Evaluation of Treatment Outcomes of Customized Fixed Intra-Oral Appliance With Maxillary Expansion and Twin Block in Pediatric Obstructive Sleep Apnea Patients: A Prospective Study

Abstract

Background and Objective Individuals diagnosed with obstructive sleep apnea (OSA) experience recurrent episodes of cessation of breathing due to blockage of the upper airway during sleep. This study investigated the outcomes of orthodontic treatment to increase the upper airway with fixed intraoral appliances in children with OSA and skeletal Class II malocclusion. Methods This study included 22 growing female participants aged 9–13 years with cervical vertebral maturation (CVM) stages 2 and 3, skeletal Class II malocclusion due to the retrognathic mandible (ANB of >4°), narrow and constricted maxillary arch, Class II malocclusion with an overbite of more than 4 mm, and mild and moderate apnea-hypopnea index on polysomnography. Cephalometric, cone-beam computed tomography, and polysomnographic values were measured preoperatively. The patients were treated with a customized fixed intraoral appliance for up to 8 months, and posttreatment values were assessed. Statistical analyses were performed using a paired t-test. Results The mean age of participants was 11.7 ± 1.5 years. There was a statistically significant restriction in maxillary growth (0.55° decrease in SNA angle), an increase in mandibular growth (1.98° increase in SNB angle), and hyoid bone moved anteriorly and cranially by 0.29 mm and 0.79 mm, respectively. The duration of the longest OSA episode was reduced by 6.9 ± 4.5 seconds, and the duration of desaturation in total sleep time of 7–8 hours was reduced by 13.1 ± 1.6 seconds. Conclusions A significant improvement in the airway and polysomnographic assessment can be achieved using customized fixed intraoral appliances in skeletal Class II patients with OSA.

Keywords

• class ii malocclusion
• obstructive sleep apnea
• orthodontic fixed appliance
• pediatric sleep apnea