Maximum voluntary retrusion or habitual bite position for mandibular advancement assessment in the treatment of obstructive sleep apnoea patients.
BACKGROUND
There is no consensus on whether the range of mandibular advancement for the construction of mandibular advancement devices in obstructive sleep apnoea (OSA) patients should be measured from a starting position of maximum voluntary retrusion or habitual bite position.


OBJECTIVE
The purposes of this study were to investigate the differences in mandibular advancement registrations starting from maximum voluntary retrusion or from habitual bite position and to evaluate the reliability of these assessments.


METHODS
A retrospective cohort analysis of 126 patients with OSA was performed. All patients had their mandibular range of motion evaluated twice (starting from maximum voluntary retrusion and from habitual bite position) through the George Gauge before undergoing drug-induced sleep endoscopy. The Dahlberg formula and paired t test were used to calculate random and systematic errors of dental positions assessment. Test-retest reliability was quantified using the intra-class correlation coefficient (ICC).


RESULTS
The mean mandibular range starting from maximum voluntary retrusion and from habitual bite position were 12.49 ± 2.19 mm and 7.68 ± 2.29 mm, respectively, with a mean distance between the two starting positions of 4.81 ± 1.75 mm. No systematic error was found (P > .05), and random errors ranged from 0.30 to 0.95 mm. ICC values were excellent for maximum voluntary protrusion (ICC = 0.986) and maximum voluntary retrusion (ICC = 0.956), whereas habitual bite position showed a good value (ICC = 0.818).


CONCLUSION
The difference between maximum voluntary retrusion and habitual bite position is potentially relevant. Maximum retrusion is advisable as starting point of the mandibular advancement registration since it provides a more reliable measure.
['Ippolito|Daniela Rita|DR|', 'Stipa|Chiara|C|', 'Cameli|Matteo|M|', 'Sorrenti|Giovanni|G|', 'Pelligra|Irene|I|', 'Alessandri-Bonetti|Giulio|G|https://orcid.org/0000-0003-1317-1901']
D006801:Humans D019186:Mandibular Advancement D017090:Occlusal Splints D015203:Reproducibility of Results D012189:Retrospective Studies D020181:Sleep Apnea, Obstructive D016896:Treatment Outcome
habitual bite obstructive sleep apnoea mandibular advancement device reliability mandibular range of motion mandibular retruded position