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Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review.

Alessandri-Bonetti G, Ippolito DR, Bartolucci ML, D'Antò V, Incerti-Parenti S - Korean J Orthod (2015)

Bottom Line: Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters.Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment.To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.

View Article: PubMed Central - PubMed

Affiliation: Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

ABSTRACT

Objective: The 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.

Methods: The MEDLINE, Google Scholar, Scopus, and Cochrane Library databases were searched through December 2014. Reference lists from the retrieved publications were also examined. English language studies published in international peer-reviewed journals concerning the predictive value of cephalometric analysis for MAD treatment outcome were considered for inclusion. Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies.

Results: Fifteen eligible studies were identified. Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters.

Conclusions: Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment. To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.

No MeSH data available.


Related in: MedlinePlus

Flow chart of literature search and study selection.
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Figure 1: Flow chart of literature search and study selection.

Mentions: The electronic database search and the review of the relevant publication reference lists yielded 939 potentially relevant titles and abstracts after duplicates were removed from a total of 1,034 records. Following the first phase of evaluation, 907 publications were rejected based on the title and the abstract. One further study was excluded because full text was not obtained by searching paper and digital format sources, nor after attempting to contact the authors by e-mail correspondence.13 In the second phase, analysis of the full text of the remaining 31 studies led to the exclusion of 16 additional publications. Fifteen studies were therefore selected for the systematic review.589101415161718192021222324 The relevant data from each study are reported in Table 2. The PRISMA flow diagram (Figure 1) shows the number of articles reviewed in each phase of this systematic review.25


Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review.

Alessandri-Bonetti G, Ippolito DR, Bartolucci ML, D'Antò V, Incerti-Parenti S - Korean J Orthod (2015)

Flow chart of literature search and study selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664907&req=5

Figure 1: Flow chart of literature search and study selection.
Mentions: The electronic database search and the review of the relevant publication reference lists yielded 939 potentially relevant titles and abstracts after duplicates were removed from a total of 1,034 records. Following the first phase of evaluation, 907 publications were rejected based on the title and the abstract. One further study was excluded because full text was not obtained by searching paper and digital format sources, nor after attempting to contact the authors by e-mail correspondence.13 In the second phase, analysis of the full text of the remaining 31 studies led to the exclusion of 16 additional publications. Fifteen studies were therefore selected for the systematic review.589101415161718192021222324 The relevant data from each study are reported in Table 2. The PRISMA flow diagram (Figure 1) shows the number of articles reviewed in each phase of this systematic review.25

Bottom Line: Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters.Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment.To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.

View Article: PubMed Central - PubMed

Affiliation: Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.

ABSTRACT

Objective: The 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.

Methods: The MEDLINE, Google Scholar, Scopus, and Cochrane Library databases were searched through December 2014. Reference lists from the retrieved publications were also examined. English language studies published in international peer-reviewed journals concerning the predictive value of cephalometric analysis for MAD treatment outcome were considered for inclusion. Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies.

Results: Fifteen eligible studies were identified. Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters.

Conclusions: Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment. To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.

No MeSH data available.


Related in: MedlinePlus