The Orthodontic Management of Obstructive Sleep Apnea: A Systematic Review


Obstructive sleep apnea
Rapid maxillary expansion
Mandibular advancement appliance
Upper airway


How to Cite

Assali A, Neani H, Bahije L, Zaoui F, Halimi A. The Orthodontic Management of Obstructive Sleep Apnea: A Systematic Review. Integr J Med Sci [Internet]. 2022 Jan. 22 [cited 2024 Jul. 24];9. Available from:


Background: Obstructive Sleep Apnea (OSA) is considered a real public health problem, often unrecognized or underdiagnosed, requiring multidisciplinary care, including orthodontics that plays an essential role in the screening and managing ventilation. Objective: Our study aims to explain the vital role of orthodontic therapies, whether orthopedic or surgical, in the multidisciplinary management of OSA and improving nasal breathing through a systematic review. Materials and Methods: The literature search was performed in the following databases: PubMed, ScienceDirect, and Cochrane Library. The investigation was limited to publications written in English and French from 2010 to January 2022. Results: Based on the keywords used, eighty-three references were initially identified. After eliminating duplicates, the number of articles was reduced to 79. Studying the titles and abstracts made it possible to select 50 articles. After reading the complete text, 16 publications were included in this systematic review. Eight studies have investigated rapid maxillary expansion (RME), five have evaluated mandibular advancement (MA), and three have investigated the effect of genioplasty in children with OSA. Conclusion: The orthodontic arsenal is well suited and highly beneficial for OSA treatment, whether orthopedic, orthodontic, or surgical correction of jaws.


Osmane AM, Carter SG, Carberry CJ, Eckert DJ. Obstructive sleep apnea: current perspective. Nature and science of sleep. 2018 Jan 23; 10:21-34.

Kulshrestha R, Tandon R, Kinger S, Rohmetra A , Vikram Singh R . Obstructive sleep apnea in orthodontics: An overview. Int J Orthod Rehabil. 2016;7(3):115-8.

Aubertin G. Le syndrome d’apnées obstructives du sommeil chez l’enfant. Rev Pneumol clin. 2013; 69: 229—236. [Accessed 2022 Jan 13]. Available from:

Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its Management. Ther Adv Chronic Dis. 2015 Sep;6(5):273-85.

Veasey SC, Rosen IM. Obstructive Sleep Apnea in Adults. N Engl J Med. 2019 Apr 11; 380(15):1442-1449.

Jaradat M , Rahhal A . Obstructive Sleep Apnea, Prevalence, Etiology & Role of Dentist & Oral Appliances in Treatment: Review Article. Open J Stomatology. 2015; 5(7): 187-201. [Accessed 2022 Jan 13]. Available from:

Hudgel DW. Sleep Apnea Severity Classification – Revisited. Sleep. 2016 May 1; 39(5): 1165-6.

National Institutes of Health. Quality Assessment of Case-Control Studies. Department of Health & Human Services. USA: Mar 2014.

Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med. 2015 Aug; 16(8):933-5.

Villa MP, Rizzoli A, Rabasco J, Vitelli O, Pietropaoli N, Cecili M, et al. Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children. Sleep Med. 2015 Jun; 16(6):709-16.

Fatsuca R, Perinetti G, Zecca PA, Nucera R, Caprioglio A. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod. 2015 Nov;85(6):955-61.

Villa MP, Castaldo R, Miano S, Paolino MC, Vitelli O, Tabarrini A, et al. Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea. Sleep Breath. 2014 Sep; 18(3):533-9.

Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol. 2014 Jan;78(1):23-7.

Marino A, Ranieri R, Chiarotti F, Villa MP, Malagola C. Rapid maxillary expansion in children with obstructive sleep apnoea syndrome (OSAS). Eur J Paediatr Dent. 2012 Mar;13(1):57–63.

Guilleminault C, Monteyrol PJ, Huynh NT, Pirelli P, Quo S, Li K. Adenotonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study. Sleep Breath. 2011 May;15(2):173–177.

Villa MP, Rizzoli A, Miano S, Malagola C. Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up. Sleep Breath. 2011 May;15(2):179-84.

Idris G, Galland B, Robertson CJ, Gray A, Farella M. Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial. J Dent. 2018 Apr;71 :9-17.

Modesti-Vedolin G, Chies C, Chaves-Fagondes S, Piza-Pelizzer E, Lima-Grossi M. Efficacy of a mandibular advancement intraoral appliance (MOA) for the treatment of obstructive sleep apnea syndrome (OSAS) in pediatric patients: A pilot-study. Med Oral Patol Oral Cir Bucal. 2018 Nov 1;23(6):e656-e663.

Machado-Júnior AJ, Signorelli LG, Zancanella E, Crespo AN. Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: A pilot study. Med Oral Patol Oral Cir Bucal 2016;21(4):e403-e7.

Zhang C, He H, Ngan P. Effects of twin block appliance on obstructive sleep apnea in children: A preliminary study. Sleep Breath. 2013 Dec;17(4):1309-14.

