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

Area of Science:

• Dental Sleep Medicine
• Respiratory Medicine
• Prosthodontics

Background:

• Mandibular advancement devices (MADs) are alternatives to CPAP for obstructive sleep apnea syndrome (OSAS), but tooth retention is a traditional contraindication.
• Edentulism affects up to 37.8% of aging populations, limiting MAD use.
• No synthesis exists on MAD efficacy in edentulous or partially edentulous patients.

Purpose of the Study:

• To systematically review the efficacy of modified MADs in patients with OSAS who have insufficient teeth.
• To evaluate outcomes including apnea-hypopnea index (AHI), oxygen saturation, and patient-reported outcomes.

Main Methods:

• A PRISMA-compliant systematic review searched multiple databases (Embase, PubMed, Cochrane, Web of Science, LILACS).
• Included studies assessed modified MADs (over edentulous ridges, teeth/mucosa, or dentures) in OSAS patients with insufficient teeth.
• Excluded patients who had surgical treatment like dental implants.

Main Results:

• Eighteen studies with 49 patients were included.
• Modified MADs significantly reduced AHI by 75.2% (from 22.39 to 5.55 events/h).
• Efficacy was consistent across different types of edentulism and MAD designs.

Conclusions:

• Modified MADs are effective for OSAS in patients with insufficient teeth, challenging previous contraindications.
• These devices offer an alternative for CPAP-intolerant patients.
• Larger randomized controlled trials are needed to confirm findings.