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 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

EFFICACY OF MANDIBULAR ADVANCEMENT DEVICE IN 
OBSTRUCTIVE SLEEP APNEA SYNDROME 

 

       

       

 

 

 

 

 

*Correspondig author: RAKOTOSON Mariette  

Department of Dento-Facial Orthopedics, Institute of Tropical Odonto-Stomatology of 

Madagascar, University of Mahajanga, Madagascar 

 

ABSTRACT 

Mandibular propulsion device is a non-surgical, mechanical means of treating sleep 

apnea. Left untreated, OSA can have serious consequences. The aim of this study was to 

evaluate the efficacy of mandibular advancement orthoses in the treatment of Obstructive 

Sleep Apnea Syndrome (OSAS). This was a systematic review including ten recent articles 

reporting on mandibular advancement orthosis and OSA.   The articles concerned described 

the efficacy of the mandibular orthosis in reducing nocturnal apneas and hypopneas. Despite 

its place as a second-line therapy in the face of continuous positive airway pressure (CPAP), 

the mandibular orthosis can be complementary to CPAP. 

Key words: Apnea, efficiency, mandible, syndrome. 

 

 

 

         

       

1Department of Dento-Facial Orthopedics, Institute of Tropical Odonto-Stomatology of 

Madagascar, University of Mahajanga, Madagascar

2Department of Prosthodontics, Institute of Tropical Odonto-Stomatology of Madagascar,

University of Mahajanga, Madagascar

  3Department of Ear, Nose and Throat (ENT), University Hospital Andohatapenaka 

Antananarivo

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Rakotoson M1*, Lalanirina GL2, Rajaonarison LF3, Ratsirarisoa T1, Andriniaina

FA1, Andrinjakarivony NN1, Rakotoharinivo HZ1, Rasoanirina MO1, Randrianarimanarivo 
HM1



IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

1. Introduction 

Obstructive Sleep Apnea Syndrome (OSAS) is defined as the occurrence during sleep of 

abnormally frequent episodes of complete or partial obstruction of the upper airways, 

responsible for interruptions (apneas) or significant reductions (hypopneas) in ventilation. of 

the upper airways, responsible for significant interruptions (apneas) or reductions (hypopneas) 

in ventilation. The frequency of obstructive airway events is considered abnormal when there 

are more than 10 apneas or hypopneas per hour of sleep (apnea-hypopnea index (AHI) greater 

than 10) [1]. Prevalence is estimated at 2% in women and 4% in men in the general 

population [2]. Its consequences can be serious for the patient and those around him or her: 

risk of daytime sleepiness with domestic or traffic accidents, cardiovascular complications: 

atherosclerosis, arterial hypertension, coronary ischemia and stroke [3]. Mandibular 

propulsion orthoses (MPOs) represent a non-surgical mechanical means of treating sleep 

apnea. They are devices designed to propel the mandible during sleep, in order to enlarge the 

pharyngeal airway [4].  The aim of this study was to evaluate the efficacy of the mandibular 

advancement orthosis in the treatment of Obstructive Sleep Apnea Syndrome (OSAS). 

 

 

2. Methodology 

Type of study: Study based on a systematic review.  

Study duration: The study ran from January to February 2024.  

Study population: The study focused on articles evaluating the effectiveness of mandibular 

advancement orthoses on Obstructive Sleep Apnea Syndrome (OSAS) using the PRISMA 

method.  

Inclusion criteria: We included all articles evaluating the effectiveness of mandibular 

advancement orthoses on Obstructive Sleep Apnea Syndrome (OSAS) before 2024, in 

English and French. 

Sampling: A total of 10 articles were selected. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

 

 

Search strategy: The search engines used were PubMed and Sciences Direct using the 

keywords: " apnea, efficiency, mandible, syndrome" indicated in Mesh Bilingue and the 

search operators used were: "And, Or, Not". 

Variables: The subject variable was based on the effectiveness of mandibular advancement 

orthoses on Obstructive Sleep Apnea Syndrome (OSAS). 

 

Articles Orthodontics et periodontics 

Year of publication 

Continent 

Language 

Types of articles 

effectiveness of mandibular advancement 

orthoses on Obstructive Sleep Apnea 

Syndrome (OSAS) 

 

Data collection and analysis: Data were then collected on a pre-tested and validated data 

extraction form and analyzed on SPSS 21.0. 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

3. Results  

Number of 
articles 

Titles and authors Results 

1 Orthodontic appliances for sleep 
apnea, a cephalometric and 
poysomnographic study. 
David M, Saba SB, Rodenstein D, 
Rombaux P   
 
 

« Orthodontic appliances are 
unquestionably effective in reducing 
the number of obstructive apneas and 

hypopneas.» [5] 

2 Long-term dental and skeletal effects 
of mandibular advancement devices in 
adults with obstructive sleep apnea: 
A systematic review 
Patel S, Rinchuse D, Zullo T, Wadhwa 
R 
 

“ Mandibular advancement orthoses 
can cause a statistically significant, 

albeit slight, change in dentition 
when worn for long periods. » [6] 

 

