Mandibular Repositioning Devices in the Management of Obstructive Sleep Apnea: A Scoping Review of Clinical Implications

Abstract

Background Obstructive sleep apnea (OSA) is a common but often underdiagnosed sleep-related breathing disorder associated with significant health risks and impaired quality of life. While continuous positive airway pressure (CPAP) remains the gold standard, adherence issues highlight the need for alternative therapies. Mandibular advancement devices (MADs) have emerged as an effective option, particularly for patients with mild to moderate OSA or those intolerant of CPAP. However, evidence on their clinical implications remains fragmented, warranting further synthesis. Aim The aim of this project is to conduct a scoping literature review of current evidence on the clinical implications of mandibular repositioning devices in the treatment of obstructive sleep apnea. Methods A scoping literature review was conducted focusing on studies that examined the use of mandibular advancement devices (MADs) in the management of obstructive sleep apnea. The review was based on a systematic search of literature using MIDLINE Ovid, Embase Ovid, and Cochrane library. All studies that met the predefined eligibility criteria, with particular attention to evidence on effectiveness, mechanism of action, determinants of success, and side effects were included. Results Of the 2,193 records identified, 36 studies met the inclusion criteria. The included studies were heterogeneous in design and outcomes assessed, but most reported significant reductions in AHI and improvements in oxygen saturation, sleep quality, and daytime sleepiness. Evidence also highlighted long-term effectiveness, with benefits sustained for over 10 years in some cases. Determinants of success included craniofacial morphology, age, BMI, and nasal obstruction, while treatment outcomes were less favorable in certain anatomical subtypes. Reported side effects were mainly dental and occlusal changes, generally mild but progressive with long-term use, emphasizing the need for regular monitoring. Conclusion In conclusion, this scoping review highlights the role of mandibular advancement devices (MADs) in the management of obstructive sleep apnea. Evidence indicates that MADs improve objective outcomes such as AHI and oxygen saturation, as well as patient-reported measures including sleep quality, daytime function, and snoring, making them a practical alternative for patients intolerant to CPAP. Treatment success, however, is influenced by individual factors such as craniofacial features, BMI, and age, and side effects underline the need for monitoring. Despite promising results, limitations including small sample sizes, methodological heterogeneity, and reliance on self-reported measures restrict generalizability. Further robust research is required to confirm their long-term effectiveness and clinical value.