Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea

Study Objectives: To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. Methods: This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Results: Twenty-one patients enrolled with a mean treatment length of 7.9 +/- 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 +/- 0.5 mm, recession 0.6 +/- 1.1 mm, and clinical attachment loss 0.8 +/- 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Conclusions: Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession.