
M
Somoza
Carmen
C
Monasterio
D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology; D003766:Dental Occlusion; D004868:Equipment Failure; D005157:Facial Pain / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007574:Jaw Relation Record / Q000379:methods; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D016382:Orthodontic Appliance Design; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012913:Snoring / Q000628:therapy; D013674:Technology, Dental; D013705:Temporomandibular Joint Disorders / Q000145:classification / Q000209:etiology; D016896:Treatment Outcome