Changes in pneumatization of the maxillary air sinuses in Korean adults following biomimetic oral appliance therapy.

OBJECTIVE: For the treatment of obstructive sleep apnea in adults, mandibular advancement devices (MADs) are often used. Since adults with a prognathic mandibular phenotype are at risk of developing an unfavorable facial profile, midfacial development using biomimetic oral appliance therapy might provide a suitable alternative. However, the effect of this procedure on the maxillary air sinuses is unknown; therefore, changes in sinus pneumatization were investigated in this study. METHODS: After obtaining informed consent, 16 consecutive Korean adults with midfacial hypoplasia had 3D cone-beam (CB) CT scans taken, and biomimetic upper appliances (DNA appliance®, Vivos Therapeutics, Inc., USA) were constructed.All subjects were instructed to wear the device 12-16 h/day. Each month, examination for the progress of midfacial development was recorded. Post-treatment, a follow-up 3D CBCT scan was undertaken with no device in the patient's mouth. Pre- and post-treatment linear and volumetric measurements were obtained using appropriate software, and compared statistically using t-tests. RESULTS: The mean age of the sample was 25.0 yrs ± 8.7. The mean treatment time was 15.5 mths ± 5.2. Post-treatment, the transpalatal bone width increased from 35.3 mm ± 3.0 to 38.5 mm ± 2.0 (P < 0.001); the maxillary air sinus volume on the left side increased from 18.8 cm3 ± 6.5 to 20.0 cm3 ± 6.0 (P < 0.05), and from 18.5 cm3 ± 5.7 to 19.7 cm3 ± 5.8 (P < 0.05) on the right side. CONCLUSIONS: Biomimetic oral appliance therapy may be able to increase the maxillary air sinus volume in adults. In view of these preliminary findings, further studies on the effect of enhanced pneumatization on paranasal sinus function and sleep parameters are warranted.