The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
권호 표지
DOI QR코드

DOI QR Code

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

코골이 및 수면 무호흡 치료를 위한 마이크로 임프란트를 이용한 하악골 전진술

  • 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)
  • Received : 2009.11.27
  • Accepted : 2010.01.18
  • Published : 2010.04.30
Download PDF
⟨ Previous Next ⟩

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.

이 증례보고는 심한 수면무호흡증으로 진단된 환자로, 다른 구강 내 OSA치료 장치와 nCPAP치료에 적응을 못하는 66세 남자 환자였다. 하악골에 2개의 교정용 마이크로 임프란트를 식립한 후, 식립 2주 후부터 구강외 고정원인 개조된 안면마스크에서 마이크로 임프란트에 힘을 가하여 하악골을 전진시켰다. 마이크로 임프란트를 이용한 하악골전진술(MiMA)은 심한 수면 무호흡환자의 AHI (apnea-hypopnea index), 코골이 및 심한 수면 무호흡증상을 개선할 수 있었다.

Keywords

References

  1. 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. https://doi.org/10.1164/rccm.200404-519OC
  2. 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. https://doi.org/10.1016/j.sleep.2008.03.017
  3. 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.
  4. 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.
  5. 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. https://doi.org/10.4041/kjod.2008.38.3.202
  6. 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. https://doi.org/10.1164/ajrccm.163.6.2004213
  7. 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.
  8. 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. https://doi.org/10.1164/rccm.2008167
  9. 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.
  10. 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. https://doi.org/10.4041/kjod.2008.38.1.31
  11. Park HS, Kyung HM, Sung JH. A simple method of molar uprighting with micro-implant anchorage. J Clin Orthod 2002;36:592-6.
  12. Kuroda S, Katayama A, Takano-Yamamoto T. Severe anterior open-bite case treated using titanium screw anchorage. Angle Orthod 2004;74:558-67.
  13. 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. https://doi.org/10.1016/j.ajodo.2006.12.022
  14. 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. https://doi.org/10.1016/j.ajodo.2005.12.032
  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. https://doi.org/10.1016/j.ajodo.2004.11.032
  16. 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. https://doi.org/10.4041/kjod.2008.38.3.149
  17. 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. https://doi.org/10.1093/sleep/29.2.240
  18. 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. https://doi.org/10.1378/chest.107.2.375
  19. 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. https://doi.org/10.1378/chest.109.6.1477
  20. 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.
  21. Battagel JM, Kotecha B. Dental side-effects of mandibular advancement splint wear in patients who snore. Clin Otolaryngol 2005;30:149-56. https://doi.org/10.1111/j.1365-2273.2004.00944.x
  22. 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. https://doi.org/10.1093/sleep/22.2.237
  23. 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. https://doi.org/10.1378/chest.122.3.871
  24. 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.
  25. 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. https://doi.org/10.1093/ejo/23.2.135
  26. 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. https://doi.org/10.1111/j.1600-0501.2007.01343.x
  27. Flanagan D. A removable snore reduction appliance for a mandibular edentulous patient. J Oral Implantol 2009;35:221-4. https://doi.org/10.1563/AAID-JOI-D-09-00007.1
  28. 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).
  29. 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. https://doi.org/10.1016/j.ajodo.2003.12.023
  30. 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. https://doi.org/10.1016/j.ijom.2008.09.006
  31. 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. https://doi.org/10.1016/j.ajodo.2007.08.017
  32. 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. https://doi.org/10.1563/767.1
  33. 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.
  34. Zdeblick TA, Kunz DN, Cooke ME, McCabe R. Pedicle screw pullout strength. Correlation with insertional torque. Spine (Phila Pa 1976) 1993;18:1673-6. https://doi.org/10.1097/00007632-199309000-00016
  35. 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.
  36. 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. https://doi.org/10.1111/j.1600-0501.2005.01211.x
  37. 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. https://doi.org/10.1111/j.1600-0501.2008.01571.x
  38. Liou EJ, Pai BC, Lin JC. Do miniscrews remain stationary under orthodontic forces? Am J Orthod Dentofacial Orthop 2004;126:42-7. https://doi.org/10.1016/j.ajodo.2003.06.018
  39. 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. https://doi.org/10.1016/j.ajodo.2007.01.031
  40. 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. https://doi.org/10.1034/j.1600-0501.2001.012004358.x
  41. 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. https://doi.org/10.2319/100107-470.1
  42. 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. https://doi.org/10.1378/chest.117.4.1065
  43. 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. https://doi.org/10.1016/j.ajodo.2005.10.001
  44. 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. https://doi.org/10.1016/j.ajodo.2005.04.034
  45. 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. https://doi.org/10.1097/00007632-200301010-00004
  46. Sato K, Nakashima T. Sleep-related deglutition in patients with sleep apnea-hypopnea syndrome. Ann Otol Rhinol Laryngol 2009;118:30-6. https://doi.org/10.1177/000348940911800106
  47. Sato K, Nakashima T. Human adult deglutition during sleep. Ann Otol Rhinol Laryngol 2006;115:334-9. https://doi.org/10.1177/000348940611500503
  48. 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. https://doi.org/10.1056/NEJM199903183401104

Cited by

  1. Do sand blasted with large grit and acid etched surface treated mini-implants remain stationary under orthodontic forces? vol.82, pp.2, 2012, https://doi.org/10.2319/032511-212.1
  2. Microimplant-based mandibular advancement therapy for the treatment of snoring and obstructive sleep apnea: a prospective study vol.82, pp.6, 2012, https://doi.org/10.2319/071311-449.1
  3. 하악전방이동 코골이 장치의 수직 교합량이 상기도에 미치는 영향 vol.15, pp.10, 2010, https://doi.org/10.14400/jdc.2017.15.10.307