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The International Journal of Prosthodontics

Edited by George A. Zarb, BChD, DDS, MS, MS, FRCD(C)

ISSN 0893-2174

May/June 2004
Volume 17 , Issue 3

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Altered Jaw Posture and Occlusal Disruption Patterns Following Mandibular Advancement Therapy for Sleep Apnea: A Preliminary Study of Cephalometric Predictors

Brian D. Monteith, BChD, MChD

Pages: 274280
PMID: 15237871

Purpose:Reports of irreversible alteration in jaw posture and destructive occlusal contact relationships in individuals using mandibular advancement devices for obstructive sleep apnea are beginning to appear. This study sought cephalometric means of identifying such individuals before commencing therapy. Materials and Methods:Cephalograms of 34 obstructive sleep apnea sufferers who had worn mandibular advancement devices for 2 years were compared retrospectively with baseline films taken at commencement of therapy and analyzed for signs of morphologic changes in jaw position and occlusal relationship. In affected patients, two distinct morphologic species of mandibular reposturing became evident: (1)bilateral posterior open bite with destructive incisal attrition; and (2)less destructive intermediate open bite over the premolar and first molar regions. From the observed morphology patterns, gonial angle and maxillary-mandibular plane angle were analyzed as possible vertical cephalometric risk predictors, with newly defined pterygoid advancement proportion (PtAP) as a horizontal predictor. Results:Three patients displayed the posterior open bite pattern and had gonial angles  119 degrees and maxillarymandibular plane angles  16 degrees, with PtAP values  0.48. Prediction intervals for the five intermediate open bite cases were 118 degrees  gonial angle  128 degrees, and 23 degrees  maxillary-mandibular plane angle  32 degrees. PtAP values were  0.52. Conclusion:Cephalometric analysis can help practitioners identify which apnea patients might be likely to develop irreversible mandibular postural changes from wearing a jaw-repositioning device. Int J Prosthodont 2004;17:274280.

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