A systematic review of mandibular advancement using clear aligners in patients with sleep apnea

Abstract

Objectives: Aligners are one of the orthodontic appliances that are rarely touched upon by orthodontists when they talk about obstructive sleep apnea (OSA) and its treatment modalities. This systematic review was aimed at understanding the effectiveness of the mandibular advancement (MA) technique using aligners in managing OSA and its associated impact on nasal airway volume, morphology, and the position of the hyoid bone. Material and Methods: A standardized data extraction form was devised to extract relevant variables from the studies that were identified through an extensive online search across multiple databases, with the whole process being conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines. Results: The four papers selected for this review were quite heterogeneous in their treatment approaches. The use of MA devices (MADs) in conjunction with orthodontic aligners was successful in managing snoring and mild sleep apnea and allowed the continuation of orthodontic treatment. Clear aligners for upper arch expansion increase nasal airway volume and intermolar distance, particularly in pediatric patients. The treatment protocol of maxillomandibular advancement (MMA), followed by post-operative surgical treatment, also resulted in successful post-operative outcomes and resolution of OSA. The use of aligners improved the upper airway morphology and hyoid bone position, with MA using aligners being more effective in improving the narrowest part of the hypopharynx. Conclusion: The study found that moving the lower jaw forward with aligners could help some people with OSA, make their nasal airways bigger, improve the shape of their upper airways, and put the hyoid bone in the best place. These findings could inform future therapeutic strategies and patient management protocols in orthodontic practice.