Venema, J.A.M. (Uniken) (2015) Dental side-effects of long-term oral appliance therapy in patients with obstructive sleep apnea syndrome. thesis, Dentistry.
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Abstract
Background: Obstructive sleep apnea syndrome (OSAS) is a sleep related breathing disorder which is characterized by partial or complete obstructions of the upper airway during sleep. People with OSAS often experience excessive daytime sleepiness. OSAS occurs more in elderly and people with a high BMI. Treatment of OSAS includes lifestyle changes, Continuous Positive Airway Pressure (CPAP), Oral Appliances (OA’s) and surgery. In the present study two oral appliances were compared with CPAP therapy. CPAP works by a nasal mask which applies positive air pressure whereby the airway is opened and breathing is not interrupted. The oral appliances work by pulling the lower jaw and the tongue bases forward, thereby decreasing the upper airway resistance. Two different types of oral appliances were used in the present study, the Somnodent and the Thornton Adjustable Positioner (TAP) oral appliance. Aim: The aim of this study is to assess possible dental side-effects associated with long-term use of the Somnodent oral appliance in patients with OSAS. These side-effects were compared with the results of a previous randomized trial comparing the TAP and the CPAP. The objective is to evaluate which oral appliance therapy is, the treatment with the fewest dental side effects. Materials and Methods: Thirty-one OSAS patients that use the Somnodent appliance, were matched with patients from the previously randomized trial by Doff et al. The patients were selected from the Centrum Bijzondere Tandheelkunde (CBT) at the University Medical Center Groningen (UMCG) and from the department of Oral and Maxillofacial Surgery from the Tjongerschans Hospital Heerenveen. All patients were required to have been using the Somnodent appliance for a period of 2 to 3 years. From each patient alginate impressions were made of the upper and lower dental arches. Plaster casts were made from the alginate impressions and compared with pretreatment models on differences in occlusion pattern and tooth movement. The outcomes were analyzed and compared to the outcomes, of the TAP and the CPAP group, from the previous randomized trial. Statistical analyses were performed using SPSS. The means, standard deviations and significance levels were reported. Paired Student’s t-tests were performed to compare the pre- and post-treatment variables of the Somnodent. ANOVA tests were done at baseline and at follow-up to analyze the difference between the CPAP, the TAP and the Somnodent groups. Results: Except for the BMI, the baseline characteristics of the Somnodent, TAP and CPAP group do not differ significantly. Some of the dental variables at follow-up showed significant differences at baseline and follow-up. The number of Occlusal contact points in the (pre)molar region showed a significant difference from baseline to follow-up in all treatment modalities, but did not differ significantly between the different treatment modalities. Contrary the delta overbite and the anterior-posterior movement showed a significant difference between the TAP and the CPAP and between the TAP and the Somnodent. In addition, both the TAP and the Somnodent group showed a mesial shift of the lower arch to a more Angle Class III occlusion. Conclusion: In conclusion, there are significant dental changes in overjet and anterior-posterior movement between the baseline and follow-up in the Somnodent, TAP and CPAP group. However these changes were less pronounced in the Somnodent and CPAP group when compared with the TAP group. Therefore it appears from dental perspective the oral appliance of first choice, which causes the fewest dental side effects, is the Somnodent.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Stellingsma, Dhr. C. |
| Supervisor name: | Hoekema, Dhr. A. and Tjongerschans, Heerenveen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1012 |
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