3 Mandibular advancement device use 
in obstructive sleep apnea: 
ORCADES study 5-year follow-up 
data 
Vecchierini MF, Collet JM, Marie-
Pia, Goutorbe F, Kerbrat JB, Leger 
D, et al 
 

« mandibular advancement device 
therapy remained effective in >50% 

of patients after 5 years” [7] 

4 A mandibular advancement device for 
the treatment of obstructive sleep 
apnea: 
Long-term use and tolerance 
Brette C, Ramanantsoa H, 
Renouardierea J, 
Renouardiere R, Roismana G, 
Escourrou P 
 

« OPM J reduces symptoms of long-
term SAHOS.» [8] 

5 Orthodontics treatments for managing 
obstructive sleep apnea syndrome in 
children: A systematic review and 
meta-analysis 
Huynh NT, Desplats E, Almeida FR 
 

« These orthodontic 
treatments may be effective in 

managing pediatric snoring and 
obstructive sleep apnea” [9] 

6 The First Steps of the Management of 
Sleep Apnea Syndrome in Yaounde 
Massongo M, Bouba AD, Siafa BA, 
Adamou BD, Komo 
NME, Yone PEW 
 

« Compliance and therapeutic 
efficacy were judged to be good» 

[10] 
 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

7 Preventive dentofacial  orthopedic 
treatment of childhood 
apnea/hypopnea syndrome? 
Guibert M, Garcia R 
 

“Early adapted treatment should 
reduce this risk” [11] 

8 Epidemiological, clinical and 
evolutionary profile of 
obstructive sleep apnea syndrome in 
Department of 
Respiratory Diseases of the CHU Ibn 
Rochd in Casablanca 
Zaghba N, Chaanoun K,  Benjelloun 
H, Yassine N 
 

“Mandibular was prescribed in 86% 
of cases.” [12] 

9 Relationship between edentulism and 
sleep 
apnea: a systematic review of the 
literature 
Ammar S, Mabrouk Y, LAbidi A, 
Mansour L, Trabelsi M 
 

“In 6 studies, an 
improvement in sleep apnea was 

noted with wearing the prosthesis at 
night” [13] 

10 Sleep apnea and prosthodontic 
implications 
Chander NG 
 

“It 
is vital to be aware sleep disorders 

and the possible impact 
that can aid in providing effective 

care to the patients 
reporting to prosthodontic clinics” 

[14] 

 

4. Discussion 

Sleep apnea syndrome (SAS) is a sleep disorder characterized by a cessation or reduction in 

respiratory flow. It is defined by the number of apneas and hypopneas per hour. The diagnosis 

of SAS is made as soon as the apnea index (AI) is greater than five (recording of more than 5 

apneas per hour) or as soon as the apnea hypopnea index (AHI) is greater than ten (recording 

of more than 10 apneas and/or hypopneas per hour) [1]. 

Removable braces are proposed for snoring patients with a measured index greater than 35, 

irrespective of the presence or absence of OSA. The degree of mandibular advancement 

depends on the individual's maximum propulsion capacity, without inducing pain in the 

temporomandibular joints [15]. The QuietKnight is a device consisting of two thermoplastic 

parts linked together by a mechanical system. The two parts are softened in boiling water for a 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

few minutes and then molded onto the upper and lower teeth. A hook system is attached to the 

upper part of the appliance and engages with a clamp on the lower part. A screw in the upper 

hook system is inserted to adjust the mandibular advancement of the lower part of the 

appliance. The appliance allows the patient to breathe through the mouth. 

The Mandibular Positioner (MP) is a mandibular propulsion device made of thermoformable 

plastic, which joins the lower jaw to the upper jaw in a propulsive movement. From the 

outset, it does not allow oral respiration or any other mandibular movement. 

 

The Herbst propulsion device has been in use for many years. A system of connecting rods 

holds the mandible in the propulsive position and allows this forward movement to be 

adjusted [16]. This device offers the advantage of enabling some mandibular movements, 

such as opening and closing the mouth, but also lateral movements. 

The Mandibular Positioner and Herbst are made from the patient's own dental casts.  Patients 

were asked to wear their appliance every night for one month. At the end of this period [5]. 

  

According to the authors, when the prosthesis is placed in the mouth, the mandible rotates 

downwards. 

activity of the genioglossus is increased, which may widen the retro-lingual space by shifting 

the tongue forward [17]. 

The prosthesis can also promote an increase in the neuromuscular activity of the pharyngeal 

muscles, which is typically reduced during sleep, and can induce changes in the position of 

the mandible, soft palate and tongue, helping to improve pharyngeal permeability [17]. 

Some authors have also considered that, in the supine position, the intercuspidation provided 

by the prosthesis could act as a brake against backward displacement of the mandible [18]. 

The prosthesis restores the vertical dimension of occlusion and consequently increases the 

retro-pharyngeal space [19]. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

In this respect, a cephalometric analysis of a subject with a prosthesis in the mouth showed an 

average increase of 1.88mm in the width of the retro-pharyngeal space and an average 

increase of 2.20mm in the depth of the pharynx compared with the analysis without a 

prosthesis [17]. 

Mandibular advancement orthoses are currently considered to be the treatment of choice for 

OSA [20]. 

