Introduction Obstructive sleep apnea syndrome affects up to 4% of middle-aged men and 2% of adult women. It is associated with obesity. Objective The objective of this article is to review the literature to determine which factors best correlate with treatment success in patients with obstructive sleep apnea syndrome treated with a mandibular repositioning appliance. Data Synthesis A search was performed of the PubMed, Cochrane, Lilacs, Scielo, and Web of Science databases of articles published from January 1988 to January 2012. Two review authors independently collected data and assessed trial quality. Sixty-nine articles were selected from PubMed and 1 from Cochrane library. Of these, 42 were excluded based on the title and abstract, and 27 were retrieved for complete reading. A total of 13 articles and 1 systematic review were considered eligible for further review and inclusion in this study: 6 studies evaluated anthropomorphic and physiologic factors, 3 articles addressed cephalometric and anatomic factors, and 4 studies evaluated variables related to mandibular repositioning appliance design and activation. All the studies evaluated had low to moderate methodologic quality and were not able to support evidence on prediction of treatment success. Conclusion Based on this systematic review on obstructive sleep apnea syndrome treatment, it remains unclear which predictive factors can be used with confidence to select patients suitable for treatment with a mandibular repositioning appliance.

Sabe-se que o tratamento ortodontico esta associado com o desenvolvimento de recessao gengival. Varios fatores podem estar envolvidos na cadeia causal deste desfecho, incluindo aspectos anatomicos e comportamentais. Dentre os aspectos anatomicos, as dimensoes da sinfise mandibular poderia ter um papel predisponente. O presente estudo avaliou a relacao entre as dimensoes da sinfise mandibular previas ao tratamento ortodontico e o desenvolvimento de recessoes gengivais nos incisivos e caninos inferiores. Prontuarios de 189 adolescentes tratados ortodonticamente foram avaliados, incluindo radiografias, modelos e fotografias intra-orais. Dimensoes da sinfise foram determinadas em cefalogramas. Alteracoes da margem gengival foram observadas em fotografias e modelos. Associacoes entre alteracoes da margem gengival e dimensoes da sinfise foram testadas por qui-quadrado (α=0.05). A ocorrencia de recessao gengival aumentou apos tratamento ortodontico. Nao foi observada associacao entre as medidas medias de sinfise e a ocorrencia de recessoes gengivais. Podese concluir que as dimensoes da sinfise pre-tratamento ortodontico nao podem ser usadas como preditores de recessao gengival pos-tratamento ortodontico.

Orthodontic therapy is known to be associated with the development of gingival recession. Several factors may be involved in the causal chain of this outcome, including anatomical and behavioral aspects. Among the anatomical aspects, the dimensions of the mandibular symphysis could play a predisposing role. This study evaluated the relationship between the mandibular symphysis dimensions prior to orthodontic therapy and the development of gingival recessions on the lower incisors and cuspids. Records from 189 orthodontically treated adolescents were evaluated, including radiographs, casts and intra-oral photographs. Symphysis dimensions were assessed by cephalograms. Gingival margin alterations were determined in photographs and cast models. Association between gingival margin alterations and symphysis dimensions was tested by chi-square (α=0.05). Occurrence of gingival recession increased after orthodontic therapy. No association was observed on average of symphysis dimensions and the occurrence of gingival recessions. It may be concluded that pretreatment symphysis dimensions may not be used as predictors of gingival recession after orthodontic therapy.

OBJETIVOS: o objetivo deste estudo foi investigar se alterações na posição vestibulolingual dos incisivos inferiores em adolescentes podem predispor ao desenvolvimento de recessões gengivais. MÉTODOS: documentações de 189 adolescentes leucodermas (107 meninos e 81 meninas) pré e pós-tratamento ortodôntico foram selecionadas. Os pacientes apresentavam uma idade média de 11,2 ± 1,9 anos nos exames iniciais e 14,7 ± 1,8 anos nos exames finais. A presença de recessão gengival foi avaliada em modelos de estudo e em fotografias. A inclinação dos incisivos inferiores, em relação ao plano mandibular (IMPA) foi medida nos cefalogramas laterais pré e pós-tratamento e os casos foram divididos em proclinados, retroinclinados e inalterados. RESULTADOS: não foi observada associação significativa entre a alteração da inclinação dentária e a presença de recessões gengivais, utilizando o teste do qui-quadrado (p = 0,277). Foi observado que 107 pacientes (56,6%) apresentaram os incisivos proclinados; 64 pacientes (33,9%) com incisivos retroinclinados; e 18 pacientes (9,5%) não apresentaram alteração na inclinação. Nos casos em que novas recessões gengivais ocorreram, 64,9% foram vestibularizados, 26,3% foram lingualizados e 8,8% não apresentaram alteração na inclinação. No grupo de pacientes que apresentou migração coronal da margem gengival, 60% foram movimentados para lingual, 30% foram vestibularizados e 10% não alteraram de posição. CONCLUSÕES: apesar de a porcentagem de casos que foram vestibularizados apresentar um maior número de novas recessões, esse não foi estatisticamente significativo.

