The Efficacy of Twin-Block Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis
Table 1
Characteristics of the included studies.
Study
Study design
Subgroup
Gender
Sample size
Age
Interventions
Eligibility criteria
Wearing time
Dropout
Primary outcomes
Secondary outcomes
Idris G
Crossover-RCT
Twin-block treatment
Male:13 Female:3
9
(8 ~ 12)
Twin-block
Inclusion criteria: Age range from 8 to 12 years, and parental report of loud snoring for three or more nights per week. Exclusion criteria were: previous orthodontic treatment, craniofacial and genetic syndromes (e.g. cleft lip and/or palate), neuromuscular disorders, and class III incisor and/or skeletal relationship as confirmed by lateral cephalometric radiograph (ANB angle ≤0°)
3 weeks (overnight)
3
Apnea-hypopnea index, lowest oxygen saturation
Growth hormone levels, SDB symptoms and daytime sleepiness questionnaires, quality-of-life questionnaire (OSA-18), behavioral assessment (the behavioral and emotional screening system), parent report of nocturnal enuresis
Control
9
Sham MAA
0
Zhang C
Case series
Twin-block
Male: 31 Female:15
46
()
Twin-block
The inclusion criteria includes: Patients who were in category two or three of the cervical vertebrae maturation indices, which indicated that patients have not reached the peak pubertal growth spurt; patients who had mandibular retrognathia determined clinically as well as with the aid of cephalometric radiographs (ANB >3°; °; incisor mm); patients who had snoring habit reported by their parents and an OSA (apnea/hypopnea index /h). The exclusion criteria included patients with acute upper airway infection, adenotonsillar hypertrophy, body mass index above cut off points of overweight which was announced by an international survey, or/h were rejected from the study.
average10.8 months (24 H except for mealtime)
0
Apnea-hypopnea index, lowest oxygen saturation
Cephalometric measurements
Lu Y
Case series
Modified twin-block
Male: 14 Female:11
25
13.4 (12~15)
Modified twin-block
Inclusion criteria: (1) patients had no history of orthodontic treatment before treatment; (2) early permanent teeth, molar, cusp distal relationship; cephalometric showed vegetative form is the average angle or low angle, mainly with mandibular retraction angle ii class malocclusion; (3) in the early or peak period of growth and development; (4)PSG results showed that it met the diagnostic criteria of OSAHS in children; (5) no TMJ disease and adolescent periodontal disease; no inflammatory hyperplasia of tonsils or other anatomic factors that may cause OSAHS.
Average 12.7 months (all the time)
0
Apnea-hypopnea index, lowest oxygen saturation
Hard and soft tissues analysis, CBCT analysis of the upper airway
Guan ZE
Case series
Twin-block
Male: 14 Female:7
21
12.7 (10.4 ~ 14)
Twin-block
Not description
>1 year (not detail apnea-hypopnea index, lowest oxygen saturation led description)
0
Apnea-hypopnea index, lowest oxygen saturation
Cephalometric measurements
Gao P
Case series
Twin-block treatment
Male: 19 Female:22
41
(12~15)
Twin-block
Inclusion criteria: (1) no history of orthodontic treatment; (2) on the maxillary development is normal, mandibular development is insufficient in patients with early permanent dentition; (3) in the early or peak period of growth and development; (4) long-term residents of Xining city, Qinghai Province (2260 meters above sea level) Exclusion criteria: (1) genetic diseases that can lead to asymmetric facial development; (2) a glandular body, rhinitis, tonsil disease or other anatomical causes of OSA-HS element; (3) the children could not cooperate or their guardians refused to participate in the study; (4) there are temporomandibular joint disease, adolescent periodontal disease, missing teeth, cleft lip and palate, facial partial trauma, unilateral condylar hypertrophy, tumor, etc.
(1) The patient had no history of orthodontic treatment before treatment; (2) clinical examination showed high arch of palatal cover, narrow upper dental arch and lower jaw “adenoid face”, such as retraction; (3) molars, cusps distal relationship, the following collar retraction based on angle CLASS II error °, °; (4) moderate and severe OSAS: portable polysomnography showed AHI25 and snoring, open-mouth breathing, lethargy, hyperactivity, inattention, and other clinical symptoms; (5) there are adenoids and/or tonsil hypertrophy: cephalic radiograph shows moderate to severe adenoid hypertrophy with A/N ; press tongue to check almond body ID degree or above; (6)age 9 to 12 years old, mixed dentition or early permanent teeth; lateral cranial radiograph showed the patient bone age in CVMS II-CVMS III (early or peak growth and development of CVMS); body mass index (BMI). The value is below the overweight range; no obvious symptoms of temporomandibular arthropathy, n-o history of trauma, and no history of labial appointment, no history of orthognathic surgery or otorhinolaryngology
Average 373 days (all the time)
0
Apnea-hypopnea index, lowest oxygen saturation, obstructive apnea index
‡Quality assessment was definite as high-quality study, and quality assessment was definite as low-quality study. MAA: mandibular advancement appliances.
