Does Long-term Use of Oral Appliance for Sleep Apnea Cause Gingival Recession?

Objectives: The purpose of this retrospective, in-vivo, clinical and cephalometric observational study is to evaluate the periodontal changes associated with OAm treatment of 4.5 or more years, in individuals with OSA.
Methods: Subjects were screened and recruited from those patients consecutively treated at the UBC Dental Sleep Clinic and an affiliated private practice between 2004 to 2014. Eligible subjects were re-called for a follow up visit where a clinical periodontal exam was performed by one investigator. A lateral cephalogram and maxillary and mandibular impressions were also obtained. Clinical crown height for mandibular anterior teeth was measured on study models. The periodontal exam included PSR (periodontal screening and recording), plaque index (Silness and Loë), gingival bleeding index (Ainamo and Bay), probing pocket depths and facial gingival margin thickness for mandibular anterior teeth in addition to clinical attachment level (CAL), recession and width of attached gingiva. Data (lateral cephalogram and study models) from baseline records (T1) and the follow up visit (T2) were compared.
Results: A total of21 patients (15 males, mean age 57.4±12.0y.o) were enrolled, with a mean treatment length of 94.2±39.5 months (range= 54 to 172 months).
At follow up all patients presented with good oral hygiene as evident by the mean plaque index of 0.4 and bleeding index of 4.1%. Periodontal screening and recording (PSR) data confirmed absence of active periodontal disease. For the mandibular anterior teeth, mean probing depth was 1.4±0.5mm, recession was -0.6±1.1mm and CAL was 0.8±1.0mm.
Compared to baseline there was a significant proclination of mandibular incisors (increased IMPA of 5.1°) with the continued use of OAm. Clinical crown height did not change (mean increase of 0.01mm) over the evaluated time period despite the significant proclination of mandibular incisors. Gingival levels were maintained with clinically insignificant changes taking place during the study period.
Conclusions: Following long-term OAm use, mandibular incisors procline with no significant change in clinical crown height. Mandibular incisor proclination was not associated with any change in gingival levels in OSA patients.