title: Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review.
abstract: OBJECTIVE
  To evaluate the effectiveness of mandibular advancement appliances (MAAs) for treatment of pediatric obstructive sleep apnea (OSA).
  
  
  METHODS
  Several electronic databases (The Cochrane Database, EMBASE, Healthstar, MEDLINE, PubMed) were systematically searched, as well as a limited grey literature (Google Scholar) and manual searches. A health sciences librarian helped with the selection of Medical Subject Headings (MeSH), key words, and combinations of key words with truncations to account for any differences in controlled terminology in the different databases. Only studies that evaluated the effects of MAAs in children with OSA were pursued.
  
  
  RESULTS
  Only 4 articles satisfied all inclusion criteria. Selected studies were retrospective except one study that was a quasi-randomized clinical trial. High risk of bias (Cochrane Risk of Bias assessment) was judged in all included studies. Based on the limited available evidence use of MAAs in a POSA population may result in improvements in Apnea Hypopnea Index (AHI) scores. However complete normalization of AHI scores was not demonstrated. Heterogeneity in study designs and collected information precluded meta-analysis.
  
  
  CONCLUSIONS
  There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Determination of AHI scores with MAAs still in the mouth should be avoided.
  
  
  CONCLUSIONS
  The current limited evidence may be suggestive that MAAs result in short-term improvements in AHI scores, but it is not possible to conclude that MMAs are effective to treat pediatric OSA. Medium- and long-term assessments are still required.
authors: *Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. and.
authors: Natasha
authors: N
authors: Nazarali
authors: *Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. and.
authors: Mostafa
authors: M
authors: Altalibi
authors: Health Sciences (Hons) Programme, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors: Samir
authors: S
authors: Nazarali
authors: *Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. and.
authors: Michael P
authors: MP
authors: Major
authors: *Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. and cf1@ualberta.ca.
authors: Carlos
authors: C
authors: Flores-Mir
authors: *Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. and.
authors: Paul W
authors: PW
authors: Major
mesh_terms: D015982:Bias; D002648:Child; D006801:Humans; D019186:Mandibular Advancement / Q000295:instrumentation*; D016382:Orthodontic Appliance Design; D020181:Sleep Apnea, Obstructive / Q000628:therapy*