 

4. Conclusion 

OSA combines a reduction in the size of the upper airways with an alteration in their 

muscular activity. Removable propulsive appliances can reverse these alterations by moving 

the mandible anteriorly and changing the position of the soft palate and tongue. Orthodontic 

appliances are effective because they increase the size of the upper airway, provide a stable 

anterior position for the mandible, move the tongue and soft palate forward, and modify the 

activity of the genioglossal muscles. These devices improve nocturnal ventilation without 

impairing sleep quality. The treatment is simple, reversible, non-invasive and cost-effective. 

 

 

References 

1. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its 

management. Ther Adv Chronic Dis 2015, Vol. 6(5) 273–85. 

2. Meslier N. Vol S, Balkau B, Gagnadoux F, Cailleau M, Petrella A, Racineux J.L, et al. 

Prevalence of symptoms of sleep apnea syndrome. Study in a middle-aged French population. 

Rev Mal Respir 2007; 24 : 305-13. 

3. Yaggi HK, et al. Obstructive sleep apnea as a risk factor for stroke and death. New Engl J 

Med 2005;353:2034–41. 

4. Cohen-Levy J, Garcia R, Petelle B, Fleury B. Treatment of the obstructive sleep apnea 

syndrome in adults by mandibular advancement device: the state of the art. Int Orthod 

2009;7:287-304. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

5. David M, Saba SB, Rodenstein D, Rombaux P. Orthodontic appliances for sleep apnea, a 

cephalometric and poysomnographic study. Bull. Group. Int. Rech. Sci. Stomatol. Odontol. 

2000 ; 42 : 73-81. 

6. Patel S, Rinchuse D, Zullo T, Wadhwa R. Long-term dental and skeletal effects of 

mandibular advancement devices in adults with obstructive sleep apnoea: 

A systematic review. International Orthodontics 2019; 17: 3–11. 

7. Vecchierini MF, Collet JM, Marie-Pia, Goutorbe F, Kerbrat JB, Leger D, et al. 

Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year 

follow-up data. J Clin Sleep Med. 2021 ; 17(8):1695–705. 

8. Brette C, Ramanantsoa H, Renouardierea J, Renouardiere R, Roismana G, Escourrou P . 

A mandibular advancement device for the treatment of obstructive sleep apnea: Long-term 

use and tolerance. International Orthodontics 2012 ; X : 1-14. 

9. Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive 

sleep apnea syndrome in children: A systematic review and meta-analysis. Sleep Medicine 

Reviews 25 (2016) 84-94. 

10. Massongo M, Bouba AD, Siafa BA, Adamou BD, Komo NME, Yone PEW. The First Steps 

of the Management of Sleep Apnea Syndrome in Yaounde. Health Sci. Dis: Vol 25 (1) January 

2024 : 51-58. 

11. Guibert M, Garcia R. Preventive dentofacial  orthopedic treatment of childhood 

apnea/hypopnea syndrome? J Dentofacial Anom Orthod 2015;18:312. 

12. Zaghba N, Chaanoun K,  Benjelloun H, Yassine N. Epidemiological, clinical and 

evolutionary profile of obstructive sleep apnea syndrome in Department of Respiratory 

Diseases of the CHU Ibn Rochd in Casablanc. J Func Vent Pulm 2021; 36(12): 1-75. 

13. Ammar S, Mabrouk Y, LAbidi A, Mansour L, Trabelsi M. Relationship between edentulism 

and sleep apnea: a systematic review of the literature. IAJD 2021;12(1): 48-57. 

14. Chander NG. Sleep apnea and prosthodontic implications. The Journal of Indian 

Prosthodontic Society.2020;20(4):335-7. 

15. Marklund M, Franklin KA, Sahlin C, Lundgren R. The effect of a mandibular 

advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest. 

1998 ; 113 : 707-13. 

16. Eveloff SE, Rosenberg CL, Carlisle CC, Millman RP. Efficacy of a Herbst mandibular 

advancementt device in obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 1994 ; 149 : 

905-9. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  

 ( ISSN: 2814-2098 )                                                                                   RAKOTOSON Mariette ¹* 

https://ijojournals.com/                                                     Volume 07 || Issue 02 || February, 2024 || 

 

 
 

 

17. Gassino G, Cicolin A, Erovigni F, Carossa S, Preti G. Obstructive sleep apnea, 

depression, and oral status in elderly occupants of residential homes. Int J Prosthodont 

2005;18:316-22. 

18. Bucca CB, Carossa S, Colagrande P, et al. Effect of edentulism on spirometric tests. Am J 

Respir Crit Care Med 2001; 162:1018 20. 

19. Arisaka H, Sakuraba S, Tamaki K, Watanabe T, Takeda J, Yoshida K. Effects of wearing 

complete dentures during sleep on the apnea-hypopnea index. Int J Prosthodont 

2009;22:173-7. 

20. Chaccur DC, Bittencourt LR, Lucchesi L, et al. Assessment of the impact of vertical 

dimension alterations on the quality of sleep in elderly patients wearing upper and lower full 

dentures. Sleep Sci 2012;5:1-6. 

 

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