Schütz TC, Dominguez GC, Hallinan MP, Cunha TC, Tufik S. Class II correction improves nocturnal breathing in adolescents. Angle Orthod. 2011 Mar; 81(2):222-8.

Bedoucha V, Boutin F, Frapier L. Impact of genioplasty during puberty on the upper airways. Int Orthod. 2015 Dec;13(4):421-35.

Frapier L, Picot Mc, Gonzales J, Massif L, Breton I, Dauvilliers Y, et al. Ventilatory disorders and facial growth: Benefits of early genioplasty. Int Orthod. 2011 Mar; 9(1): 20-41.

Frapier L, Jaussent A, Yachouh J, Goudot P, Dauvilliers Y, Picot MC. Impact of genioplasty on mandibular growth during puberty. Int Orthod. 2010 Dec; 8(4):342–59 .

Belkhiri A. Obstructive sleep apnea syndrome (OSAS) in children and the contribution of orthodontist in the treatment. Intern J Applied Dent Sci. 2021;7: 216-219.

Bucci R, Montanaro D, Rongo R, Valletta R, Michelotti A, D'Antò V. Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta-analyses. J Oral Rehabil. 2019 Apr;46(4):377-387.

Erdur EA, Yıldırım M, Karatas RM, Akın M. Effects of symmetric and asymmetric rapid maxillary expansion treatments on pharyngeal airway and sinus volume: A cone-beam computed tomography study. Angle Orthod. 2020 May 1; 90(3):425-431.

Almuzian M, Xiangyang Ju, Almukhtar A, Ashraf A, Al-Muzian L, McDonald JP. Does rapid maxillary expansion affect nasopharyngeal airway? A prospective Cone Beam Computerised Tomography (CBCT) based study. Surgeon. 2018 Feb;16(1):1-11.

Lin SY, Su YX, Wu YC, Chang JZ, Tu YK. Management of paediatric obstructive sleep apnoea: A systematic review and network meta-analysis. Int J Paediatr Dent. 2020 Mar; 30(2):156-170.

Modesti-Vedolin G, Chies C, Chaves-Fagondes S, Piza-Pelizzer E, Lima-Grossi M. Efficacy of a mandibular advancement intraoral appliance (MOA) for the treatment of obstructive sleep apnea syndrome (OSAS) in pediatric patients: A pilot-study. Med Oral Patol Oral Cir Bucal. 2018 Nov 1; 23(6):e656-e663.

Basyuni S, Barabas M, Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. J Thorac Dis. 2018 Jan; 10(1), S48-S56.

Carvalho FR, Lentini-Oliveira DA, Prado LBF, Prado GF, Carvalho LBC. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2016 Oct 5; 10(10): CD005520.

Villa, Maria ,Bernkopf, Edoardo , Pagani, Jacopo ,Broia, Vanna , Montesano, Marilisa ,Ronchetti, Roberto. (2002). Randomized Controlled Study of an Oral Jaw-Positioning Appliance for the Treatment of Obstructive Sleep Apnea in Children with Malocclusion. January 2002.American Journal of Respiratory and Critical Care Medicine 165(1):123-7.

Blanco J , Zamarrón C, Abeleira Pazos MT, Lamela C, Suarez Quintanilla D. Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath. 2005 Mar; 9(1):20-5.

Cozza P, Polimeni A, Ballanti F. A modified monobloc for the treatment of obstructive sleep apnea in paediatric patients. Eur J Orthod. 2004 Oct; 26(5):523-30.

Kim YK, Kim JW, Yoon IY, Rhee CS, Lee CH, Yun PY. Influencing factors on the effect of mandibular advancement device in obstructive sleep apnea patients: analysis on cephalometric and polysomnographic parameters. Sleep Breath. 2014 May; 18(2):305-11.

Serra-Torres S, Bellot-Arcís C, Montiel-Company JM, Marco-Algarra J, Almerich-Silla JM. Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review. Laryngoscope. 2016 Feb; 126(2):507-14.

Yanyan M, Min Y, Xuemei G. Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis. Sleep Med. 2019 Aug; 60:145-151.

Santos Junior JF, Abrahão M, Gregório LC, Zonato AI, Gumieiro EH. Genioplasty for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome and mandibular retrognathia. Rev Bras Otorrinolaringol 2007; 73(4):480-6.

Elhaddaoui R, Bahoum A, Azaroual MF, Garcia C, Zaoui F, Halimi A, et al. A predictive model of advancement genioplasty in Class III bimaxillary surgical cases. Int Orthod. 2018 Sep; 16(3):530-544.

Bedoucha V, Boutin F, Frapier L. Impact of genioplasty during puberty on the upper airways. Int Orthod. 2015 Dec; 13(4): 421-35.

Chamberland S, Proffit WR, Chamberland P. Functional genioplasty in growing patients. Angle Orthod. 2015 May;85(3):360-73.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2021 Assali A et al.


Download data is not yet available.


Metrics Loading ...