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  • 1
    Online Resource
    Online Resource
    The effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnoea in adults: a methodological quality assessment of systematic reviews
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Orthodontics Vol. 42, No. 5 ( 2020-11-03), p. 483-493
    Details
    In: European Journal of Orthodontics, Oxford University Press (OUP), Vol. 42, No. 5 ( 2020-11-03), p. 483-493
    Abstract: There is growing interest in the use of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnoea (OSA). Many systematic reviews (SRs) have investigated their effectiveness, but the applicability of SR results is affected by their methodological quality. This study critically appraises the methodological quality of SRs on this topic using a more detailed and updated version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Materials and methods The literature was searched for SRs on MAD effectiveness in adults (≥18 years of age) for OSA treatment as compared with other non-surgical or surgical interventions or no intervention. Any objective or subjective measures of treatment outcome were considered eligible. AMSTAR2 was used to assess methodological quality. Results The literature search yielded 64 potential reports; 10 met the eligibility criteria. All SRs had more than one critical flaw in AMSTAR2, so their methodological quality was rated as critically low. The most common issues included non-registration of study protocol, absence of list of excluded studies, no acknowledgment of fundings of included studies, no impact of risk of bias on SR results or interpretation and discussion of results, and data extraction not in duplicate. Limitations If a SR was not clearly identified by title or abstract as a SR or meta-analysis, it may have been missed during the screening process. Conclusions The methodological quality of SRs was suboptimal and warrants further improvement in order to provide strong evidence of MAD effectiveness and increase applicability of SR results for clinical decision-making.
    Type of Medium: Online Resource
    ISSN: 0141-5387 , 1460-2210
    URL: Article
    DOI: 10.1093/ejo/cjz065
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 1466699-6
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  • 2
    Online Resource
    Online Resource
    Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta‐analysis and meta‐regression
    Wiley ; 2022
    In:  Journal of Oral Rehabilitation Vol. 49, No. 5 ( 2022-05), p. 553-572
    Details
    In: Journal of Oral Rehabilitation, Wiley, Vol. 49, No. 5 ( 2022-05), p. 553-572
    Abstract: Mandibular advancement devices (MADs) are used as an alternative to continuous positive airways pressure to treat obstructive sleep apnoea (OSA) patients, but to date, specific data on the adherence to MAD therapy are lacking. Objectives The aim of the present systematic review was to investigate the dropout rate and adherence of OSA patients to different custom‐made (CM) and non‐custom‐made (NCM) MAD therapies. Search Methods An electronic search was performed in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, LILACS and Web of Science. Selection Criteria Randomised controlled trials (RCTs) assessing the compliance to customised and not customised MADs in the treatment of adult OSA patients were included. Data Collection and Analysis The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in RCT. The dropout rate of each study was computed and the adherence to MAD therapy in terms of hours per night and nights per week was extracted from each study. Results Thirty‐two RCTs were included. The risk of bias resulted low in most of the studies. The GRADE scores indicated that the quality of evidence was from very low to moderate. The meta‐analyses showed that the mean dropout rate did not significantly differ between CM and NCM MADs: The overall mean dropout rate was 0.171 [0.128–0.213] with a mean follow‐up of 4.1 months. The hours per night adherence was significantly higher for CM MADs (6.418 [6.033–6.803] ) compared to NCM MADs (5.107 [4.324–5.890]. The meta‐regression showed that the dropout rate increases significantly during time ( p  〈  .05). Conclusions There is a very low to moderate quality of evidence that the dropout rate of MAD therapy is similar among CM and NCM MADs, that the dropout rate increases significantly during time and that CM MADs have higher hours per night adherence compared with NCM MAD. Registration The study protocol was registered on PROSPERO (n. CRD42020199866).
