title: Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients.
abstract: OBJECTIVE
  To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients.
  
  
  METHODS
  Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05.
  
  
  RESULTS
  At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011).
  
  
  CONCLUSIONS
  A larger sample size could increase the generalizability of the findings.
  
  
  CONCLUSIONS
  MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.
authors.affiliation: Department of Orthodontics, School of Dentistry, University of Bologna.
authors.forename: Giulio
authors.initials: G
authors.lastname: Alessandri-Bonetti
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.|Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: D'Antò
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.
authors.forename: Chiara
authors.initials: C
authors.lastname: Stipa
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rongo
authors.affiliation: Department of Orthodontics, School of Dentistry, University of Bologna.
authors.forename: Serena
authors.initials: S
authors.lastname: Incerti-Parenti
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.
authors.forename: Ambrosina
authors.initials: A
authors.lastname: Michelotti
mesh_terms: D000328:Adult; D000368:Aged; D002508:Cephalometry / Q000379:methods; D003735:Dental Casting Technique; D005260:Female; D006801:Humans; D007180:Incisor / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008312:Malocclusion, Angle Class II / Q000209:etiology / Q000473:pathology; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation*; D008437:Maxilla / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D057887:Overbite / Q000209:etiology / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012913:Snoring / Q000628:therapy*