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

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.

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.

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.

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.