    Type of Medium: Online Resource
    ISSN: 0305-182X , 1365-2842
    URL: Issue
    URL: Article
    DOI: 10.1111/joor.v49.5
    DOI: 10.1111/joor.13290
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2007587-X
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  • 3
    Online Resource
    Online Resource
    Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Orthodontics Vol. 42, No. 4 ( 2020-09-11), p. 434-440
    Details
    In: European Journal of Orthodontics, Oxford University Press (OUP), Vol. 42, No. 4 ( 2020-09-11), p. 434-440
    Abstract: Surgically assisted rapid maxillary expansion (SARME) is a surgical technique developed to correct transverse discrepancies in skeletally mature patients. However, there is limited evidence concerning the immediate skeletal and dental changes obtained only due to SARME. Objective The aim of the present systematic review is to investigate the immediate skeletal and dental effects of SARME in adult patients with transverse maxillary hypoplasia. Search Methods An electronic search of the literature in MEDLINE, The Cochrane Library, Lilacs and Scopus databases was performed. Selection Criteria Only randomized controlled trials (RCTs) studies investigating the skeletal and dental effects of SARME procedures in adult patients were included. Data Collection and Analysis The included studies received a methodological quality scoring according to the revised Cochrane risk-of-bias tool for randomized trials. The quality of evidence was assessed by means of the Grading Recommendation Assessment, Development and Evaluation (GRADE) system. For each included study and for each analysed parameter, the difference in means and 95 per cent confidence interval was calculated between baseline and immediate post-expansion. A meta-analysis of original outcome data, if possible, was conducted. Results Nine articles were selected. The methodological quality ratings indicated that one study was at low risk of bias, seven presented some concerns and only one was at high risk of bias. In all the included studies, the SARME procedure resulted in a significant expansion of the maxillary transverse dimension. The meta-analysis compared skeletal and dental inter-molar width before and after treatment: the mean difference was of 3.3 mm (2.8–3.9) and 7.0 mm (6.1–7.8), respectively (P-value less than 0.001). The quality of evidence was low-moderate. Conclusions SARME is effective in obtaining a significant expansion of the maxillary transverse dimension. However, the immediate SARME effect is mainly a molar expansion rather than a pure bone transverse widening of the maxilla. Registration The review protocol was registered at PROSPERO database with the registration number CRD42018117967.
    Type of Medium: Online Resource
    ISSN: 0141-5387 , 1460-2210
    URL: Article
    DOI: 10.1093/ejo/cjz057
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 1466699-6
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  • 4
    Online Resource
    Online Resource
    The Effect of Different Archwires on Initial Orthodontic Pain Perception: A Prospective Controlled Cohort Study
    MDPI AG ; 2023
    In:  Applied Sciences Vol. 13, No. 8 ( 2023-04-14), p. 4929-
    Details
    In: Applied Sciences, MDPI AG, Vol. 13, No. 8 ( 2023-04-14), p. 4929-
    Abstract: The early stages of orthodontic treatment are frequently associated with pain that can vary in intensity and duration, representing one of the main reasons for treatment discontinuation. Whilst the use of drugs is recognised as being effective to control orthodontic pain, there are no reliable data indicating the best first archwire for efficacy and minimum discomfort. A prospective controlled cohort study was conducted to compare the intensity and the characteristics of orthodontic pain during the first 15 days of treatment with 2 archwires. Fifty subjects were enrolled and divided into two groups: one received 0.012 inch stainless steel (SS) as the first archwire; the other, a 0.014 inch super-elastic nickel–titanium (Ni-Ti) archwire. Patients compiled a visual analogue scale to measure pain intensity over 15 days, a questionnaire for pain characteristics, the Somatosensory Amplification Scale and the State-Trait Anxiety Inventory to control the psychosocial component of pain. Dental casts were digitally analysed to evaluate the initial arch length discrepancy. In the first 3 days of treatment, the mean VAS values of the SS group were significantly lower than those of the Ni-Ti group (p 〈 0.05). No significant differences emerged between the groups concerning pain characteristics. The 0.012 inch SS archwire could be used at the beginning of orthodontic treatment to minimise pain perception and improve compliance.
