Long-term use of mandibular advancement devices for the treatment of obstructive sleep apnea: A systematic review of craniofacial changes


Objective: The aim of this study is to identify the craniofacial changes of long term use of Mandibular Advancement Devices (MAD) for Obstructive Sleep Apnea (OSA) treatment trough a systematic review of the literature.

Materials and methods: A systematic review was performed assessing the following electronic databases: PubMed, EBSCOhost, The Cochrane Library and EMBASE,between January 2000 and May 2014, human studies and english language. Inclusion and exclusion criteria were applied to the results. Selected articles were evaluated with the use of an international check list related to the type of the study (CONSORT). A classification of the level of evidence and the degree of recommendation were performed trough the SORT strategy.

Results: 1383 articles were identified after the initial search. After applying the criteria selection and complete the check list selected (CONSORT) only 1 study fulfilled the inclusion criteria. A classification of the level of evidence and grade of recommendation were performed by using the SORT strategy to the selected article.

Conclusions: No enough body of evidence were found in this study to identify the craniofacial changes with the long term use of Mandibular Advancement Devices for the treatment of Obstructive Sleep Apnea.


  • Julian Balanta-Melo Universidad del Valle, Cali Colombia.


Download data is not yet available.


Author Biography

, Universidad del Valle, Cali Colombia.

Profesor Escuela de Odontología; Grupo de Investigación Biomateriales Dentales


1. Panossian L, Daley J. Sleep-disordered breathing. Continuum (Minneap Minn). 2013; 19(1 Sleep Disorders):86-103.

2. Conley RS. Evidence for dental and dental specialty treatment of obstructive sleep apnoea. Part 1: the adult OSA patient and Part 2: the paediatric and adolescent patient. J Oral Rehabil 2011; 38(2):136-56.

3. Kendzerska T, Mollayeva T, Gershon AS, Leung RS, Hawker G, Tomlinson G. Untreated obstructive sleep apnea and the risk for serious long-termadverse outcomes: A systematic review. Sleep Med Rev 2014; 18(1):49-59.

4. Bista SR, Barkoukis TJ. Medical disorders impacted by obstructive sleep apnea. Dent Clin North Am 2012; 56(2):373-86.

5. Zamarron C, García Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008; 19(6):390-8.

6. Barewal RM, Hagen CC., Management of snoring and obstructive sleep apnea with mandibular repositioning appliances: a prosthodontic approach. Dent Clin North Am 2014; 58(1):159-80.

7. Fleisher KE, Krieger AC. Current trends in the treatment of obstructive sleep apnea. J Oral Maxillofac Surg 2007; 65(10):2056- 68.

8. Schütz TC, Cunha TC, Moura-Guimaraes T, Luz GP, Ackel-D’Elia C, Alves Eda S. Comparison of the effects of continuous positiveairway pressure, oral appliance and exercise trainingin obstructive sleep apnea syndrome. Clinics (Sao Paulo). 2013; 68(8):1168-74.

9. Okuno K, Sato K, Arisaka T, Hosohama K, Gotoh M, Taga H. The effect of oral appliances that advanced the mandibleforward and limited mouth opening in patients withobstructive sleep apnea: A systematic review andmetaanalysis of randomised controlled trials. J Oral Rehabil. 2014; 21.

10. Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. A J Respir Crit Care Med 2013; 187(8):879- 87.

11. Giannasi LC, Almeida FR, Nacif SR, de Oliveira LV. Efficacy of an oral appliance for the treatment of obstructive sleep apnea. Int J Prosthodont 2013; 26(4):334-9.

12. Ngiam J, Balasubramaniam R, Darendeliler MA, Cheng AT, Waters K, Sullivan CE.Clinical guidelines for oral appliance therapy in thetreatment of snoring and obstructive sleep apnoea. Aust Dent J 2013; 58(4):408-19.

13. Almeida FR, Lowe AA. Principles of oral appliance therapy for the management of snoring and sleep
disordered breathing. Oral Maxillofac Surg Clin North Am 2009; 21(4):413-20.

14. Chen H, Lowe AA., Updates in oral appliance therapy for snoring and obstructive sleep apnea, Sleep Breath. 2013 May;17(2):473-86.

15. Wiens JP, Priebe JW. Occlusal stability, Dent Clin North Am 2014; 58(1):19-43. 16. Bidra AS. Evidence-based prosthodontics: fundamental considerations, limitations, and guidelines, Dent Clin North Am 2014; 58(1):1-17.

17. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health careinterventions: explanation and elaboration. PLoS Med 2009; 6(7):e1000100.

18. Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004; 69(3):548-56.

19. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ. CONSORT 2010 explanation and
elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340:c869.

20. Ang HC, Dreyer C, A comparison of dental changes produced by mandibular advancement splints in the management of obstructive sleep apnoea. Aust Orthod J 2010; 26(1):66-72.

21. Martínez-Gomis J, Willaert E, Nogues L, Pascual M, Somoza M, Monasterio C. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 2010; 80(1):30-6.

22. Ghazal A, Jonas IE, Rose EC. Dental side effects of mandibular advancement appliances - a 2-year follow up. J Orofac Orthop 2008; 69(6):437-47.

23. Chen H, Lowe AA, de Almeida FR, Fleetham JA, Wang B. Three-dimensional computer-assisted study model analysis of long-term oral-appliance wear. Part 2. Side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod Dentofacial Orthop 2008; 134(3):408-17.

24. Ueda H, Almeida FR, Lowe AA, Ruse ND., Changes in occlusal contact area during oral appliance therapy assessed on study models, Angle Orthod. 2008 Sep;78(5):866-72.

25. Hammond RJ, Gotsopoulos H, Shen G, Petocz P, Cistulli PA, Darendeliler MA. A follow-up study of dental and skeletal changes associated with mandibular advancement splint use in obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2007; 132(6):806-14.

26. Hou HM, Sam K, Hägg U, Rabie AB, Bendeus M, Yam LY. Long-term dentofacial changes in Chinese obstructive sleep apnea patients after treatment with a mandibular advancement device. Angle Orthod 2006; 76(3):432-40.

27. Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2006; 129(2):214-21.

28. Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Longterm sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis. Am J Orthod Dentofacial Orthop
2006; 129(2):205-13.

29. Almeida FR, Lowe AA, Sung JO, Tsuiki S, Otsuka R. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis. Am J Orthod Dentofacial Orthop 2006; 129(2):195-204.

30. Fransson AM, Tegelberg A, Johansson A, Wenneberg B. Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: a 2-year follow-up. Am J Orthod Dentofacial Orthop 2004; 126(6):687-93.

31. Monteith BD., Altered jaw posture and occlusal disruption patterns following mandibular advancement
therapy for sleep apnea: a preliminary study of cephalometric predictors. Int J Prosthodont 2004;17(3):274-80.

32. Robertson C, Herbison P, Harkness M. Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients. Eur J Orthod 2003; 25(4):371-6.

33. Ringqvist M, Walker-Engström ML, Tegelberg A, Ringqvist I. Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study. Am J Orthod Dentofacial Orthop 2003; 124(1):53-60.

34. Fransson A. A mandibular protruding device in obstructive sleep apnea and snoring, Swed Dent J Suppl 2003; 163:1- 49.

35. Marklund M, Franklin KA, Persson M. Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea, Eur J Orthod 2001; 23(2):135-44.

36. Clark GT, Sohn JW, Hong CN. Treating obstructive sleep apnea and snoring: assessment of an anterior mandibular positioning device, J Am Dent Assoc 2000; 131(6):765-71.

37. BondemarkL ,LindmanR . Craniomandibular status and function in patients with habitual snoring and obstructive sleep apnoea after nocturnal treatment with a mandibular advancement splint: a 2-year follow up. Eur J Orthod 2000; 22(1):53-60.

38. Gong X, Zhang J, Zhao Y, Gao X., Long-term therapeutic efficacy of oral appliances in treatment of obstructive sleep apnea-hypopnea syndrome. Angle Orthod 2013; 83(4):653-8.

39. Rose EC, Staats R, Virchow C Jr, Jonas IE. Occlusal and skeletal effects of an oral appliance in the treatment of obstructive sleep apnea. Chest 2002; 122(3):871-7.

40. Robertson CJ. Dental and skeletal changes associated with long-term mandibular advancement. Sleep 2001; 24(5):531-7.

41. Li W, Xiao L, Hu J., The comparison of CPAP and oral appliances in treatment of patients with OSA: a systematic review and meta-analysis. Respir Care 2013; 58(7):1184-95.

42. Doff MH, Finnema KJ, Hoekema A, Wijkstra PJ, de Bont LG, Stegenga B. Long-term oral appliance therapy in obstructive sleep apneasyndrome: a controlled study on dental side effects. Clin Oral Investig 2013; 17(2):475 82.

43. Doff MH, Hoekema A, Pruim GJ, Huddleston Slater JJ, Stegenga B. Longterm oral-appliance therapy in obstructive sleep apnea:A cephalometric study of craniofacial changes. J Dent 2010; 38(12):1010-8.

44. Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH,Meinesz AF, de Bont LG. Obstructive sleep apnea therapy. Journal of Dental Research 2008; 87:882-7.

45. http://www.controlled-trials.com/ ISRCTN18174167. 46. Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston SlaterJJ, de Bont LG. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 2013; 36(9):1289- 96.

47. Türp JC, Greene CS, Strub JR. Dental occlusion: a critical reflection on past, present andfuture concepts. J Oral Rehabil. 2008; 35(6):446-53

48. Sánchez-Ayala A, Campanha NH, Garcia RC. Relationship between body fat and masticatory function. J Prosthodont. 2013; 22(2):120-5.

49. Nikolopoulou M, Ahlberg J, Visscher CM, Hamburger HL, Naeije M, Lobbezoo F. Effects of occlusal stabilization splints on obstructive sleep apnea: a randomized controlled trial. J Orofac Pain. 2013; 27(3):199-205.

50. Jokstad A. Methodological challenges in the study of dental occlusion. J Oral Rehabil 2012; 39(7):480-8.

51. Nallamuthu NA, Braden M, Patel MP. Some aspects of the formulation of alginate dental impression materialssetting characteristics and mechanical properties. Dent Mater 2012; 28(7):756-62.
| 298 |
How to Cite
Balanta-Melo, J. (2017). Long-term use of mandibular advancement devices for the treatment of obstructive sleep apnea: A systematic review of craniofacial changes. Revista Estomatología, 22(2), 35-45. https://doi.org/10.25100/re.v22i2.5780
Systematic Review - Meta-Analysis

Most read articles by the same author(s)