Class II correction improves nocturnal breathing in adolescents
Open accessAbstract
OBJECTIVE: To examine modifications in sleep pattern and in craniofacial morphology of adolescents with mandibular retrognathism. MATERIALS AND METHODS: Sixteen subjects at maximum pubertal growth (12.6 years [±11.5 months]) were selected and treated for 12 months with maxillary expansion and mandibular advancement with a Herbst appliance. Cephalometric radiography and magnetic resonance imaging were obtained prior to and after treatment and were compared using the paired Student's t-test or the nonparametric Wilcoxon rank-sum test. Four polysomnographic recordings were obtained with pressurized nasal cannulae and were analyzed by analysis of variance. RESULTS: The length of the mandible was increased, while the antero-posterior position of the maxilla remained stable. The posterior airway space was increased, the length of the tongue was preserved, and the hyoid bone was moved to a more anterior position. After Herbst treatment, sleep efficiency, sleep latency, rapid eye movement (REM) sleep latency, and percentage of REM sleep remained stable. We did observe a reduction (P < .05) in the relative proportions of stage 1 and stage 3-4 (from 4.30 ± 1.99 to 2.61 ± 1.83 for stage 1 and from 25.78 ± 7.00 to 19.17 ± 7.58 for stages 3-4) as well as an increase (P < .01) in the percentage of stage 2 after treatment (49.03 ± 6.25 to 56.90 ± 6.22). There was a reduction (P < .05) in the number of respiratory effort-related arousals (7.06 ± 5.37 to 1.31 ± 1.45 per hour of sleep) due to an increase (P < .01) in airway volume. CONCLUSIONS: In the short term, the increase in airway space improved nocturnal breathing associated with the correction of mandibular retrognathism.
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In a meta-analysis pooling only treatment data from all included studies except one abstract without AHI testing, the reduction of AHI after mandibular advancement appliance treatment was 4.23 events/h (95% CI 1.07 to 7.38), with high heterogeneity (I2 = 98%).
“Reduction of AHI after treatment was 4.23 events/h, (95% CI: 1.07, 7.38), which was stronger than the meta-analysis result of only RCTs (see Fig. 6).”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [36]
After mandibular advancement appliance treatment, the number of respiratory effort-related arousals reduced, and there was a reduction in the relative proportions of stage 1 and stages 3-4 sleep as well as an increase in the percentage of stage 2 sleep.
“As for sleep architecture, the number of respiratory effort-related arousals reduced, and a reduction in the relative proportions of stage 1 and stages 3e4 as well as an increase in the percentage of stage 2 after treatment were observed, which may be explained by brain maturation [36].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [36]
Airway volume increased as measured by acoustic pharyngometry and magnetic resonance imaging in included studies.
“Airway volume increased measured by acoustic pharyngometry and magnetic resonance imaging [33,36].”
From Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis (2019) · cites this paper as [36]
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- Authors
- Schütz, T. C. B., Dominguez, G. C., Hallinan, M. P., Cunha, T. C. A., & Tufik, S.
- Venue
- The Angle Orthodontist
- Published
- 2011-03
- Volume
- 81
- Issue
- 2
- Pages
- 222-228
- ISSN
- 0003-3219 (ISSN-L)
- 1945-7103
- PMC
- PMC8925255
- OpenAlex
- W2115370084
- Cited by
- 115
- References
- 22
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 11 · 2022: 5 · 2021: 9 · 2020: 9 · 2019: 8 · 2018: 3 · 2017: 14 · 2016: 7 · 2015: 12 · 2014: 5 · 2013: 8 · 2012: 4
- FWCI
- 9.19
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Angle Orthodontist (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Americanae (AECID Library) (submittedVersion, other-oa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Topics
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- Class II malocclusion, mandibular retrognathism, maxillary expansion, Herbst appliance, mandibular advancement, sleep-disordered breathing, sleep architecture, craniofacial morphology, posterior airway space, adolescents, polysomnography
- MeSH terms
- Adolescent, Analysis of Variance, Cephalometry, Child, Female, Humans, Hyoid Bone, Male, Malocclusion, Angle Class II, Mandible, Mouth Breathing, Palatal Expansion Technique, Pharynx, Prospective Studies, Sleep Apnea Syndromes, Snoring, Polysomnography, Orthodontic Appliances, Functional, Statistics, Nonparametric, Mandibular Advancement, Retrognathia
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