    Type of Medium: Online Resource
    ISSN: 2076-3417
    URL: Article
    DOI: 10.3390/app13084929
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2704225-X
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  • 5
    Online Resource
    Online Resource
    Is There a Relationship Between Obstructive Sleep Apnea Severity and Dental Arch Form in Adult Patients? An Observational Retrospective Study
    American Academy of Dental Sleep Medicine ; 2022
    In:  Journal of Dental Sleep Medicine Vol. 9, No. 4 ( 2022-10-10)
    Details
    In: Journal of Dental Sleep Medicine, American Academy of Dental Sleep Medicine, Vol. 9, No. 4 ( 2022-10-10)
    Type of Medium: Online Resource
    ISSN: 2333-9756
    URL: Article
    DOI: 10.15331/jdsm.7262
    Language: Unknown
    Publisher: American Academy of Dental Sleep Medicine
    Publication Date: 2022
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  • 6
    Online Resource
    Online Resource
    Effectiveness of different mandibular advancement device designs in obstructive sleep apnoea therapy: A systematic review of randomised controlled trials with meta‐analysis
    Wiley ; 2021
    In:  Journal of Oral Rehabilitation Vol. 48, No. 4 ( 2021-04), p. 469-486
    Details
    In: Journal of Oral Rehabilitation, Wiley, Vol. 48, No. 4 ( 2021-04), p. 469-486
    Abstract: Mandibular advancement devices (MADs) are used to treat patients with obstructive sleep apnoea (OSA). To date, there are no data that identify the most effective MAD design for apnoea‐hypopnea index (AHI) reduction. The purpose of this systematic review is to investigate the effectiveness of different MAD designs in AHI reduction and oxygen saturation improvement in OSA patients. An electronic search was performed in MEDLINE, Cochrane Database, Scopus, Web of Knowledge and LILACS. Randomised controlled trials (RCTs) investigating the reduction of AHI on adult patients wearing MAD for OSA were included. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in randomised controlled trial. The success rate of each study was computed: [(mean baseline AHI − mean AHI after treatment)/mean baseline AHI]. Fifty RCTs were included. The risk of bias resulted with some concerns in most of the studies. The GRADE scores indicated that the quality of evidence was very low. The meta‐analysis showed a success rate with mono‐bloc and duo‐bloc MADs respectively of 0.821 [0.722‐0.887] and 0.547 [0.443‐0.637]. The mono‐bloc compared with duo‐bloc better improved the minimum oxygen saturation (10.048 [7.733‐12.363] and 3.357 [2.290‐4.423], respectively). There is a very low quality body of evidence that mono‐bloc MADs are more effective in reducing AHI and improving minimum oxygen saturation compared with duo‐bloc MADs. The study protocol was registered on PROSPERO (n. CRD42019118084).
    Type of Medium: Online Resource
    ISSN: 0305-182X , 1365-2842
    URL: Issue
    URL: Article
    DOI: 10.1111/joor.v48.4
    DOI: 10.1111/joor.13077
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 7
    Online Resource
    Online Resource
    The Effect of Bite Raise on AHI Values in Adult Patients Affected by OSA: A Systematic Review with Meta-Regression
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 11 ( 2023-05-23), p. 3619-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 11 ( 2023-05-23), p. 3619-
    Abstract: Obstructive sleep apnea (OSA) is a highly prevalent sleep breathing disorder characterized by the collapse of the pharyngeal walls that entails recurrent episodes of cessation of breathing or decrease in airflow while sleeping. This results in sleep fragmentation, decreased oxygen saturation and an increase in the partial pressure of carbon dioxide, causing excessive daytime sleepiness, hypertension and increased prevalence of cardiovascular morbidity and mortality. Mandibular advancement devices (MAD) represent a valid alternative therapy to Continuous Positive Airway Pressure, thrusting the mandible forward, increasing the lateral diameter of the pharynx and reducing the collapsibility of the airway. Several investigations have focused on the detection of the best mandibular advancement amount in terms of effectiveness and tolerance, but few and contrasting data are available on the role of occlusal bite raise in reducing the apnea/hypopnea index (AHI). The aim of this systematic review with meta-regression analysis was to investigate the effect of the bite raise of MAD on AHI values in adult patients affected by OSA. An electronic search was performed in MEDLINE, the Cochrane Database, Scopus, Web of Science and LILACS. Randomized controlled trials (RCT) investigating the effectiveness of MAD in OSA patients were included. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias with the Cochrane risk-of-bias tool for randomized trials (RoB2). Six RCT were included. The success rate of each study was computed: (mean baseline AHI − mean post treatment AHI)/mean baseline AHI. The GRADE scores indicated that the quality of evidence was very low. The meta-regression analysis showed that there was no correlation between the occlusal bite raise and the AHI improvement.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12113619
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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