title: Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review.
abstract: OBJECTIVE
  The efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnea (OSA) ranges between 42% and 65%. However, it is still unclear which predictive factors can be used to select suitable patients for MAD treatment. This study aimed to systematically review the literature on the predictive value of cephalometric analysis for MAD treatment outcomes in adult OSA patients.
  
  
  METHODS
  The MEDLINE, Google Scholar, Scopus, and Cochrane Library databases were searched through December 2014. Reference lists from the retrieved publications were also examined. English language studies published in international peer-reviewed journals concerning the predictive value of cephalometric analysis for MAD treatment outcome were considered for inclusion. Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies.
  
  
  RESULTS
  Fifteen eligible studies were identified. Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters.
  
  
  CONCLUSIONS
  Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment. To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.
authors.affiliation: Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Alessandri-Bonetti
authors.affiliation: Department of Orthodontics, University of Brescia, Brescia, Italy.
authors.forename: Daniela Rita
authors.initials: DR
authors.lastname: Ippolito
authors.affiliation: Department of Neuroscience, Reproductive Science and Oral Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Maria Lavinia
authors.initials: ML
authors.lastname: Bartolucci
authors.affiliation: Department of Neuroscience, Reproductive Science and Oral Science, University of Naples "Federico II", Naples, Italy. ; Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: D'Antò
authors.affiliation: Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Incerti-Parenti
keywords: Mandibular advancement; Obstructive sleep apnea, Cephalometry