| Background:In recent years,with the continuous progress of the field of orthodontics,the relationship between the dimension and function of the upper airway and orthodontic treatment has attracted increasing attention from orthodontists.The upper airway is a structure susceptible to the changes of surrounding bone and soft tissue structures.Previous studies found that the change of oral volume would change the position of the tongue and hyoid bone,and the upper airway change accordingly.Some scholars believe that the maxillary expansion increases the oral volume,which will increase the volume of the upper airway,while the posterior movement of the anterior boundary,such as massive adduction of the anterior teeth,may reduce the upper airway.Further research is needed to determine whether lingual orthodontics,which occupy part of the oral volume,can lead to constriction of the upper airway and sleep apnea.Objective:This study aims to analyze the Apnea hypopnea Index(AHI),upper airway volume,upper airway minimum axial area,hyoid bone position and tongue size after treatment by using Polysomnography(PSG)and Cone Beam Computed Tomography(CBCT).To investigate the effects of lingual active wing appliances on upper airway and sleep apnea,and to provide a basis for the selection of lingual appliance indications and the prevention of Obstructive Sleep Apnea(OSA).Contents:1.Effect of lingual active wing appliances on upper airway volume and upper airway minimum axial area.2.Effect of lingual active wing appliances on hyoid bone position and tongue volume.3.Effect of lingual active wing appliances on sleep apnea in adults.Methods:1.Eighteen patients in labial appliance group and eighteen patients in lingual active wing appliance group were included in this study.CBCT was taken before orthodontic treatment(T0)and after treatment about 5 months(T1).CBCT was imported into Dolphin Imaging11.8 for measuring the volume of the upper airway,as well as the upper airway minimum axial area.SPSS 25.0 statistical software was used for data analysis.If the data were consistent with normal distribution and homogeneity of variance,paired sample T-test was used to compare the differences of the labial and lingual groups of indicators after treatment.Independent sample t test was used to analyze the difference between the labial and lingual groups of indicators.Wilcoxon signed-rank test was used if no agreement was reached.The difference of 0.05 was statistically significant.2.Eighteen patients in labial appliance group and eighteen patients in lingual active wing appliance group were included in this study.CBCT dates and lateral radiographs were taken before orthodontic treatment(T0)and after treatment about 5 months(T1).The CBCT was imported into Mimics 20.0 to measure the volume of the tongue.The lateral radiographs were imported into the Uceph to measure the position of the hyoid bone(hyoid-FH plane distance,hyoid-mandibular plane distance,hyoid-cervical distance and hyoid-sella distance).SPSS 25.0 statistical software was used for data analysis.If the data were consistent with normal distribution and homogeneity of variance,paired sample T-test was used to compare the differences of the labial and lingual groups of indicators after treatment.Independent sample t test was used to analyze the difference between the labial and lingual groups of indicators.Wilcoxon signed-rank test was used if no agreement was reached.The difference of 0.05 was statistically significant.3.12 patients in control group and 12 patients in test group were included in this study.Before treatment(T0),the day after bonding the lingual appliance(T1)and at 5 months after treatment(T2),portable polysomnography(EMBLA MPR,Beijing,China)was used for monitoring the Oxygen Desaturation Index(ODI)and the AHI value.SPSS 25.0statistical software was used for data analysis,and repeated analysis of measurement variance was used to compare the differences between pretreatment and posttreatment of the two groups to evaluate the effect of lingual appliances on sleep apnea.Results:1.Changes in the upper airway volume and upper airway minimum axial areaThe results of this study showed that the minimum axial area of the nasopharyngeal airway in the lingual appliance group decreased from 321.17±85.57(mm~2)to 315.33±94.32(mm~2),with an average reduction of 5.83±32.71(mm~2),and the difference of the minimum axial area of the nasopharyngeal airway was not statistically significant(P>0.05).The nasopharyngeal airway volume decreased from 8.91±2.72(cm~3)to 8.76±3.05(cm~3),with an average reduction of 0.15±1.02(cm~3),and the difference of the nasopharyngeal airway volume was not statistically significant(P>0.05).The minimum axial area of the velopharyngeal airway decreased from 247.00±112.21(mm~2)to 209.33±93.93(mm~2),with an average reduction of 37.67±65.52(mm~2),and the difference of the minimum axial area of the velopharyngeal airway was statistically significant(P<0.05).The velopharyngeal airway volume decreased from 10.74±4.03(cm~3)to 9.87±3.45(cm~3),with an average reduction of 0.87±1.71(cm~3),and the difference of the velopharyngeal airway volume was statistically significant(P<0.05).The minimum axial area of the glossopharyngeal airway decreased from 252.61±101.17(mm~2)to 204.56±61.19(mm~2),with an average reduction of 48.06±58.07(mm~2),and the difference of the minimum axial area of the glossopharyngeal airway was statistically significant(P<0.05).The glossopharyngeal airway volume decreased from 4.47±2.08(cm~3)to 4.25±1.66(cm~3),with an average reduction of 0.23±1.46(cm~3),and the difference of the glossopharyngeal airway volume was not statistically significant(P>0.05).The minimum axial area of the laryngopharyngeal airway decreased from 234.61±92.10(mm~2)to 215.06±55.31(mm~2),with an average reduction of 19.56±64.83(mm~2),and the difference of the minimum axial area of the laryngopharyngeal airway was not statistically significant(P>0.05).The volume of laryngopharyngeal airway decreased from 6.72±2.87(cm~3)to 5.88±1.96(cm~3),with an average reduction of 0.84±1.82(cm~3),and the difference of the volume of laryngopharyngeal airway was not statistically significant(P>0.05).There was no significant difference in upper airway volume and the minimum axial area in the control group,compared before treatment(P>0.05).At the same time,there was a significant difference in the change of glossopharyngeal minimum axial area between the two groups before and after treatment(P<0.05).The results indicate that the presence of lingual appliances has compressed the volume of the oral cavity,and the tongue may have regressed,affecting the upper airway.2.Changes in hyoid positionThe results of this study showed that the hyoid-FH plane distance in the test group increased from 83.88±6.84(mm)to 84.84±7.60(mm),with an average increase of0.96±2.68(mm),and the difference of the hyoid-FH plane distance was not statistically significant(P>0.05).The hyoid-mandibular plane distance increased from 8.63±4.82(mm)to 9.03±4.27(mm),with an average increase of 0.40±2.71(mm),and the difference of the hyoid-mandibular plane distance was not statistically significant(P>0.05).The hyoid-cervical distance decreased from 33.77±2.96(mm)to 33.00±3.05(mm),with an average reduction of 0.77±1.66(mm),and the difference of the hyoid-cervical distance was not statistically significant(P>0.05).The hyoid-sella distance increased from 14.28±6.70(mm)to 14.45±7.09(mm),with an average increase of 0.16±2.89(mm),and the difference of the hyoid-sella distance was not statistically significant(P>0.05).Compared before treatment,there was no significant difference in hyoid-FH plane distance,hyoid-mandibular plane distance,hyoid-cervical anterior plane distance,and hyoid-sellar distance in control group(P>0.05).There was no significant difference in the hyoid bone between the lingual and labial groups before and after treatment(P>0.05).The results indicate that the lingual appliance has little effect on the hyoid bone and the hyoid position is stable.3.Change in tongue volumeThe results of this study showed that the tongue volume of the test group decreased from 43.75±5.89(cm~3)to 38.68±4.54(cm~3),with an average reduction of 5.07±4.03(cm~3),and the difference of the tongue volume was statistically significant(P<0.05).Compared with pre-treatment,there was no significant difference in tongue volume in the labial group(P>0.05).At the same time,the changes in tongue volume before and after treatment in the two groups were statistically significant(P<0.05).These results indicated that the tongue volume decreased significantly during lingual orthodontics.4.Changes in AHI and ODI valuesThe results showed that there were no significant differences in AHI and ODI values between the two groups(P>0.05),no time effect was found(P>0.05),and there was no significant interaction between time and different groups(P>0.05).Conclusions:Lingual active wing appliances compress the volume of the oral cavity,and the palatopharyngeal and glossopharyngeal airways was constricted.At the same time,the volume of the tongue was significantly reduced during the treatment,and the position of the hyoid bone did not change,which was a favorable factor the upper airway stenosis and collapse.In the lingual group,AHI and ODI values were stable before and after treatment.Although the upper airway was narrowed,it did not induce sleep apnea in adults. |
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