Bartolucci Maria Lavinia, Bortolotti Francesco, Martina Stefano, Corazza Giulia, Michelotti Ambra, Alessandri-Bonetti Giulio
Section of Orthodontics, Department of Biomedical Sciences, University of Bologna, Bologna, Italy.
Section of Orthodontics, Department of Neurosciences, University of Naples "Federico II", Naples, Italy.
Eur J Orthod. 2019 Jan 23;41(1):89-100. doi: 10.1093/ejo/cjy036.
Mandibular advancement devices (MAD) are effective in reducing apnea episodes and they are frequently used as first-line therapy in obstructive sleep apnea (OSA) patients.
The MAD must be used every night for a lifetime and since it performs its function discharging the forces on dental elements the aim of this systematic review was to identify the dental and skeletal long-term side effects of MAD therapy and to evaluate the influence of time on them in OSA or snoring patients.
An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, Scopus, and LILACS. Studies until 4 April 2018 were analysed, without language restrictions.
Randomized controlled trials and cohort studies investigating dental and/or skeletal side effects on adult patients wearing MAD for OSA or snoring treatment with at least 2 years follow-up were included and independently evaluated by two investigators.
The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by means of Cochrane's tools. For each study included and for each dental and/or skeletal parameter, the difference in means and 95% CI was calculated between baseline and follow-up.
Twenty-one studies with follow-up between 2 and 11 years were included. The side effects reported were a reduction in overjet, overbite, and in the upper incisor inclination, and an increase in lower incisor inclination, A point-Nasion-B point, and anterior facial height. The meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). The quality of evidence was low/moderate.
MAD therapy produces time-related dental and skeletal side effects. After a long period of treatment, the dental side effects are clinically relevant and therefore the clinician should inform the patients about this issue. Since the side effects are progressive, patients need to be continuously monitored over time.
The study protocol was not registered.
下颌前移装置（MAD）在减少呼吸暂停发作方面有效，并且经常被用作阻塞性睡眠呼吸暂停（OSA）患者的一线治疗方法。
MAD必须每晚使用一生，并且由于它通过对牙齿部件施加力来发挥其功能，因此本系统评价的目的是确定MAD治疗的牙齿和骨骼长期副作用，并评估时间对OSA或打鼾患者的这些副作用的影响。
在MEDLINE、Cochrane数据库、谷歌学术测试版、Scopus和LILACS中进行了电子检索。分析了截至2018年4月4日的研究，无语言限制。
纳入对佩戴MAD治疗OSA或打鼾的成年患者进行牙齿和/或骨骼副作用调查的随机对照试验和队列研究，随访至少2年，并由两名研究人员独立评估。
使用推荐分级评估、制定和评价（GRADE）对证据质量进行评估，并通过Cochrane工具评估偏倚风险。对于纳入的每项研究以及每个牙齿和/或骨骼参数，计算基线和随访之间的均值差异和95%置信区间。
纳入了21项随访时间为2至11年的研究。报告的副作用包括覆盖减小、覆牙合减小、上切牙倾斜度减小，以及下切牙倾斜度增加、A点-鼻根点-B点和前面高增加。元回归分析表明，所有参数的副作用均受治疗持续时间的影响（P<0.05）。证据质量为低/中。
MAD治疗会产生与时间相关的牙齿和骨骼副作用。经过长期治疗后，牙齿副作用在临床上具有相关性，因此临床医生应告知患者这一问题。由于副作用是渐进性的，需要对患者进行长期持续监测。
本研究方案未注册。
