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UBC Theses and Dissertations

Long-term periodontal changes during oral appliance treatment for sleep apnea Heda, Piyush


Background: 2 to 4% of estimated population within the age range of 30 to 60 years is diagnosed with obstructive sleep apnea (OSA). Contemporary management of OSA commonly involves continuous positive airway pressure (CPAP) or oral appliance (OAm) therapy. One of the side effects of long-term OAm wear is mesialization of mandibular dentition resulting in the proclination of mandibular incisors. Similar movement of incisors following orthodontic treatment has been associated with gingival recession. Purpose: The purpose of this retrospective, in-vivo, clinical and cephalometric observational study is to evaluate the periodontal changes associated with OAm treatment of 4.5 or more years, in individuals with OSA. Research Design: Patients consecutively treated between 2004 to 2014 at UBC Dental Sleep Clinic and an affiliated private practice were screened. Eligible subjects were followed up where periodontal exam was performed. A lateral cephalogram and impressions were also obtained. Clinical crown height was measured on study models. Periodontal exam included PSR (periodontal screening and recording), plaque index, gingival bleeding index, probing pocket depths and facial gingival margin thickness, in addition to clinical attachment level (CAL), recession and width of attached gingiva. Baseline (T1) and follow up (T2) data was compared. Results: A total of 21 patients (15 males, mean age 57.4±12.0 y.o) were enrolled, with a mean treatment length of 7.6±3.3 years (range = 4.5 to 14.3 years). At follow up all patients presented with good oral hygiene with mean plaque index of 0.4 and bleeding index of 4.1%. PSR data confirmed absence of active periodontal disease. For mandibular anterior teeth, mean probing depth was 1.4±0.5 mm, recession was -0.6±1.1 mm and CAL was 0.8±1.0 mm. Compared to baseline there was significant proclination of mandibular incisors (mean increase in IMPA of 5.1º) with the continued use of OAm. Clinical crown height did not change (mean increase of 0.01 mm) over the evaluated time period. Conclusions: The inclination of mandibular incisors increases significantly with the use of mandibular advancing oral appliance in OSA patients. The positional changes in these teeth was not associated with any measured evidence of increase in periodontal disease or increased clinical crown height.

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