A Eficácia de Cirurgias Orais no Tratamento da Apneia Obstrutiva do Sono: Revisão Sistemática sobre Dispositivos de Avanço Mandibular e Avanço Maxilomandibular
DOI:
https://doi.org/10.36557/2674-8169.2025v7n5p1609-1624Palavras-chave:
Apneia obstrutiva do sono, avanço mandibular, cirurgia ortognática, avanço maxilomandibular, CPAP, cirurgia oral.Resumo
Introdução: A apneia obstrutiva do sono (AOS) é um distúrbio respiratório prevalente,
associado a múltiplas comorbidades. Apesar da eficácia da pressão positiva contínua
nas vias aéreas (CPAP), sua baixa adesão clínica motiva a busca por alternativas
terapêuticas, entre elas os dispositivos de avanço mandibular (DAM) e o avanço
maxilomandibular (MMA).
Objetivo: Avaliar, por meio de uma revisão sistemática, a eficácia das cirurgias orais,
com ênfase em DAM e MMA, no tratamento da AOS.
Metodologia: A busca foi realizada nas bases PubMed, Scopus, Web of Science,
EMBASE e BVS, incluindo estudos publicados entre 2000 e 2024. Foram selecionados
estudos clínicos, revisões sistemáticas e metanálises com pacientes adultos
diagnosticados com AOS que relataram desfechos como o índice de apneia-hipopneia
(IAH), saturação de oxigênio e qualidade de vida.
Resultados: Vinte estudos foram incluídos, demonstrando que os DAMs são eficazes
em casos leves a moderados, com impacto positivo sobre o IAH e adesão ao
tratamento. O MMA mostrou-se altamente eficaz em casos graves, com taxas de
sucesso superiores a 80% e resultados duradouros. Estudos comparativos indicaram
que DAMs e MMA podem ser alternativas seguras ao CPAP, com menor impacto sobre
estruturas como a articulação temporomandibular.
Conclusão: DAMs e MMA são intervenções efetivas no tratamento da AOS, oferecendo
alternativas viáveis à terapia convencional. Estudos clínicos robustos são necessários
para padronizar indicações e ampliar o uso dessas abordagens na prática
interdisciplinar.
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Referências
Uniken Venema JAM et al. Mandibular advancement device design: A systematic
review on outcomes in obstructive sleep apnea treatment. Sleep Med Rev. 2021.
Ramar K et al. Clinical Practice Guideline for the Treatment of Obstructive Sleep
Apnea and Snoring with Oral Appliance Therapy. J Clin Sleep Med. 2015.
Noller MW et al. (2018) Mandibular advancement for pediatric obstructive sleep
apnea: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2018.
Noller MW et al. (2017) Mandibular advancement for adult obstructive sleep
apnea: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2017.
Liao J et al. Efficacy of Oral Appliance for Mild, Moderate, and Severe
Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2024.
Christino M et al. Impact of counterclockwise rotation of the occlusal plane on the
mandibular advancement, pharynx morphology, and polysomnography results in
maxillomandibular
osta YM et al. Impact of a mandibular advancement device on corticomotor
plasticity in patients with obstructive sleep apnea. J Oral Rehabil. 2024.
Dal-Fabbro C et al. Mandibular advancement device and CPAP upon
cardiovascular
parameters
in
OSA.
Sleep
Breath.
Gottsauner-Wolf S et al. Posterior Airway Changes Following Orthognathic
Surgery in Obstructive Sleep Apnea. J Oral Maxillofac Surg. 2018.
Trindade PAK et al. Is maxillomandibular advancement an effective treatment for
obstructive sleep apnea? Systematic review and meta-analysis. Braz J
Otorhinolaryngol.2023.
Camacho M et al. Long-term Results for Maxillomandibular Advancement to
Treat Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg.
Ou YH et al. Mandibular Advancement vs CPAP for Blood Pressure Reduction in
Patients With Obstructive Sleep Apnea. J Am Coll Cardiol. 2024.
Attia AAMM et al. Effects of different treatments for obstructive sleep apnea on
temporomandibular joint: a randomized clinical trial. BMC Oral Health. 2024.
Wang W et al. Clinical Effect of Personalized Adjustable Mandibular
Advancement Device on Obstructive Sleep Apnea. Br J Hosp Med. 2024.
Babaei M et al. A comprehensive bench-to-bed look into the application of
gamma-sterilized 3D-printed polycaprolactone/hydroxyapatite implants. Biomater
Adv.
tenting
Khaled H et al. Maxillary sinus floor elevation using hydroxyapatite nanoparticles
vs
technique.
Clin
Implant
Dent
Relat
Res.
Nour M et al. Two Stage Sinus Lifting Using Nanohydroxyapatite Particles
Versus Deproteinized Bovine Bone. Clin Implant Dent Relat Res. 2025.
Suresh N et al. The Effectiveness of Curcumin Nanoparticle-Coated Titanium
Surfaces in Osteogenesis: A Systematic Review. J Funct Biomater. 2024.
Dewi AH et al. The use of hydroxyapatite bone substitute grafting for alveolar
ridge preservation, sinus augmentation, and periodontal bone defect. Heliyon.
Kattimani VS et al. Role of Synthetic Hydroxyapatite-In Socket Preservation: A
Systematic Review and Meta-analysis. J Contemp Dent Pract. 2019.
Uniken Venema JAM et al. Mandibular advancement device design: A systematic
review on outcomes in obstructive sleep apnea treatment. Sleep Med Rev. 2021.
Ramar K et al. Clinical Practice Guideline for the Treatment of Obstructive Sleep
Apnea and Snoring with Oral Appliance Therapy. J Clin Sleep Med. 2015.
Noller MW et al. (2018) Mandibular advancement for pediatric obstructive sleep
apnea: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2018.
Noller MW et al. (2017) Mandibular advancement for adult obstructive sleep
apnea: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2017.
Liao J et al. Efficacy of Oral Appliance for Mild, Moderate, and Severe
Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2024.
Christino M et al. Impact of counterclockwise rotation of the occlusal plane on the
mandibular advancement, pharynx morphology, and polysomnography results in
maxillomandibular
advancement
surgery.
Sleep
Breath.
Costa YM et al. Impact of a mandibular advancement device on corticomotor
plasticity in patients with obstructive sleep apnea. J Oral Rehabil. 2024.
Dal-Fabbro C et al. Mandibular advancement device and CPAP upon
cardiovascular
parameters
in
OSA.
Sleep
Breath.
Gottsauner-Wolf S et al. Posterior Airway Changes Following Orthognathic
Surgery in Obstructive Sleep Apnea. J Oral Maxillofac Surg. 2018.
Trindade PAK et al. Is maxillomandibular advancement an effective treatment for
obstructive sleep apnea? Systematic review and meta-analysis. Braz J
Otorhinolaryngol.
Camacho M et al. Long-term Results for Maxillomandibular Advancement to
Treat Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg.
Ou YH et al. Mandibular Advancement vs CPAP for Blood Pressure Reduction in
Patients With Obstructive Sleep Apnea. J Am Coll Cardiol. 2024.
Attia AAMM et al. Effects of different treatments for obstructive sleep apnea on
temporomandibular joint: a randomized clinical trial. BMC Oral Health. 2024.
Wang W et al. Clinical Effect of Personalized Adjustable Mandibular
Advancement Device on Obstructive Sleep Apnea. Br J Hosp Med. 2024.
Babaei M et al. A comprehensive bench-to-bed look into the application of
gamma-sterilized 3D-printed polycaprolactone/hydroxyapatite implants. Biomater
Adv.
tenting
Khaled H et al. Maxillary sinus floor elevation using hydroxyapatite nanoparticles
vs
technique.
Clin
Implant
Dent
Relat
Res.
Nour M et al. Two Stage Sinus Lifting Using Nanohydroxyapatite Particles
Versus Deproteinized Bovine Bone. Clin Implant Dent Relat Res. 2025.
Suresh N et al. The Effectiveness of Curcumin Nanoparticle-Coated Titanium
Surfaces in Osteogenesis: A Systematic Review. J Funct Biomater. 2024.
Dewi AH et al. The use of hydroxyapatite bone substitute grafting for alveolar
ridge preservation, sinus augmentation, and periodontal bone defect. Heliyon.
Kattimani VS et al. Role of Synthetic Hydroxyapatite-In Socket Preservation: A
Systematic Review and Meta-analysis. J Contemp Dent Pract. 2019.
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Copyright (c) 2025 Ana Luiza de Castro e Silva , Gabriel da Silva Costa, Jessica castro Costa , Aléxia Caroline Leandro da Conceição , Jennifer Vera Santos Gumert, Henrique Galvão de Zúniga Honorato , Manuella Chavantes Silva , Klarice Rafaella Menezes de Oliveira , Renata Camargo Ferraz , Dyego Matielo Peres Lemos
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os autores são detentores dos direitos autorais mediante uma licença CCBY 4.0.
