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http://dx.doi.org/10.4041/kjod.2010.40.2.115

Microimplant mandibular advancement (MiMA) therapy for the treatment of snoring and obstructive sleep apnea (OSA)  

Ngiam, Joachim (Orthodontic Postgraduate, Department of Orthodontics, School of Dentistry, Kyungpook National University)
Kyung, Hee-Moon (Department of Orthodontics, School of Dentistry, Kyungpook National University)
Publication Information
The korean journal of orthodontics / v.40, no.2, 2010 , pp. 115-126 More about this Journal
Abstract
This case report describes the treatment of a 66 year old adult patient with a diagnosis of severe obstructive sleep apnea who was intolerant of nasal continuous positive airway pressure (nCPAP) treatment and oral appliance therapy. An alternative treatment of snoring and obstructive sleep apnea (OSA) with 2 orthodontic microimplants anchored to the mandible providing skeletal anchorage for mandibular advancement was implemented. After a 2 week healing period, a custom designed facemask provided extraoral anchorage to which the microimplants were connected to for titratable mandibular advancement. Microimplant Mandibular Advancement (MiMA) therapy resulted in resolution of the symptoms of severe OSA with a reduction of the apnea-hypopnea index (AHI), snoring and OSA symptoms.
Keywords
Severe obstructive sleep apnea; Microimplant; Mandibular advancement;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
Times Cited By Web Of Science : 1  (Related Records In Web of Science)
Times Cited By SCOPUS : 2
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1 Tegelberg A, Wilhelmsson B, Walker-Engstrom ML, Ringqvist M, Andersson L, Krekmanov L, et al. Effects and adverse events of a dental appliance for treatment of obstructive sleep apnoea. Swed Dent J 1999;23:117-26.
2 Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-5.
3 Yao CC, Lai EH, Chang JZ, Chen I, Chen YJ. Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveolar protrusion. Am J Orthod Dentofacial Orthop 2008;134:615-24.   DOI   ScienceOn
4 Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest 1996;109:1477-83.   DOI   ScienceOn
5 Battagel JM, Kotecha B. Dental side-effects of mandibular advancement splint wear in patients who snore. Clin Otolaryngol 2005;30:149-56.   DOI   ScienceOn
6 Pantin CC, Hillman DR, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep 1999;22:237-40.   DOI
7 Flanagan D. A removable snore reduction appliance for a mandibular edentulous patient. J Oral Implantol 2009;35:221-4.   DOI   ScienceOn
8 Huja SS, Rao J, Struckhoff JA, Beck FM, Litsky AS. Biomechanical and histomorphometric analyses of monocortical screws at placement and 6 weeks postinsertion. J Oral Implantol 2006;32:110-6.   DOI   ScienceOn
9 Liou EJ, Pai BC, Lin JC. Do miniscrews remain stationary under orthodontic forces? Am J Orthod Dentofacial Orthop 2004;126:42-7.   DOI   ScienceOn
10 Freudenthaler JW, Haas R, Bantleon HP. Bicortical titanium screws for critical orthodontic anchorage in the mandible: a preliminary report on clinical applications. Clin Oral Implants Res 2001;12:358-63.   DOI   ScienceOn
11 Kato J, Isono S, Tanaka A, Watanabe T, Araki D, Tanzawa H, et al. Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest 2000;117:1065-72.   DOI   ScienceOn
12 Almeida FR, Lowe AA, Sung JO, Tsuiki S, Otsuka R. Longterm sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis. Am J Orthod Dentofacial Orthop 2006;129:195-204.   DOI   ScienceOn
13 Hitchon PW, Brenton MD, Coppes JK, From AM, Torner JC. Factors affecting the pullout strength of self-drilling and self-tapping anterior cervical screws. Spine (Phila Pa 1976) 2003;28:9-13.   DOI   ScienceOn
14 Sato K, Nakashima T. Sleep-related deglutition in patients with sleep apnea-hypopnea syndrome. Ann Otol Rhinol Laryngol 2009;118:30-6.   DOI
15 Park HS, Jeong SH, Kwon OW. Factors affecting the clinical success of screw implants used as orthodontic anchorage. Am J Orthod Dentofacial Orthop 2006;130:18-25.   DOI   ScienceOn
16 Huja SS, Litsky AS, Beck FM, Johnson KA, Larsen PE. Pull-out strength of monocortical screws placed in the maxillae and mandibles of dogs. Am J Orthod Dentofacial Orthop 2005;127:307-13.   DOI   ScienceOn
17 Chen Y, Kyung HM, Zhao WT, Yu WJ. Critical factors for the success of orthodontic mini-implants: a systematic review. Am J Orthod Dentofacial Orthop 2009;135:284-91.   DOI   ScienceOn
18 Panula K, Keski-Nisula K. Irreversible alteration in occlusion caused by a mandibular advancement appliance: an unexpected complication of sleep apnea treatment. Int J Adult Orthodon Orthognath Surg 2000;15:192-6.
