Long-Term Efficacy of Orthopedic Mandibular Advancement Therapy in Pediatric Obstructive Sleep Apnea: A 7-Year Follow-Up Study

Study Objectives: To evaluate the long-term effects of monoblock mandibular advancement therapy on craniofacial morphology, upper airway dimensions, and sleep-related parameters in children with obstructive sleep apnea (OSA). Methods: This prospective longitudinal cohort study included 13 children (mean age 10.97 ± 1.51 years) with OSA and mandibular retrognathia treated with a monoblock appliance. Assessments were conducted at baseline (T1), post-treatment (T2), and 7 years after treatment (T3), including lateral cephalometric radiographs, polysomnography, and Pittsburgh Sleep Quality Index (PSQI) scores. Pharyngeal airway changes were analyzed using a standardized cephalometric protocol across 11 sagittal reference planes. Repeated measures ANOVA and nonparametric equivalents were applied for longitudinal comparisons. Results: Increases in oropharyngeal and hypopharyngeal airway dimensions (S6–S10) observed after treatment were generally maintained over time. Skeletal parameters showed relative stability at follow-up. Although AHI decreased significantly after treatment, a moderate increase was noted at T3; however, values remained below the adult diagnostic threshold in most patients. PSQI scores improved initially and did not show significant long-term deterioration. An increase in REM sleep percentage at T3 may reflect normalization of sleep architecture following earlier first-night effects. Conclusions: Monoblock mandibular advancement therapy initiated during childhood may be associated with favorable and largely sustained changes in skeletal and airway parameters over a 7-year period. While partial recurrence of AHI was observed during adolescence, the overall pattern suggests a potential long-term benefit in selected patients, warranting further investigation in larger cohorts.