1,721,070 research outputs found
Periodontal Side Effect During Orthopedic Face Mask Therapy
No full textA 7-year-old patient exhibited gingival recession of tooth #41 and severe plaque accumulation after 3 months of face mask therapy. The recession improved only slightly after appropriate oral hygiene instructions and motivation. Decisive improvement began when the vertical chin pad extension was reduced to avoid pressure on the affected area
APPARATO DI AVANZAMENTO E MISURA E METODO DI RILEVAZIONE PER RILEVARE UNA POSIZIONE MODIFICATA IN AVANZAMENTO DELLA MANDIBOLA
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Oral appliances for obstructive sleep apnea
No full textImportance: Obstructive sleep apnea (OSA) is a major public health issue that can have serious medical consequences. Although continuous positive airways pressure (CPAP) is currently the first-line treatment for OSA, there is increasing evidence on the effectiveness of oral appliances (OAs) which show higher treatment adherence compared with CPAP. This review focuses on indications, effectiveness and side effects of treatment with OAs in adult OSA patients. The role of dentists in the multidisciplinary diagnosis and management of OSA is also discussed and the most up-to-date scientific evidence for an evidence-based clinical decision-making process is summarized. Observations: Qualified dentists in dental sleep medicine can screen patients for OSA using questionnaires and evaluating the presence of anatomic risk factors during routine examinations. Sleep physicians confirm the diagnosis of OSA, determine whether treatment is indicated and may recommend OAs. Qualified dentists evaluate patients for suitability of OAs and begin therapy with the proper device. A collaborative follow-up should be performed during treatment, with patients being periodically monitored by sleep physicians for objective sleep testing and, also, by qualified dentists for OA adjustment and management of any side effect. Conclusion and Relevance: Custom-made and titratable OAs are indicated for adult OSA patients who do not tolerate or who are not good candidates for CPAP. A multidisciplinary approach allows to establish the least possible amount of mandibular advancement while achieving the highest reduction of OSA severity, thus optimizing the treatment effectiveness, reducing the occurrence of side effects and decreasing the risk of treatment discontinuation
Die Anwendung von Protrusionsschienen zur Behandlung des obstruktiven Schlafapnoe-Syndroms bei erwachsenen Patienten The use of oral appliances in the treatment of obstructive sleep apnea syndrome in adult patients
No full textObstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial closure of the upper airway during sleep leading to sleep fragmentation and oxygen desaturation. This sleep-related breathing disorder is associated with daytime sleepiness, impaired quality of life, poor work performance, neurocognitive decline, increased risk of motor vehicle accidents and, in the long term, an increased risk of cardio-vascular disease and mortality. Nasal continuous positive airway pressure (nCPAP) maintains a positive pressure in the upper airway through a nose mask worn during sleep and is currently the most effective treatment option for OSA patients. Nevertheless, adherence to this therapy is low. The availability of alternative treatment options is therefore of the utmost importance. Mandibular advancement devices (MADs), which hold the mandible forward with the aim of preventing collapse of the upper airway during sleep provide a less invasive, more comfortable, and less costly treatment alternative for patients with mild to moderate OSA who do not tolerate, do not respond to, or are not appropriate candidates for treatment with nCPAP. Forward repositioning of the mandible increases the upper airway volume, widens the lateral dimension of the velopharynx, it stretches tongue muscles counteracting tongue's retrolapse during sleep, and it moves the hyoid bone anteriorly and stabilizes epiglottis and soft palate preventing the posterior rotation of the jaw. The therapy with a mandibular advancement device (MAD) represents a treatment option to obtain this anterior jaw repositioning. In this article, we will review the indications, the efficacy, the role in the clinical practice and the adverse effects of MADs for the management of OSA
Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review
No full textThe efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnea (OSA) ranges between 42% and 65%. However, it is still unclear which predictive factors can be used to select suitable patients for MAD treatment. This study aimed to systematically review the literature on the predictive value of cephalometric analysis for MAD treatment outcomes in adult OSA patients
The Effects of Mandibular Advancement Device on Pressure Pain Threshold of Masticatory Muscles: A Prospective Controlled Cohort Study
No full textAIMS:
To determine if pressure pain thresholds (PPTs) of masticatory and neck muscles change after the application of a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA).
METHODS:
A prospective study was conducted in a sample of 27 OSA patients (24 males and 3 females; mean age ± standard deviation [SD]: 54.8 ± 11.8, mean apnea-hypopnea index ± SD: 23.5 ± 13.3) and 27 age- and sex-matched healthy controls. Exclusion criteria were signs and symptoms of temporomandibular disorders (TMD), metabolic diseases, and use of antidepressants, analgesics, or anti-inflammatory drugs. A calibrated examiner evaluated PPTs of seven head and neck muscles bilaterally by using a Fischer algometer. In the OSA group, PPTs were recorded immediately before the MAD application (T0), after 15 days (T1), and after 6 months (T2) of therapy; in the control group, PPTs were recorded at the same time intervals. PPT differences at baseline and over time within each group and between OSA and control groups were analyzed by Friedman and Mann-Whitney tests.
RESULTS:
There were no PPT differences between groups at baseline. In the OSA group, PPTs of temporalis and masseter muscles decreased significantly at T1 compared with T0 (P < .05), but no differences were found at T2. No significant PPT differences were found in the neck muscles or over time in the control group.
CONCLUSION:
MAD application induces a decrease of PPTs of masticatory muscles at the beginning of the therapy, but a physiologic adaptation occurs by 6 months
Effects of thread shape on the pullout strength of miniscrews
No full textIntroduction: The aim of this study was to determine the effects of variations in thread shape on the axial pullout strength of orthodontic miniscrews. Methods: A total of 35 miniscrews, 7 of each design being considered, were tested by performing pullout tests on a synthetic bone support. We used self-tapping and self-drilling miniscrews having a diameter of 2 mm and a thread shaft length of 12 mm (the longest and the largest supplied by the manufacturer). A buttress reverse thread shape served as the control design and was tested against 4 experimental designs, each manufactured with a modification in thread shape while maintaining all other characteristics. The experimental groups had the following thread designs: buttress, 75° joint profile, rounded, and trapezoidal. Results: The control group with a buttress reverse thread shape had consistently higher pullout strength values than did the other designs. A statistically significant reduction in pullout force was found between the buttress reverse and the buttress thread miniscrews. Conclusions: Thread design influenced the resistance to pullout of the orthodontic miniscrews. The buttress reverse thread shape provided the greatest pullout strength. © 2012 by the American Association of Orthodontists
Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials
No full textBACKGROUND:
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
The effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnoea in adults: a methodological quality assessment of systematic reviews
No full textBACKGROUND AND OBJECTIVES:
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
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