title: Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects.
abstract: OBJECTIVE
  This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy.
  
  
  METHODS
  As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables.
  
  
  RESULTS
  Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior-posterior change in the occlusion (-1.3 ± 1.5 mm) in the oral appliance group compared to the CPAP group (-0.1 ± 0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (β) = -0.02, 95 % confidence interval (-0.04 to -0.00)].
  
  
  CONCLUSIONS
  Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur.
  
  
  CONCLUSIONS
  Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands. m.h.j.doff@umcg.nl
authors.forename: M H J
authors.initials: MH
authors.lastname: Doff
authors.forename: K J
authors.initials: KJ
authors.lastname: Finnema
authors.forename: A
authors.initials: A
authors.lastname: Hoekema
authors.forename: P J
authors.initials: PJ
authors.lastname: Wijkstra
authors.forename: L G M
authors.initials: LG
authors.lastname: de Bont
authors.forename: B
authors.initials: B
authors.lastname: Stegenga
mesh_terms: D001641:Bicuspid / Q000473:pathology; D045422:Continuous Positive Airway Pressure; D003481:Cuspid / Q000473:pathology; D003766:Dental Occlusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007574:Jaw Relation Record / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008310:Malocclusion / Q000145:classification / Q000209:etiology; D008334:Mandible / Q000473:pathology; D019186:Mandibular Advancement / Q000295:instrumentation; D008875:Middle Aged; D003765:Models, Dental; D009967:Orthodontic Appliances / Q000009:adverse effects; D057887:Overbite / Q000145:classification / Q000473:pathology; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D012913:Snoring / Q000628:therapy