Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil.
Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
Sleep Breath. 2024 Oct;28(5):2283-2294. doi: 10.1007/s11325-024-03093-2. Epub 2024 Jul 24.
This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response.
23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion.
The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response.
MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.
本研究旨在主要评估使用锥形束计算机断层扫描（CBCT）的下颌骨髁突和患者对 MAD 治疗的反应。此外，本研究还提出分析髁突位置、OSA 严重程度和下颌前突的变化是否会影响患者的反应。
本研究纳入 23 例被诊断为轻/中度 OSA 并接受 MAD 治疗的患者。在基线时和使用 MAD 进行治疗性前伸（使用 MAD 4-6 个月）时进行临床、CBCT 和 PSG 评估。在基线和治疗性前伸时评估髁突位置的垂直和水平方向。
MAD 使髁突位置发生显著变化，表现为前（7.3 ± 2.8 毫米；p < 0.001）和下（3.5 ± 1 毫米；p < 0.001）移位。轻度 OSA 的患者需要更多的前伸（p = 0.02）才能改善。有反应者的基线髁突前位明显突出（p = 0.04）。治疗反应与基线髁突前位（p = 0.03；r = -0.4）以及 OSA 严重程度与治疗性前伸所需最大前伸百分比（p = 0.02；r = -0.4）之间存在中度负相关。治疗反应与基线时的髁突位置之间存在中度负相关（p = 0.03；r = -0.4），而 OSA 严重程度与治疗性前伸所需的最大前伸百分比之间也存在中度负相关（p = 0.02；r = -0.4）。患者的前伸量不能预测髁突位置的变化。髁突位置、OSA 严重程度和治疗性前伸均不能预测 MAD 治疗反应。
MAD 导致髁突前下移位，前伸量不能预测髁突位置的变化。有反应者的基线髁突位置更靠前。OSA 严重程度和下颌前突不能预测治疗反应。
