An often-mentioned side effect of mandibular advancement is morning malocclusion. Some patients report, “My bite doesn’t fit in the morning.” It has been shown in an objective study that a greater amount of protrusion can lead to more side effects. This dose response suggests that clinicians should pursue a conservative, less-is-more approach to titrating appliances.
Research has shown that, in most patients with mild to moderate OSA, advancement of 50% of the patient’s range of motion is equally as effective as a 75% titration. One study showed that these occlusal changes are transient and of little concern to the patient. In some instances, these changes can become permanent. However, they can easily be managed once the cause of dental malocclusion is understood.
Basically, the shape of the articular disc changes depending on the position of the condyle in the mandibular fossa and forces applied to it. The disc acts like a sponge; it absorbs fluid due to the reduced pressure as the condyle is held down and forward by the oral appliance.