{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T09:06:26Z","timestamp":1762074386523,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,29]],"date-time":"2022-10-29T00:00:00Z","timestamp":1667001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients\u2019 Apnoea\u2013Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. Methods: This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. Results: A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg\/m2), the angle formed by the occlusal plane to the sella\u2013nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. Conclusions: The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA.<\/jats:p>","DOI":"10.3390\/ijerph192114154","type":"journal-article","created":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T04:57:34Z","timestamp":1667105854000},"page":"14154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mandibular Torus as a New Index of Success for Mandibular Advancement Devices"],"prefix":"10.3390","volume":"19","author":[{"given":"Teresa","family":"Diaz de Teran","sequence":"first","affiliation":[{"name":"Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1387-2655","authenticated-orcid":false,"given":"Pedro","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Cantabria Primary Health Care Management, Instituto Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"de Carlos","sequence":"additional","affiliation":[{"name":"Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"Macias","sequence":"additional","affiliation":[{"name":"Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Cabello","sequence":"additional","affiliation":[{"name":"Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Cantalejo","sequence":"additional","affiliation":[{"name":"Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-0751","authenticated-orcid":false,"given":"Paolo","family":"Banfi","sequence":"additional","affiliation":[{"name":"Don Gnocchi Foundation IRCCS, 20121 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8286-7406","authenticated-orcid":false,"given":"Antonello","family":"Nicolini","sequence":"additional","affiliation":[{"name":"Don Gnocchi Foundation IRCCS, 20121 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Solidoro","sequence":"additional","affiliation":[{"name":"Division of Respiratory Diseases Cardiovascular and Thoracic Department, AOU Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Instituto Marqu\u00e9s de Valdecilla (IDIVAL), University of Cantabria, 39011 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/S0140-6736(81)92140-1","article-title":"Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares","volume":"1","author":"Sullivan","year":"1981","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1183\/09031936.00144711","article-title":"Non-CPAP therapies in obstructive sleep apnoea: Mandibular advancement device therapy","volume":"39","author":"Marklund","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_3","first-page":"53","article-title":"Changes in the upper airway of patients who wear a modified functional appliance to treat obstructive sleep apnea","volume":"10","author":"Cobo","year":"1995","journal-title":"Int. J. Adult Orthodon. Orthognath. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1136\/thx.54.11.972","article-title":"Mandibular advancement oral appliance therapy for obstructive sleep apnoea: Effect on awake calibre of the velopharynx","volume":"54","author":"Ryan","year":"1999","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.smrv.2015.11.007","article-title":"Prediction of oral appliance treatment outcomes in obstructive sleep apnea: A systematic review","volume":"30","author":"Okuno","year":"2016","journal-title":"Sleep Med. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.5664\/jcsm.5198","article-title":"Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies","volume":"11","author":"Manfredini","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1834-7819.1995.tb04820.x","article-title":"Torus palatinus and torus mandibularis: A review of the literature","volume":"40","author":"Seah","year":"1995","journal-title":"Aust. Dent. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3109\/00016359209012748","article-title":"Palatine and mandibular torus. A morphologic study in the current Norwegian population","volume":"50","author":"Haugen","year":"1992","journal-title":"Acta Odontol. Scand."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/j.1600-0528.1991.tb00101.x","article-title":"Variation in torus mandibularis prevalence in Norway. A statistical analysis using logistic regression","volume":"19","author":"Eggen","year":"1991","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s11325-013-0905-5","article-title":"Mandibular torus size is related to obstructive sleep apnea and treatment success with an oral appliance","volume":"18","author":"Palm","year":"2014","journal-title":"Sleep Breath."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., and Lemeshow, S. (2000). Variable Selection. Applied Logistic Regression, Willey. [2nd ed.].","DOI":"10.1002\/0471722146"},{"key":"ref_12","unstructured":"American Academy of Sleep Medicine (2014). The international Classification of Sleep Disorders, Westcherter AAoSM. [3rd ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s10006-012-0332-y","article-title":"Efficacy of the Silensor for treating obstructive sleep apnea syndrome","volume":"17","author":"Nakano","year":"2013","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1093\/sleep\/29.2.240","article-title":"Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: An update for 2005","volume":"29","author":"Kushida","year":"2006","journal-title":"Sleep"},{"key":"ref_15","first-page":"10164","article-title":"Comparison of the phenotypic characteristics between responders and non-responders to obstructive sleep apnea treatment using mandibular advancement devices in adult patients: Systematic review and meta-analysis","volume":"64","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_16","unstructured":"Menard, S. (2020). Applied Logistic Regression Analisis, Sage. [2nd ed.]. Sage University Papers Series on quantitave Applications in social Sciens, 07-103."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"210200","DOI":"10.1183\/16000617.0200-2021","article-title":"European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea","volume":"30","author":"Randerath","year":"2021","journal-title":"Eur. Respir. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11325-006-0084-8","article-title":"Review of oral appliances for treatment of sleep-disordered breathing","volume":"11","author":"Hoffstein","year":"2007","journal-title":"Sleep Breath."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1164\/rccm.200203-208OC","article-title":"Oral appliance therapy improves symptoms in obstructive sleep apnea: A randomized, controlled trial","volume":"166","author":"Gotsopoulos","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1378\/chest.12-2609","article-title":"Oropharyngeal crowding and obesity as predictors of oral appliance treatment response to moderate obstructive sleep apnea","volume":"144","author":"Tsuiki","year":"2013","journal-title":"Chest"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Cama\u00f1es-Gonzalvo, S., Marco-Pitarch, R., Plaza-Esp\u00edn, A., Puertas-Cuesta, J., Agust\u00edn-Panadero, R., Fons-Font, A., Fons-Badal, C., and Garc\u00eda-Selva, M. (2021). Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices. J. Clin. Med., 10.","DOI":"10.3390\/jcm10225255"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s11325-003-0119-3","article-title":"A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea","volume":"7","author":"Ringqvist","year":"2003","journal-title":"Sleep Breath."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1365-2869.2008.00645.x","article-title":"Mandibular advancement appliance for obstructive sleep apnoea: Results of a randomised placebo controlled trial using parallel group design","volume":"17","author":"Petri","year":"2008","journal-title":"J. Sleep Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1164\/rccm.200701-114OC","article-title":"Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea","volume":"178","author":"Vanderveken","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1378\/chest.125.4.1270","article-title":"Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: Tolerability and predictors of treatment success","volume":"125","author":"Marklund","year":"2004","journal-title":"Chest"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"439","DOI":"10.5664\/JCSM.1300","article-title":"Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea","volume":"7","author":"Lettieri","year":"2011","journal-title":"J. Clin. Sleep Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1164\/ajrccm.163.6.2004213","article-title":"A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea","volume":"163","author":"Metha","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/ejo\/24.3.239","article-title":"Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: A randomized cross-over trial","volume":"24","author":"Tan","year":"2002","journal-title":"Eur. J. Orthod."},{"key":"ref_29","first-page":"8811700","article-title":"Efficacy of a trial oral appliance in OSAS management: A new protocol to recognize responder\/nonresponder patients","volume":"2021","author":"Cosi","year":"2021","journal-title":"Int. J. Dent."},{"key":"ref_30","unstructured":"Ramon, M.A., Sampol, G., Anitua, E., Cobo, J., de Carlos, F., and Gonz\u00e1lez, M. (2017). Gu\u00eda espa\u00f1ola de pr\u00e1ctica cl\u00ednica sobre la utilizaci\u00f3n de dispositivos de avance mandibular (DAM) en el tratamiento de pacientes adultos con s\u00edndrome de apneas-hipopneas del sue\u00f1o. Gu\u00eda Pr\u00e1ctica Cl\u00ednica Sist. Nac. Salud, Available online: ses.org.es\/wp-content\/uploads\/2016\/12\/SES_Guia-Espanola-de-pratica-clinica_17-04-2017.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1590\/1807-3107bor-2017.vol31.0037","article-title":"Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome","volume":"31","author":"Cunha","year":"2017","journal-title":"Braz. Oral Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/j.joms.2011.12.009","article-title":"Prevalence and anatomic topography of mandibular torus: Computed tomographic analysis","volume":"70","author":"Choi","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"215","DOI":"10.2147\/NSS.S96450","article-title":"Which oropharyngeal factors are significant risk factors for Obstructive sleep apnea?","volume":"8","author":"Ruangsri","year":"2016","journal-title":"Nat. Sci. Sleep"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.amepre.2018.02.014","article-title":"Effect of smoking on periodontitis: A systematic review and meta-regression","volume":"54","author":"Leite","year":"2018","journal-title":"Am. J. Prev. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00784-021-04064-7","article-title":"Long-term dentoskeletal side effects of mandibular advancement therapy in patients with obstructive sleep apnea: Data from the Pays de la Loire sleep cohort","volume":"26","author":"Baldini","year":"2022","journal-title":"Clin. Oral Investig."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:05:42Z","timestamp":1760144742000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,29]]},"references-count":35,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192114154"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192114154","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,10,29]]}}}