Knappe S W, Bakke M, Svanholt P, Petersson A, Sonnesen L
Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Section of Oral Medicine (Clinical Oral Physiology), Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Oral Rehabil. 2017 May;44(5):354-362. doi: 10.1111/joor.12485. Epub 2017 Feb 2.
Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3-6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analysed as long term (T0-T3, n = 14) and short term (T0-T2, n = 24) by t-test, Fisher's exact test and anova. Both long- and short-term analyses revealed a reduction in AHI (P < 0·002). Significant long term were increased scores in the NOT-S Interview (P < 0·045), reduced vertical overbite (P < 0·031) and increased jaw protrusive movement (P < 0·027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short term as a decrease and subsequent recurrence (P < 0·053; P < 0·037). No significant radiological changes were found. In conclusion, MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups.
长期使用下颌前移装置（MAD）治疗阻塞性睡眠呼吸暂停（OSA）以增加上呼吸道空间的患者，可能会因睡眠时下颌前突位置而导致颞下颌关节（TMJ）和口面部功能发生变化。本研究旨在探讨长期MAD治疗对颞下颌关节、口面部功能和咬合的影响。这项前瞻性研究纳入了30名男性和13名女性（中位年龄54岁）的OSA患者[呼吸暂停低通气指数（AHI）：7 - 57]。他们接受了北欧口面部测试筛查（NOT - S）、颞下颌关节紊乱病研究诊断标准（RDC/TMD）以及颞下颌关节的锥形束计算机断层扫描（CBCT）检查。检查在MAD治疗前（T0）、治疗开始后3 - 6个月（T1，无CBCT）、1年（T2）和3年（T3）进行。通过t检验、Fisher精确检验和方差分析对结果进行长期（T0 - T3，n = 14）和短期（T0 - T2，n = 24）分析。长期和短期分析均显示AHI降低（P < 0.002）。长期来看，NOT - S访谈得分显著增加（P < 0.045），垂直覆牙合减小（P < 0.031），下颌前突运动增加（P < 0.027）。发现颞下颌关节变化表现为关节弹响，即往复性弹响和摩擦音，短期内先减少随后复发（P < 0.053；P < 0.037）。未发现明显的影像学变化。总之，MAD治疗对一些OSA患者有益，但可能会引起颞下颌关节、口面部功能和咬合的变化。然而，通过仔细的调整、控制和随访，这些变化似乎比之前报道的危害更小。
