Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review
Abstract
OBJECTIVE: To evaluate the effectiveness of mandibular advancement appliances (MAAs) for treatment of pediatric obstructive sleep apnea (OSA). METHODS: Several electronic databases (The Cochrane Database, EMBASE, Healthstar, MEDLINE, PubMed) were systematically searched, as well as a limited grey literature (Google Scholar) and manual searches. A health sciences librarian helped with the selection of Medical Subject Headings (MeSH), key words, and combinations of key words with truncations to account for any differences in controlled terminology in the different databases. Only studies that evaluated the effects of MAAs in children with OSA were pursued. RESULTS: Only 4 articles satisfied all inclusion criteria. Selected studies were retrospective except one study that was a quasi-randomized clinical trial. High risk of bias (Cochrane Risk of Bias assessment) was judged in all included studies. Based on the limited available evidence use of MAAs in a POSA population may result in improvements in Apnea Hypopnea Index (AHI) scores. However complete normalization of AHI scores was not demonstrated. Heterogeneity in study designs and collected information precluded meta-analysis. LIMITATIONS: There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. Determination of AHI scores with MAAs still in the mouth should be avoided. CONCLUSIONS: The current limited evidence may be suggestive that MAAs result in short-term improvements in AHI scores, but it is not possible to conclude that MMAs are effective to treat pediatric OSA. Medium- and long-term assessments are still required.
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A 50% decrease in AHI indicates successful treatment.
“Herein, AHI in children with OSA treated with MTBA decreased from 6.92 ± 4.77 before treatment to 2.75 ± 2.12 after treatment (50% decrease), indicating a successful treatment [25].”
From Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances (2025) · cites this paper as [25]
Studies 17 through 21 were carried out with children who had not undergone adenotonsillar surgery.
“Studies 17 18 19 20 21 were carried out with children who had not undergone adenotonsillar surgery.”
From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [19]
In two included studies, Bariani et al. and Nazarali et al., the reduction in apnea-hypopnea index after mandibular advancement appliance treatment could not be statistically analyzed because of considerable heterogeneity of the data.
“In two studies, 18 19 although there was a reduction in the AHI, it could not be statistically analyzed due to the considerable heterogeneity of the data.”
From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [19]
If skeletal and dentoalveolar correction is accomplished permanently, pediatric patients no longer need to wear mandibular advancement appliances, because skeletal growth is complete and the obstructive sleep apnea predisposing factor is solved.
“If these changes are accomplished permanently, pediatric patients no longer need to wear the MAAS, since the skeletal growth is complete and this important OSA predisposing factor will be solved. 19”
From Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review (2023) · cites this paper as [19]
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- Authors
- Nazarali, N., Altalibi, M., Nazarali, S., Major, M. P., Flores-Mir, C., & Major, P. W.
- Affiliations
- University of Alberta (CA)
- McMaster University (CA)
- ORCID
- Major, Paul W.
- Venue
- The European Journal of Orthodontics
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-02-12
- Volume
- 37
- Issue
- 6
- Pages
- 618-626
- ISSN
- 0141-5387 (ISSN-L)
- 1460-2210
- OpenAlex
- W2131236218
- Semantic Scholar
- 813a09eddd784e09694db890026706f909dafec7
- Cited by
- 62
- References
- 99
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 7 · 2019: 10 · 2018: 7 · 2017: 1 · 2016: 5 · 2015: 2
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Orthodontics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- mandibular advancement device, pediatric obstructive sleep apnea, apnea-hypopnea index, orthodontic appliances, treatment effectiveness
- MeSH terms
- Child, Humans, Bias, Orthodontic Appliance Design, Mandibular Advancement, Sleep Apnea, Obstructive
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