19 Takano-Yamamoto T, Kuroda S. Titanium screw anchorage for correction of canted occlusal plane in patients with facial asymmetry. Am J Orthod Dentofacial Orthop 2007;132:237-42.   DOI   ScienceOn
20 Ueda H, Almeida FR, Lowe AA, Ruse ND. Changes in occlusal contact area during oral appliance therapy assessed on study models. Angle Orthod 2008;78:866-72.   DOI   ScienceOn
21 Pepin JL, Leger P, Veale D, Langevin B, Robert D, Levy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest 1995;107:375-81.   DOI   ScienceOn
22 de Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, et al. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med 2005;1:143-52.
23 McLain RF, Fry MF, Moseley TA, Sharkey NA. Lumbar pedicle screw salvage: pullout testing of three different pedicle screw designs. J Spinal Disord 1995;8:62-8.
24 Motoyoshi M, Hirabayashi M, Uemura M, Shimizu N. Recommended placement torque when tightening an orthodontic mini-implant. Clin Oral Implants Res 2006;17:109-14.   DOI   ScienceOn
25 Kyung HM, Park HS, Bae SM, Sung JH, Kim IB. Development of orthodontic micro-implants for intraoral anchorage. J Clin Orthod 2003;37:321-8.
26 Kuroda S, Katayama A, Takano-Yamamoto T. Severe anterior open-bite case treated using titanium screw anchorage. Angle Orthod 2004;74:558-67.
27 Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis. Am J Orthod Dentofacial Orthop 2006;129:205-13.   DOI   ScienceOn
28 Sato K, Nakashima T. Human adult deglutition during sleep. Ann Otol Rhinol Laryngol 2006;115:334-9.   DOI
29 Petit FX, Pepin JL, Bettega G, Sadek H, Raphael B, Levy P. Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J Respir Crit Care Med 2002;166:274-8.   DOI
30 Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005. Sleep 2006;29:240-3.   DOI
31 Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 1999;340:847-51.   DOI   ScienceOn
32 Salmoria KK, Tanaka OM, Guariza-Filho O, Camargo ES, de Souza LT, Maruo H. Insertional torque and axial pull-out strength of mini-implants in mandibles of dogs. Am J Orthod Dentofacial Orthop 2008;133:790 e715-722.
33 Brettin BT, Grosland NM, Qian F, Southard KA, Stuntz TD, Morgan TA, et al. Bicortical vs monocortical orthodontic skeletal anchorage. Am J Orthod Dentofacial Orthop 2008;134:625-35.   DOI   ScienceOn
34 Joo S, Baik I, Yi H, Jung K, Kim J, Shin C. Prevalence of excessive daytime sleepiness and associated factors in the adult population of Korea. Sleep Med 2009;10:182-8.   DOI   ScienceOn
35 Lee SY, Cha JY, Yoon TM, Park YC. The effect of loading time on the stability of mini-implant. Korean J Orthod 2008;38:149-58.   DOI
36 de Carlos F, Cobo J, Fernandez Mondragon MP, Alvarez Suarez A, Calvo Blanco J. Orthoimplants: an alternative treatment for SAHS? Sleep Breath 2009 Sep 18 (Epub ahead of print).
37 Zdeblick TA, Kunz DN, Cooke ME, McCabe R. Pedicle screw pullout strength. Correlation with insertional torque. Spine (Phila Pa 1976) 1993;18:1673-6.   DOI   ScienceOn
38 Marklund M, Franklin KA, Persson M. Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea. Eur J Orthod 2001;23:135-44.   DOI   ScienceOn
39 Park HS, Kyung HM, Sung JH. A simple method of molar uprighting with micro-implant anchorage. J Clin Orthod 2002;36:592-6.
40 Motoyoshi M, Inaba M, Ono A, Ueno S, Shimizu N. The effect of cortical bone thickness on the stability of orthodontic mini-implants and on the stress distribution in surrounding bone. Int J Oral Maxillofac Surg 2009;38:13-8.   DOI   ScienceOn
41 Lee HA, Park YC. Treatment and posttreatment changes following intrusion of maxillary posterior teeth with miniscrew implants for open bite correction. Korean J Orthod 2008;38:31-40.   DOI
42 Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008;31:1207-13.
43 Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 2001;163:1457-61.   DOI   ScienceOn
44 Chen YJ, Chang HH, Lin HY, Lai EH, Hung HC, Yao CC. Stability of miniplates and miniscrews used for orthodontic anchorage: experience with 492 temporary anchorage devices. Clin Oral Implants Res 2008;19:1188-96.   DOI   ScienceOn
45 Rose EC, Staats R, Virchow C Jr, Jonas IE. Occlusal and skeletal effects of an oral appliance in the treatment of obstructive sleep apnea. Chest 2002;122:871-7.   DOI   ScienceOn
46 Hoekema A, de Vries F, Heydenrijk K, Stegenga B. Implant-retained oral appliances: a novel treatment for edentulous patients with obstructive sleep apnea-hypopnea syndrome. Clin Oral Implants Res 2007;18:383-7.   DOI   ScienceOn
47 Kim J, In K, You S, Kang K, Shim J, Lee S, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 2004;170:1108-13.   DOI   ScienceOn
48 Hwang SH, Park IS, Nam KY, Kim JB, Cho YW, Suh YS, et al. Cephalometric differences in obstructive sleep apnea between obese and non-obese Korean male patients. Korean J Orthod 2008;38:202-13.   DOI