Dentoskeletal long-term side effects of mandibular advancement devices in obstructive sleep apnoea patients: a systematic review with meta-regression.

AIMS: To identify in a systematic review with meta-regression the dental and skeletal long-term side effects of mandibular advancement device (MAD) therapy and to evaluate the influence of time. MATERIALS AND METHOD: An electronic search was performed in Medline, Cochrane Database of Systematic Reviews, Google Scholar Beta, ISI Web of Knowledge, Scopus and Lilacs to select randomized controlled trials and cohort studies investigating dental and/or skeletal side effects in adult patients wearing a MAD for obstructive sleep apnoea or snoring treatment for at least two years. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). For each study included and for each dental and/or skeletal parameter, the mean difference and 95 per cent confidence interval was calculated between baseline and follow-up. RESULTS: Twenty studies with a follow-up between 2 and 11 years were included. The side effects identified were a decrease of overjet, overbite and upper incisor inclination, and an increase of lower incisor inclination, ANB and anterior face height. Meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). According to GRADE, the quality of evidence was moderate for all the outcomes except for lower incisor inclination which was low. CONCLUSION: MAD therapy produced both dental and skeletal side effects which are influenced by the duration of therapy. The dental side effects could be clinically relevant, while the clinical importance of skeletal side effects seems to be questionable. Since the side effects are progressive, patients need to be continuously monitored over time.