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At least 649 records · Page 36Linked to original sources
PubMed1995

Maxillomandibular advancement surgery in obstructive sleep apnea syndrome patients: long-term surgical stability.

PURPOSE: This study examined the long-term skeletal stability of relatively large maxillomandibular advancement surgery in the treatment of obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: The presurgical, immediate (< 1 month), and long-term (> 12 months) postsurgical cephalometric radiographs of 19 patients undergoing maxillomandibular advancement with simultaneous genioplasty for OSAS were studied. The cephalometric measurements and calculations were performed using a commercial cephalometric software. RESULTS: Maxillary and mandibular advancement seems to be stable in the horizontal and vertical planes over the long term. There was no significant correlation between the amount of surgical advancement and the amount of postsurgical instability, with the exception of gonion in the vertical plane. CONCLUSION: The results from this study indicate that large surgical advancements in OSAS patients result in relatively stable repositioning of the maxilla and mandible over the long term.

Bone Plates↗
PubMed1993

Stability of mandibular constriction with a symphyseal osteotomy.

The purposes of this study are to determine the stability of surgical mandibular constriction with a midline osteotomy and to evaluate the periodontal and temporomandibular joint responses. A symphyseal osteotomy to facilitate mandibular construction was performed in 15 patients to correct transverse discrepancies. At the same time a surgical anterior or posterior repositioning of the mandible was done by using a bilateral sagittal osteotomy of the vertical ramus. Tomograms in the coronal plane including the mandibular second molars were taken preoperatively (T1), immediately postoperatively (T2) and 8 weeks postoperatively (T3). Linear measurements between the cortical borders of the mandible were assessed from the tomograms at each time period. Median surgical and postoperative changes in mandibular width were determined. When evaluating the entire group no statistically significant change in the surgical constriction was found postoperatively (T2 and T3), although there was some individual variability. An examination of the periodontal response at the osteotomy site revealed no statistically significant change between the initial and the 5-month postoperative examinations. No changes in joint noise were detected postoperatively, and all mandibular joint movements returned to preoperative values except for excursive movements. Mandibular constriction with a midline osteotomy on conjunction with a bilateral sagittal osteotomy was found to be a stable modality for correcting transverse disharmonies.

Adolescent↗
PubMed2005

The interaction between changes in upright mandibular position and supine airway size in patients with obstructive sleep apnea.

INTRODUCTION: The purpose of this study was to investigate the interaction between upright mandibular position change and supine upper airway size in men with obstructive sleep apnea fitted with titratable oral appliances. METHODS: Baseline supine cephalometry before placement of the oral appliance and after titration with the oral appliance in place were undertaken in 14 patients, and upright mandibular position change was evaluated with and without the titrated oral appliance in place with a DigiGraph workstation (Dolphin Imaging Systems, Valencia, Calif). RESULTS: The apnea-hypopnea index was significantly reduced after titration of the oral appliance (P < .01). Upright mandibular position change was associated with significant vertical (P < .01) and horizontal (P < .01) mandibular repositioning. The size of the supine velopharynx (P < .05), but not the supine oropharynx, was significantly enlarged at the titrated mandibular position. The supine oropharyngeal size change was correlated with the upright horizontal repositioning of the mandible (r = 0.69, P < .01). CONCLUSIONS: Evaluation of upright mandibular position changes with the DigiGraph workstation enables one to predict supine oropharyngeal enlargement with oral appliance therapy. Dose-dependent effects of the horizontal component of upright mandibular protrusion on supine oropharyngeal size in addition to velopharyngeal enlargement might contribute to oral appliance effectiveness in obstructive sleep apnea patients.

Adult↗
PubMed2006

A comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea.