OBJECTIVES: The aim of this study was to investigate whether altering the labial-lingual position of lower incisors in adolescents might predispose to the development of gingival recession. METHODS: Records from 189 Caucasian adolescents (107 female and 81 male) pre and post orthodontic treatment were selected. Patients yielded mean ± SD values of initial records age 11.2 ± 1.9 years and final records age 14.7 ± 1.8 years. The presence of gingival recession was evaluated in models and photographs. The inclination of lower incisors to the mandibular plane angle (IMPA) was measured on lateral cephalograms, pre and post treatment. RESULTS: No significant association was observed between changes in tooth inclination and the presence of gingival recessions, based on chi-square analysis (p = 0.277). Data demonstrated that in 107 patients (56.6%) incisors were proclined, in 64 patients (33.9%) incisors were retroinclined and 18 patients (9.5%) did not show any changes in tooth inclination. In the cases where new gingival recessions occurred, 64.9% had been moved buccally, 26.3% had been moved lingually and 8.8% did not change inclination. In the group of patients that displayed coronal migration of the gingival margin, 60% were moved lingually, 30% were moved buccally and 10% did not change inclination. CONCLUSIONS: Even though the percentage of cases where teeth were proclined showed a larger number of new gingival recessions, it was not statistically significant.

O objetivo deste estudo retrospectivo foi associar a quantidade de gengiva ceratinizada existente em adolescentes pré-tratamento ortodôntico e o desenvolvimento de recessões gengivais pós-tratamento ortodôntico. A amostra consistiu de fotografias intra-orais e modelos de estudo de 209 pacientes leucodermas com idades médias de 11,20 ± 1,83 anos nos exames iniciais e 14,7 ± 1,8 anos nos exames finais. Os pacientes eram Classe I ou II de Angle e foram submetidos a tratamento ortodôntico sem extrações. As recessões gengivais foram avaliadas por inspeção visual dos incisivos e caninos inferiores nas fotografias e nos modelos de estudo iniciais e finais dos pacientes. As alterações da margem gengival pós-tratamento foram medidas com paquímetro digital e subdivididas em inalterada, migração coronal da margem gengival, ou migração apical da margem gengival. A quantidade de gengiva ceratinizada foi medida da linha mucogengival à margem gengival nas fotografias pré-tratamento ortodôntico. Tanto os dentes que desenvolveram recessões gengivais como aqueles que não tiveram a posição da margem gengival alterada não diferiram entre si quanto à quantidade de gengiva ceratinizada inicial (3,00 ± 0,61 e 3,5 ± 0,86 mm, respectivamente). Contraditoriamente, dentes que apresentaram migração coronal da gengiva tinham uma quantidade menor de gengiva ceratinizada inicial (2,26 ± 0,31 mm). A quantidade média de gengiva ceratinizada inicial não predispôs a recessões gengivais de incisivos e caninos inferiores.

The purpose of this retrospective study was to associate the amount of keratinized gingiva present in adolescents prior to orthodontic treatment to the development of gingival recessions after the end of treatment. The sample consisted of the intra-oral photographs and orthodontic study models from 209 Caucasian patients with a mean age of 11.20 ± 1.83 years on their initial records and 14.7 ± 1.8 years on their final records. Patients were either Angle Class I or II and were submitted to non-extraction orthodontic treatment. Gingival recession was evaluated by visual inspection of the lower incisors and canines as seen in the initial and final study models and intra-oral photographs. The amount of recession was quantified using a digital caliper and the observed post-treatment gingival margin alterations were classified as unaltered, coronal migration of the gingival margin or apical migration of the gingival margin. The width of the keratinized gingiva was measured from the mucogingival line to the gingival margin on the pre-treatment photographs. The teeth that developed gingival recession and those that did not have their gingival margin position changed did not differ in relation to the initial amount of keratinized gingiva (3.00 ± 0.61 and 3.5 ± 0.86 mm, respectively). Paradoxically, teeth that presented a coronal migration of the gingival margin had a smaller initial amount of keratinized gingiva (2.26 ± 0.31 mm). The mean amount of initial keratinized gingiva did not predispose lower incisors and canines to gingival recession.