Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea

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Abstract
The aims of this study were to investigate possible orthodontic side‐effects following the use of mandibular advancement devices (MAD) in adults with snoring and sleep apnoea. A second objective was to analyse the effect of the appliance design. Seventy‐five patients treated with MAD and 17 reference patients were studied at follow‐up after 2.5 ± 0.5 years. In the test group, 47 patients were provided with soft elastomeric devices, while the remaining 28 patients received hard acrylic devices. The treatment induced a change in overjet of −0.4 ± 0.8 mm (mean ± SD) and a change in overbite of −0.4 ± 0.7 mm (mean ’ SD). These changes were larger than those found in the reference group (P < 0.01). The odds ratio (OR) for the largest quartile of reduction in overjet was 3.8 in patients using hard acrylic devices compared with those using soft elastomeric devices (P < 0.05). A large reduction in overjet in patients using the hard acrylic devices was unrelated to the degree of mandibular protrusion by the device. The OR for a large reduction in overjet in patients using the soft elastomeric devices with a protrusion of 6 mm or above was 6.8 compared with smaller mandibular protrusions (P < 0.05). The results indicate that the orthodontic side‐effects are small during the treatment of adult subjects with MAD for snoring and sleep apnoea, especially in patients using soft elastomeric devices with mandibular protrusions of less than 6 mm. The follow‐up of patients treated with MAD is recommended, as individual patients may experience marked orthodontic side‐effects.

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