Biomedical subjects

C J Robertson

Publications and source records attributed to C J Robertson.

11 recordsLinked to original sources

PubMed2001

Dental and skeletal changes associated with long-term mandibular advancement.

STUDY OBJECTIVES: Little is known of the possible dental or skeletal side effects following the use of mandibular advancement in the treatment of obstructive sleep apnea. A study has subsequently been designed to investigate these issues. DESIGN: 100 consecutively treated medically referred patients were reviewed cephalometrically in 6-month intervals (6-30 months) following mandibular advancement therapy. SETTING: Orthodontic Private Practice. PATIENTS: 87 males, 13 females (mean age 49 years, SD 8.5, range 33-74 years). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Reference points and planes in the cranial base, maxilla, and mandible were digitized with a reflex metrograph and their means converted to linear and angular measurements. Significant changes following mandibular advancement were observed in lower face height, vertical condylar position, incisor angulation, overbite, and overjet. Skeletal changes were attributed to a vertical repositioning of the mandibular condyle relative to the cranial base and were present at the first review period (6 months). Dental changes occurred later with treatment with the most significant changes occurring at the final review period (30 months) which resulted in a 4.9 degrees proclination of the mandibular incisors and a reduction in overbite of 1.82mm. CONCLUSION: The data suggests that long-term use of mandibular advancement can cause dental and skeletal changes which may be progressive over time. As many consider mandibular advancement a treatment for life, it is strongly recommended that all patients be fully informed of the potential for such changes prior to treatment and undergo mandatory dental reviews with long-term mandibular advancement.

Adult↗

PubMed2000

The effect of long-term mandibular advancement on the hyoid bone and pharynx as it relates to the treatment of obstructive sleep apnoea.

A cephalometric analysis was carried out to determine the effects of long-term mandibular advancement on the hard and soft tissues of the upper airway and, in particular, the relationship of the hyoid bone to both the cranium and the cervical spine, following mandibular advancement. One hundred consecutively-treated patients (87 males and 13 females; mean age: 49.26 years; SD: 8.56; range: 33-74 years) diagnosed with obstructive sleep apnoea and/or habitual snoring were reviewed at 6-month intervals over 6 to 30 months of treatment with a mandibular advancement splint. Significant changes to both the oropharynx and velopharynx were observed. At 12 months, the posterior airway space had increased from 10.71 mm to 11.99 mm (mean difference: 1.28 mm). At 6 months, significant changes had occurred in the soft palate length and thickness: a mean reduction in length of 1.46 mm (p < 0.0001) and in thickness of 0.57 mm. No changes were observed in the hypopharynx: the position of the hyoid bone remained unchanged in relation to both the cranium and cervical spine in all linear and angular measurements. The author concludes that mandibular advancement with oral appliances should be considered as a treatment for life.

Adult↗

PubMed1998

Treatment of obstructive sleep apnoea in edentulous patients--design of a combination appliance: a case study.

This report describes the fabrication of a prosthesis to prevent obstructive sleep apnoea in edentulous patients. The objective of treatment in a 62-year-old man was to establish a comfortable protrusive and vertical position of the mandible that minimised hypopharyngeal obstruction nocturnally. An appliance was designed incorporating two concepts in the elimination of obstructive sleep apnoea: mandibular advancement, which maintains hypopharyngeal width nocturnally; and advancement of the tongue with the aid of a device holding the tongue in a protrusive position by vacuum pressure. This combination appliance offers a treatment modality to a large group of otherwise forgotten patients.

Humans↗

PubMed1997

Obstructive sleep apnoea. Part II: Treatment with a customised dental appliance.

The use of dental appliances in the treatment of patients with snoring and obstructive sleep apnoea is an important treatment modality for those patients not severe enough for continuous positive airway pressure (CPAP) or who cannot tolerate this form of treatment. A mandibular advancement splint has been specifically designed to eliminate snoring and obstructive sleep apnoea. The appliance's design parameters included ease of insertion, comfort, and maximum effectiveness. Customised appliances have been designed for dentate, semi-dentate, and edentulous patients. To date, over 100 appliances have been used with a symptomatic improvement in snoring and well-being in over 80 percent of patients. Dental appliances for the treatment of snoring and obstructive sleep apnoea are simple, cost effective, and reversible.

Child↗

PubMed1996

Obstructive sleep apnoea. Part I: Diagnosis, aetiology, and current treatment.

Obstructive sleep apnoea is a multi-factorial condition associated with high morbidity and mortality. Its prevalence is highest in middle-aged males with a predisposition to obesity. Certain facial types have been identified as being at risk. Cephalometric parameters have now been established to identify those patients who are anatomically compromised. Treatment modalities are dependent on the correct diagnosis of the site(s) of obstruction. Overnight polysomographic testing is the only definitive measure to quantify the presence and severity of obstructive sleep apnoea. Treatment options include behavioural, medical, surgical, and the use of oral appliances.

Airway Obstruction↗

PubMed1976