RESUMEN
BACKGROUND: The purpose of this study was to evaluate the effectiveness of mandibular advancement devices (MADs) for treatment of obstructive sleep apnea syndrome (OSAS) compared with the results obtained with a placebo device in accordance with the following indicators: apnea hypopnea index (AHI) per hour of sleep, apnea index (AI) per hour of sleep, mean oxyhemoglobin saturation, sleep efficiency, and percentage of rapid eye movement (REM) sleep. METHODS: This is a controlled, prospective longitudinal study with a follow-up time of 10.5 months. Nineteen patients (8 females and 11 males) with mean age 48.6 years (SD 9.6) were selected for the study. The sample was randomized in terms of device use, and the evaluation design was double blind. A total of 57 polysomnography tests were studied (at baseline, after the use of a MAD, and after the use of placebo). The following variables were assessed: AHI, AI, mean oxyhemoglobin saturation, percentage of REM sleep, and sleep efficiency. Wilcoxon and Mann-Whitney tests were used for evaluating data (p<0.05). RESULTS: Reductions from 16.3 to 11.7 in AHI and from 5.7 to 3.8 in AI were observed after MAD use. During the use of placebo, AHI increased from 16.3 to 19.6, and AI from 5.7 to 7.5. The other indexes showed no statistically significant differences. CONCLUSIONS: Treatment with oral appliances, i.e., MADs, can be an effective alternative for mild and medium-to-moderate OSAS, but requires strict monitoring due to differences in individual response to this therapy.
Asunto(s)
Avance Mandibular/instrumentación , Diseño de Aparato Ortodóncico , Apnea Obstructiva del Sueño/terapia , Adulto , Estudios Cruzados , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Oxihemoglobinas/análisis , Placebos , Polisomnografía/métodos , Estudios Prospectivos , Sueño/fisiología , Apnea Obstructiva del Sueño/fisiopatología , Sueño REM/fisiología , Resultado del TratamientoRESUMEN
INTRODUCTION: Rapid maxillary expansion (RME) for the treatment of maxillary deficiency and posterior crossbite may induce changes in the vertical dimension. Expanders with occlusal splints have been developed to minimize unwanted vertical effects. OBJECTIVE: This preliminary study used cephalometri radiographs to evaluate the vertical effects of RME using a Hyrax appliance in children with maxillary deficiency. METHOD: Twenty-six patients (11 boys; mean age = 8 years and 5 months) with maxillary deficiency and posterior crossbite were treated using a Hyrax appliance with an acrylic occlusal splint. Radiographs and cephalometric studies were performed before the beginning of the treatment (T1) and after RME active time (T2), at a mean interval of 7 months. Results were compared with normative values. RESULTS AND CONCLUSIONS: At the end of treatment, there were no statistically significant changes, and measurements were similar to the normative values. Data showed that there were no significant effects on vertical growth, which suggests that appliances with occlusal splints may be used to correct transverse deficiencies regardless of the patient's growth pattern.
RESUMEN
INTRODUÇÃO: o diagnóstico, o tratamento e o acompanhamento de pacientes portadores da síndrome da apneia obstrutiva do sono (SAOS) são essenciais, por se tratar de um distúrbio que pode causar alterações sistêmicas. A efetividade do tratamento da SAOS com aparelhos intrabucais foi demonstrada através de estudos cefalométricos. OBJETIVO: o objetivo deste estudo foi avaliar o efeito do aparelho de avanço mandibular (Twin Block, TB) no volume das vias aéreas superiores, por meio de tomografia computadorizada Cone-Beam (CBCT). Dezesseis pacientes (6 homens e 10 mulheres) portadores de SAOS leve a moderada, idade média de 47,06 anos, utilizaram um aparelho de avanço mandibular e foram acompanhados por 7 meses, em média. MÉTODOS: foram feitas duas CBCT, sendo uma sem e outra com o aparelho em posição. A segmentação e a obtenção dos volumes das vias aéreas superiores foram realizadas e utilizado o teste t de Student pareado para análise estatística, com 5 por cento de significância. RESULTADOS: houve aumento do volume da via aérea superior com TB quando comparado com o volume sem TB (p<0,05). CONCLUSÃO: pode-se concluir que o aumento de volume da via aérea superior observado foi associado ao aparelho de avanço mandibular.
INTRODUCTION: Diagnosis, treatment and monitoring of patients with obstructive sleep apnea syndrome (OSAS) are crucial because this disorder can cause systemic changes. The effectiveness of OSAS treatment with intraoral devices has been demonstrated through cephalometric studies. OBJECTIVE: The purpose of this study was to evaluate the effect of a mandibular advancement device (Twin Block, TB) on the volume of the upper airways by means of Cone-Beam Computed Tomography (CBCT). Sixteen patients (6 men and 10 women) with mild to moderate OSAS, mean age 47.06 years, wore a mandibular advancement device and were followed up for seven months on average. METHODS: Two CBCT scans were obtained: one with and one without the device in place. Upper airway volumes were segmented and obtained using Student's paired t-tests for statistical analysis with 5 percent significance level. RESULTS: TB use increased the volume of the upper airways when compared with the volume attained without TB (p<0.05). CONCLUSION: It can be concluded that this increased upper airway volume is associated with the use of the TB mandibular advancement device.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada de Haz Cónico , Avance Mandibular , Síndromes de la Apnea del Sueño , Obstrucción de las Vías Aéreas , Imagenología Tridimensional , Cavidad Nasal , Programas InformáticosRESUMEN
OBJECTIVES: To describe the microscopic pulpal reactions resulting from orthodontically induced tooth movement associated with low-level laser therapy (LLLT) in rats. MATERIALS AND METHODS: Forty-five young male Wistar rats were randomly assigned to three groups. In group I (n = 20), the maxillary right first molars were submitted to orthodontic movement with placement of a coil spring. In group II (n = 20), the teeth were submitted to orthodontic movement plus LLLT at 4 seconds per point (buccal, palatal, and mesial) with a GaAlAs diode laser source (830 nm, 100 mW, 18 J/cm(2)). Group III (n = 5) served as a control (no orthodontic movement or LLLT). Groups I and II were divided into four subgroups according to the time elapsed between the start of tooth movement and sacrifice (12 hours, 24 hours, 3 days, and 7 days). RESULTS: Up until the 3-day period, the specimens in group I presented a thicker odontoblastic layer, no cell-free zone of Weil, pulp core with differentiated mesenchymal and defense cells, and a high concentration of blood vessels. In group II, at the 12- and 24-hour time points, the odontoblastic layer was disorganized and the cell-free zone of Weil was absent, presenting undifferentiated cells, intensive vascularization with congested capillaries, and scarce defense cells in the cell-rich zone. In groups I and II, pulpal responses to the stimuli were more intense in the area underneath the region of application of the force or force/laser. CONCLUSIONS: The orthodontic-induced tooth movement and LLLT association showed reversible hyperemia as a tissue response to the stimulus. LLLT leads to a faster repair of the pulpal tissue due to orthodontic movement.
Asunto(s)
Pulpa Dental/patología , Terapia por Luz de Baja Intensidad , Técnicas de Movimiento Dental , Animales , Capilares/patología , Núcleo Celular/patología , Cromatina/patología , Citoplasma/patología , Pulpa Dental/irrigación sanguínea , Pulpa Dental/efectos de la radiación , Eritrocitos/patología , Fibroblastos/patología , Hiperemia/patología , Láseres de Semiconductores , Masculino , Mesodermo/patología , Diente Molar/patología , Diente Molar/efectos de la radiación , Odontoblastos/patología , Alambres para Ortodoncia , Distribución Aleatoria , Ratas , Ratas Wistar , Factores de Tiempo , Técnicas de Movimiento Dental/instrumentaciónRESUMEN
Os objetivos deste estudo foram avaliar o efeito do aparelho de avanço mandibular (Twin block - TB) no volume das vias aéreas superiores, por meio de tomografia computadorizada cone beam (CBCT); analisar, por meio da polissonografia, as mudanças no índice de apneia e hipopneia (IAH) e índice de apneia por hora de sono (IA), saturação de oxi-hemoglobina e eficiência do sono; e correlacionar o volume na CBCT e as polissonografias. Dezesseis pacientes portadores de apneia obstrutiva do sono, idade média de 47,06 anos, participaram deste estudo prospectivo, com acompanhamento médio de 7 meses. Foram feitas polissonografias iniciais (T1) e de acompanhamento (T2) com o TB em posição, e CBCT sem e com TB em posição. A segmentação e obtenção dos volumes das vias aéreas superiores foram realizadas e utilizados os testes t de Student pareado, de Wilcoxon e o índice de correlação de Spearman, com 5% de significância. Os resultados das polissonografias mostraram diferenças estatisticamente significativas entre T1 e T2 apenas para IAH (p<0,05). Houve aumento do volume da via aérea superior com TB quando comparado com o volume sem TB (p<0,05). Foi possível estabelecer-se correlação positiva entre volume da via aérea superior sem TB e IAH e IA em T1 (p<0,05), mas não houve correlação entre o volume da via aérea com TB e índices polissonográficos em T2. Pode-se concluir que, houve aumento de volume da via aérea superior com o TB e houve redução do IAH em T2 porém, sem correlação entre estes dados.
The aim of this study were to evaluate the effect of a mandibular advancement device (Twin Block TB) in the upper airway volume, with cone beam computed tomography (CBCT); to analyze, by polysomnographys, changes in apnea and hipopnea index per hour (AHI), apnea index per hour of sleep (AI), oxyhemoglobin saturation and sleep efficiency; and correlate changes in volume in CBCT and the results of polysomnography. Sixteen OSA patients, mean age of 47.07 years, participated in this prospective study, with follow up of 7 months. Initial polysomnography (T1) and follow up polysomnography (T2) were taken with TB in position, and CBCT with and without TB were taken. Upper airway segmentations and volumes were performed and were evaluated by the Student t test, the Wilcoxon test, and Spearman correlation, with 5% significance level. The results of the polysomnographs showed statistically significant differences between T1 and T2, only for AHI (p<0.05). There was an increased airway volume with TB in position when compared to volume without TB (p<0.05). A positive correlation between upper airway volume without TB and T1 AHI and AI was established (p<0.05), but there was no correlation between upper airway volume with TB and T2 polysomnography indexes. In conclusion, there was an increase in volume of the upper airway with the TB and reduction of AHI in T2 but without correlation with these data.