Hidden Clues: Radiographic Incidental Findings That Could Compromise MAD Therapy Success or Tolerance for OSA - A Targeted Literature Review
Reimy Evangelista De León DDS1*, Naira Bellinghieri DDS2, Merelyn Hong DDS3, Luis Quintero DDS4, Flavia Tamayo DDS5, Rafael Cabrera DDS6
1Adjunct Faculty, Tufts University School of Dental Medicine. MA, USA.
2Universidad Central de Venezuela, Venezuela.
3Assistant Professor, Tufts University School of Dental Medicine, Comprehensive Care Department. MA, USA.
4Universidad del Zulia, Venezuela.
5Universidad de Carabobo, Venezuela.
6Pontificia Universidad Católica Madre y Maestra. PUCMM. Dominican Republic.
*Corresponding Author: Reimy Evangelista De Leon, DDS, Vermont Orofacial Pain Associates, South Burlington, VT 05403, USA.
https://doi.org/10.58624/SVOADE.2026.07.017
Received: April 28, 2026
Published: May 20, 2026
Citation: Evangelista De Leon, R, Bellinghieri N, Hong M, Quintero L, Tamayo F, Cabrera R. Hidden Clues: Radiographic Incidental Findings That Could Compromise MAD Therapy Success or Tolerance for OSA - A Targeted Literature Review. SVOA Dentistry 2026, 7:3, 117-133. doi: 10.58624/ SVOADE.2026.07.017
Abstract
Background: Mandibular advancement devices (MADs) are widely used for the treatment for patients with mild to moderate obstructive sleep apnea (OSA), particularly for those who cannot tolerate continuous positive airway pressure (CPAP) therapy, the current gold standard. These appliances function by advancing the mandible during sleep to maintain upper airway patency and reduce respiratory events. Although MAD therapy can be effective, its success is highly dependent on anatomical, musculoskeletal, and systemic conditions that affect airway dynamics and mandibular function.
Aim: This review aims to identify and discuss clinical and radiographic findings that may complicate the use of MADs. Conditions such as nasal obstruction, temporomandibular joint (TMJ) disorders, craniofacial anomalies, cervical spine changes, and certain systemic diseases may affect appliance tolerance, retention, and overall therapeutic effectiveness. Radiographic findings, including TMJ osteoarthritis, subchondral cysts, and structural nasal abnormalities, may serve as important diagnostic indicators when evaluating patients for oral appliance therapy.
Discussion: A comprehensive assessment that includes medical history, clinical examination, and appropriate imaging is essential prior to initiating MAD therapy. In many cases, interdisciplinary collaboration with ENT specialists, rheumatologists, sleep physicians, or orofacial pain specialists may be necessary to optimize treatment outcomes. Recognizing these anatomical and radiographic challenges allows clinicians to improve patient selection, tailor appliance design when necessary, and reduce the risk of complications.
Conclusion: Overall, a personalized, evidence-based approach is essential for maximizing the effectiveness and long-term success of MAD therapy in patients with obstructive sleep apnea.
Keywords: Mandibular advancement device (MAD); Obstructive sleep apnea (OSA); Temporomandibular joint (TMJ); Radiographic findings; Craniofacial anatomy; Nasal airway obstruction; Oral appliance therapy; Temporomandibular joint disorders (TMD); CBCT imaging; Anatomical contraindications.