INTRODUCTION: This retrospective study compared cephalometric variables between responders and nonresponders to a titratable oral appliance (OA) in a group of subjects matched for sex, pretreatment age, and body mass index (BMI). METHODS: Nine nonresponders as defined by an improvement in the apnea hypopnea index (AHI; <20%) and their individually matched responders were selected for this study. The difference in age for each matched pair was +/-5 years, and, for BMI, the difference was +/-15%. The pretreatment AHI was matched to the same category (moderate, >15 to < or =30; severe I, >30 to < or =45; and severe II, >45 AHI). RESULTS: Middle and inferior airway space and oropharyngeal airway cross-sectional area were significantly larger in the nonresponders. Position of the mandible relative to the cervical spine was the only significant skeletal variable and was larger in nonresponders. Changes in BMI between the groups were statistically significant; the averages were a 2.9% increase in the nonresponders and a 0.5% decrease in responders. The wider airway in nonresponders might reflect an enhanced neuromuscular compensation while awake. The weight gain in nonresponders was relatively small, but it might have reduced the effectiveness of the OA. CONCLUSION: When treating OSA patients with OA therapy, clinicians should pay particular attention to airway size and weight changes.

Adult↗
PubMed2006

Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis.

INTRODUCTION: Side effects observed in the occlusion and dental arches of patients using an oral appliance (OA) to treat snoring or sleep apnea for more than 5 years have not yet been investigated. METHODS: Stone casts trimmed in centric occlusion before appliance placement and after an average of 7.4 +/- 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists. RESULTS: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class II Division 1 and Class II Division 2 malocclusions were more likely to have favorable or no changes. More favorable changes in overbite occurred in subjects with large baseline overbites. A greater baseline overjet and more distal mandibular canine relationship were correlated to favorable changes. A greater initial overjet was correlated to a more favorable change, a decrease in mandibular crowding, a smaller change in anterior crossbite, and a greater change in overjet. CONCLUSIONS: OA wear after a mean of 7.4 years induces clinically relevant changes in the dental arch and the occlusion.

Analysis of Variance↗
PubMed2006

A new look at the treatment of Class II Division 2 malocclusions.

This case report illustrates a treatment option for managing a skeletal Class II relationship with a Class II Division 2 malocclusion and impinging overbite. The patient's maxillary first premolars were extracted during unsuccessful orthodontic treatment at age 15. These extractions and the retraction of the maxillary anterior teeth during space closure worsened the facial profile deficiency caused by the original facial skeletal Class II discrepancies. During the retreatment described here, the second premolars were moved into the place of the previously extracted first premolars. The opened spaces at the second premolars were then restored with implant-supported restorations. Lingual brackets were used to correct the severe overbite. This approach created sufficient overjet to correct the Class II skeletal relationship with bisagittal mandibular advancement osteotomy. Reconstruction of the skeletal and occlusal relationships resulted in a more desirable facial profile for this patient.

Adult↗
PubMed2006

Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis.

INTRODUCTION: Oral appliances (OAs) have been widely used to treat snoring and sleep apnea, but their effects on craniofacial structures in patients after 5 years or more of wear have not yet been quantified. METHODS: Seventy-one patients who had worn adjustable mandibular repositioners to treat snoring or sleep apnea were evaluated. Upright lateral cephalometric radiographs in centric occlusion taken before treatment and after a mean of 7.3 +/- 2.1 years of OA use were compared. Baseline sleep studies and patient demographic data were included in the analysis. RESULTS: Cephalometric analyses after long term OA use showed significant (P < .01) changes in many variables, including increases in mandibular plane and ANB angles; decreases in overbite and overjet; retroclined maxillary incisors; proclined mandibular incisors; increased lower facial height; and distally tipped maxillary molars with mesially tipped and erupted mandibular molars. The initial deep overbite group had a significantly greater decrease in overbite. Duration of OA use correlated positively with variables such as decreased overbite and increased mandibular plane angle; changes in the dentition appeared to be progressive over time. CONCLUSIONS: After long-term use, OAs appear to cause changes in tooth positions that also might affect mandibular posture.

Analysis of Variance↗
PubMed2006

Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea.

