title: Does propulsion mechanism influence the long-term side effects of oral appliances in the treatment of sleep-disordered breathing?
abstract: BACKGROUND
  Mandibular advancement appliances (MAAs) can be used to treat sleep-disordered breathing, and differences in their designs have been thought to influence the occurrence of secondary effects. With bibloc devices, the lateral attachments producing mandibular propulsion can be inserted to generate traction or compression. We evaluated the clinical impact of this difference by comparing the long-term secondary effects and compliance of two devices.
  
  
  METHODS
  One hundred sixty-two records of patients fitted with a traction-based or compression-based MAA before January 2008 were reviewed retrospectively for physical examination findings and cephalometry. Patients were sent a postal survey and contacted by phone 2 weeks later. They were offered a follow-up medical visit with repeat cephalometry. Main outcomes were long-term (> 2 years) secondary effects, compliance, or satisfaction.
  
  
  RESULTS
  Of the patients who attended the follow-up visit, 48 had worn the MAA for > 2 years (16 traction based and 32 compression based), and nine for < 6 months (used as control subjects). Mean follow-up times for the traction and compression groups were 3.7 ± 1.2 years and 3.6 ± 1.2 years, respectively. No difference was found between the MAAs for subjective and objective side effects, except for greater early pain to the masticatory muscles (P = .02) and residual tongue pain (P = .04) in the compression group. However, pain intensity was low and clinical relevance was uncertain. No difference was found for compliance, satisfaction, and objective or subjective efficacy.
  
  
  CONCLUSIONS
  This study suggests that traction-based appliances are similar to compression-based devices with regard to secondary effects and compliance.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Suresnes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vezina
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Suresnes, France.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Blumen
authors.affiliation: Department of Stomatology, Foch Hospital, Suresnes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Buchet
authors.affiliation: Department of Neurology, Foch Hospital, Suresnes, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Hausser-Hauw
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Suresnes, France. Electronic address: f.chabolle@hopital-foch.org.
authors.forename: Frederic
authors.initials: F
authors.lastname: Chabolle
mesh_terms: D002508:Cephalometry; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D010808:Physical Examination; D017286:Polysomnography; D011474:Prosthesis Design; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires