published_or_final_version / Dentistry / Master / Master of Orthodontics

published_or_final_version / Dentistry / Master / Master of Orthodontics

published_or_final_version / Dentistry / Master / Master of Orthodontics

published_or_final_version / Dentistry / Master / Master of Orthodontics

Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive closure of the upper airway during sleep and associated with significant adverse health effects including hypertension, heart disease and stroke. Current treatment with continuous positive airway pressure (CPAP) is highly effective but reduced compliance levels have resulted in suboptimal outcomes. Oral appliances such as mandibular advancement splints (MAS) are an alternative treatment and have potential advantages including greater patient compliance, comfort and portability. Although they have been shown to be successful across all categories of OSA severity, overall they are less effective than CPAP. A key limitation to its more widespread use has been the inability to predict which patients will be a treatment success. Prediction of treatment outcome would greatly enhance both MAS utilization and overall OSA management. However, little is known about the mechanisms of action of MAS therapy and a more detailed understanding is likely to improve patient selection and outcome. The aim of this thesis is to improve the prediction of treatment outcome through improved understanding of the mechanisms and site(s) of action of MAS therapy during sleep, through extrapolating this knowledge into daytime prediction tests and by developing prediction equations which can be tested prospectively. The work in this thesis presents novel ideas and findings. It is the first to examine and find that MAS therapy improves upper airway collapsibility during sleep. The site(s) of upper airway collapse was also examined and found to predict treatment outcome. Primary oropharyngeal collapse during sleep predicted treatment success and this was extrapolated into a simple daytime test hypothesized to reflect oropharyngeal function. These primary oropharyngeal collapsers were found to have characteristic awake flow-volume curves and this was then studied prospectively. Cephalometric X-rays and anthropomorphic measurements were also evaluated to formulate prediction equations for treatment outcome with MAS. These new findings together with their implications for clinical practice and future research are then summarized. It is concluded, however, that although many advancements have been made, the mechanisms of MAS action and prediction of treatment outcome remain incompletely understood reflecting the complex pathophysiology of the upper airway.

Master of Science in Dentistry / Objectives: The aims of this study were: • to evaluate the exact level of the mandibular canal using Cone Beam Volumetric Tomography (CBVT) using measurements taken on images from the NewTom3G and i-CAT machines and manually • to determine the course of the mandibular canal in the regions of the first, second , and third molars • to compare the course of the mandibular canals bilaterally • to compare variables measured between the CBVT and panoramic units • to determine appropriate positions for the implant placement at the region of the mandibular molars in relation to the mandibular canal. Methods: Ten mandibles were selected, including seven edentulous and three dentate ones. They were marked at four positions from the distal border of the mental foramina in the posterior direction at intervals of 10.00 mm. On each dry mandible, at four sites namely M0, M1, M2, and M3, Gutta Percha (GP) points, known as markers, were attached to the mandible so that they were parallel to the midline of the mandible on both buccal and lingual sides. On the NewTom 3G and i-CAT, variables of cross-sectional images were measured from the alveolar crest of the mandible to the superior border of the mandibular canal (AC); the lingual rim of the canal to the lingual margin of the mandible (LC); the buccal rim of the canal to the buccal margin of the mandible (BC); the inferior rim of the canal to the lower border of the mandible (IC), and from the lingual margin to the buccal margin of the mandible (BW: Bone Width). Dry mandibles were subsequently sacrificed by cutting at the four marked sites. On each cross-section of mandibles, distances AC, BC, LC, IC, and BW were measured using a caliper as the manual measurement. IC distances on a conventional OrthophosIII panoramic machine were also measured to compare with the CBVT. Data were managed by Microsoft Office Excel 2003 and transferred to the software of Statistics Package for Social Sciences (SPSS) version 15.0 for Windows for analysis. Data were presented as Mean, Standard Deviation (SD), and Mean Difference, and Standard Error of Mean (SEM) with decimal at 0.00. T-test and One-way ANOVA were used to analyse variables measured in which T-test was used to analyse variables with paired samples and One-way ANOVA was used with adjustment for multiple comparisons of Bonferroni. Statistical significance has an assumed P- value of 0.05 or less. Results: The findings showed that there was no significant difference among measured variables from the NewTom 3G, i-CAT and manual measurement (P>0.05). There was significant statistical difference between the Orthophos OPG machine and CBVT system (P=0.00<0.05). There was no significant difference in the course of the mandibular canals bilaterally (P>0.05). On average, Distances AC, BC, LC, and IC were obtained for reference purposes. The bone width of the mandible on the right side was slightly different from that on the left side. Conclusions: The findings implied CBVT was an accurate diagnostic tool for locating the course of the mandibular canal and for placing dental implants in the region of the mandibular molars. The course of the mandibular canal on the left and right sides was variable. The distances measured at the region of the first, second, and third mandibular molars should be considered as a valuable reference. The bone width of the mandible on the right and left sides was slightly different. The accuracy of the NewTom3G and i-CAT was superior to the panoramic Orthophos machine. However, a panoramic radiograph is still valuable in the daily dental clinic.

Dissertation (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Vita. Bibliography: p. 86.

Thesis (M.S. )--University of Tennessee Health Science Center, 2005. / Title from title page screen (viewed on May 21, 2008). Research advisor: Denis D'angelo, Ph.D. Document formatted into pages (xiv, 137 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 76-85).

Thesis (M.S.)--University of Michigan, Ann Arbor, 1983. / Typescript (photocopy). Includes bibliographical references (leaves 45-48). Also issued in print.

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 116-130). Also available in print.