INTRODUCTION: Orthodontic side effects can complicate the long-term use of mandibular advancement devices (MADs) in the treatment of patients with snoring and obstructive sleep apnea. The aim of this study was to find predictors of dental side effects from monoblock MADs. METHODS: Four hundred fifty patients, who consecutively received treatment with either soft elastomeric or hard acrylic devices, were followed up after 5.4 +/- 0.8 years (mean +/- SD). The continuing patients responded to questionnaires and had dental examinations and plaster casts made. RESULTS: Twenty-seven patients had moved or died during the follow-up period. Two hundred thirty-six of the remaining 423 patients (56%) continued treatment, and 187 of them reported compliance rates of > or = 50% at night. A small reduction in overjet of < 1 mm was associated with a deepbite with an overbite of > 3 mm and an overjet of < or = 3 mm (odds ratio [OR] = 7.5; P = .015), nasal congestion (OR = 2.9; P = .005), or the use of a soft elastomeric device (OR = 2.7; P = .014) controlled for age, sex, treatment time, and mandibular displacement. A small reduction in overbite of < 1 mm was related to a small opening of the mandible of < 11 mm (OR = 2.5; P = .008). CONCLUSIONS: Orthodontic side effects might be predictable on the basis of initial characteristics in dental occlusion and the design of MADs.

Adult↗
PubMed2004

The skeletal stability of one-piece Le Fort 1 osteotomy to advance the maxilla; Part 1. Stability resulting from non-bone grafted rigid fixation.

During the past decade, we have increasingly preferred to do a one-piece Le Fort 1 osteotomy to advance the maxilla, sometimes in isolation to treat patients with maxillary retrusive skeletal Class III patients or combined with mandibular advancement to treat bimaxillary retrusive skeletal Class II. Clinical impressions of rigid fixation techniques have indicated that there is improved stability when compared with wire fixation. There are few studies in the literature that have addressed relapse following one-piece Le Fort 1 osteotomy to advance the maxilla. Such surgery involves one single spatial movement and thereby eliminates other possible surgical variables, which may impact on the degree of stability achievable postoperatively. We studied 45 patients who had undergone a uniform one-piece maxillary advancement with elimination of controllable variables, apart from 15 patients who had simultaneous mandibular advancement. Rigid fixation was adopted throughout the study. The mean surgical change documented was 7.42 mm. The mean stability calculated at 12 months revealed a relapse of 0.72 mm (10%). This was not significant (P = 0.3). We conclude that the Le Fort 1 advancement osteotomy is a stable and surgically predictable procedure that gives only slight relapse at 12 months.

Adolescent↗
PubMed2006

Management of lateral mandibular discontinuity by maxillary guidance.

Balance and symmetry of mandibular function is disturbed by loss of continuity of the mandible, which leads to altered mandibular movements and deviation of the residual fragment, as a consequence of which problems with chewing, swallowing, speech, and aesthetics develop. Methods such as maxillary fixation, and use of mandibular and palatal guidance have been used to reduce or eliminate the mandibular deviation. The aim of this study was to achieve a normal maxillomandibular relation in a patient with mandibular discontinuity. An acceptable maxillomandibular relation was obtained within 3 months with a maxillary guidance ramp prosthesis.

Adolescent↗
PubMed2007

Joint intracapsular disorders: diagnostic and nonsurgical management considerations.

This article reviews common intracapsular temporomandibular disorders encountered in the dental practice. It begins with a brief review of normal temporomandibular joint anatomy and function followed by a description of the common types of disorders known as internal derangements. The etiology, history, and clinical presentation of each are reviewed. Nonsurgical management is presented based on current long-term scientific evidence.

Humans↗
PubMed2007

Myogenous temporomandibular disorders: diagnostic and management considerations.

Myogenous temporomandibular disorders (or masticatory myalgia) are characterized by pain and dysfunction that arise from pathologic and functional processes in the masticatory muscles. There are several distinct muscle disorder subtypes in the masticatory system, including myofascial pain, myositis, muscle spasm, and muscle contracture. The major characteristics of masticatory myalgia include pain, muscle tenderness, limited range of motion, and other symptoms (eg, fatigability, stiffness, subjective weakness). Comorbid conditions and complicating factors also are common and are discussed. Management follows with stretching, posture, and relaxation exercises, physical therapy, reduction of contributing factors, and as necessary, muscle injections.

Analgesics↗