STUDY OBJECTIVES: The mandibular advancement device (MAD) is widely used as a non-continuous positive airway pressure treatment option for obstructive sleep apnea (OSA), but it is associated with some side effects. To figure out the side effects related to MAD design and aid clinical decision-making, this systematic review compares the types and severity of side effects caused by both the adjustable and the non-adjustable MADs.

METHODS: Three databases were searched until May 2024 and 26 relevant studies were eligible for inclusion. The side effects examined include dentoskeletal changes and issues related to the temporomandibular joint, masticatory muscles or periodontium.

RESULTS: Compared with adjustable MADs (OverJet: MD: 0.98, 95% CI: 0.66 to 1.30; OverBite: MD: 0.99, 95% CI: 0.67 to 1.30), non-adjustable MADs show less change in overjet (MD: 0.88, 95% CI: 0.49 to 1.28) and overbite (MD: 0.79, 95% CI: 0.32 to 1.26). Adjustable MADs have less impact on temporomandibular joint and masticatory muscles than non-adjustable MADs. However, there were no significant differences in sella-nasion-A point (MD: 0.10, 95% CI: -0.36 to 0.56), sella-nasion-B point (MD: 0.19, 95% CI: -0.28 to 0.67), A-nasion-B point (MD: -0.14, 95% CI: -0.42 to 0.15) after treatment of either type of MAD. There were no signs of periodontitis or bone resorption observed after treatment with adjustable MAD.

CONCLUSIONS: The findings provide valuable information for clinicians in selecting appropriate MAD. However, given the limitations of the current evidence, there is no single superior custom MAD design in terms of side effects at present.

SYSTEMATIC REVIEW REGISTRATION: Registry: PROSPERO; Identifier: CRD42024526666.