Modified Mandibular Advancement Device Is Effective in Patients With Insufficient Teeth: A Systematic Review.

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of oral rehabilitation Pub Date : 2025-09-25 DOI:10.1111/joor.70061

Chee Weng Yong, Bernadette Quah, Qi-Yan Chung, Mei Na Tan, Frank Kong Fei Lee, Raymond Chung Wen Wong

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引用次数: 0

Abstract

Background: Mandibular advancement devices (MADs) are established alternatives to continuous positive airway pressure (CPAP) for obstructive sleep apnea syndrome (OSAS), particularly valued for better patient compliance. Traditional contraindications include insufficient healthy teeth for retention, affecting a significant portion of patients due to global edentulism rates of up to 37.8% in ageing populations. Despite emerging reports challenging this, no synthesis exists on MAD efficacy in edentulous or partially edentulous patients.

Methods: This PRISMA-compliant systematic review (PROSPERO: CRD420251078741) searched Embase, PubMed, Cochrane, Web of Science, and LILACS from inception to June 25, 2025. OSAS patients with insufficient teeth, treated with modified MADs (over edentulous ridges, teeth/mucosa, or dentures) were included. Patients are excluded if they had surgical treatment (i.e., dental implants) as part of their care. Outcomes assessed include: apnea-hypopnea index (AHI), oxygen saturation and patient-reported outcome measures (PROMs). Risk of bias was assessed using the JBI checklist and ROBINS-I.

Results: Eighteen studies (3 prospective cohort studies, 15 case reports; n = 49 patients) were included. In general, modified MADs were effective in treating OSAS when evaluating AHI, lowest oxygen saturation and PROMs. The mean AHI reduced from 22.39 ± 12.08 events/h to 5.55 ± 3.60 events/h after treatment (75.2% reduction). Similar efficacy was noted when comparing patients with bimaxillary edentulous ridge, edentulous ridge in only 1 arch and patients with bimaxillary partial edentulism. The same finding was observed when comparing MADs over teeth/mucosa and over dentures.

Conclusions: Modified MADs appeared effective in traditionally contraindicated patients, challenging prior guidelines and offering options for CPAP-intolerant individuals with insufficient teeth. Larger RCTs are needed for confirmation.

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改良下颌前移装置对缺牙患者有效：系统回顾。

背景：下颌推进装置（MADs）是阻塞性睡眠呼吸暂停综合征（OSAS）患者持续气道正压通气（CPAP）的替代方案，尤其具有更好的患者依从性。传统的禁忌症包括没有足够的健康牙齿用于固位，由于全球老龄人口的假牙率高达37.8%，这影响了很大一部分患者。尽管新出现的报道对这一观点提出了质疑，但目前还没有关于MAD在无牙或部分无牙患者中的疗效的综合研究。方法：这项符合prisma标准的系统评价（PROSPERO: CRD420251078741）检索了Embase、PubMed、Cochrane、Web of Science和LILACS，检索时间从成立到2025年6月25日。包括牙齿不足的OSAS患者，使用改良的MADs（无牙嵴，牙齿/粘膜或假牙）治疗。如果患者在治疗过程中接受过手术治疗（即植牙），则不包括在内。评估的结果包括：呼吸暂停低通气指数（AHI）、氧饱和度和患者报告的结果测量（PROMs）。使用JBI检查表和ROBINS-I评估偏倚风险。结果：纳入18项研究（3项前瞻性队列研究，15例病例报告，n = 49例患者）。总的来说，在评估AHI、最低血氧饱和度和PROMs时，改性MADs治疗OSAS是有效的。治疗后平均AHI从22.39±12.08事件/小时降低到5.55±3.60事件/小时（降低75.2%）。比较双颌无牙嵴患者、仅1个牙弓无牙嵴患者和双颌部分全牙患者的疗效相似。当比较MADs在牙齿/粘膜和假牙上的效果时，也观察到同样的结果。结论：改良的MADs对传统禁忌患者有效，挑战了先前的指南，并为牙齿不足的cpap不耐受患者提供了选择。需要更大的随机对照试验来证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.