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Airway Orthodontic Innovations That Have Transformed Patient Care

I would love to say that there are many airway innovations and orthodontic advancements in orthodontic care that are enhancing the airway health of large segments of the population.  I don’t, however,  see the “breakthrough treatment” that easily helps large segments of the population. Dental technology has been focused on implants and cosmetic dentistry more than airway orthodontics. Perhaps one of the most significant of new dental tools which impacts patient care dentistry is the Cone Beam X-Ray (CBCT). This valuable tool has been around now for over 20 years and has become a must-have tool in the office of anyone wanting to provide airway orthodontic treatment. We are able to visualize the entire airway from the nostrils down to the trachea in intimate detail. Seeing the problem is great, but seeing doesn’t automatically provide a solution. It helps us know where we need to focus our efforts to improve someone’s airway.

There is growing concern in the profession regarding the inadequacy of polysomnography (traditional sleep test) and many people are discussing how home sleep tests can be an alternative in some cases. Having said that, there are many in the industry who question the entire efficacy of sleep tests. I believe tools which may become more useful in the future will include autonomic testing which specifically focuses on heart-rate variability and DISE (drug induced sleep endoscopy).   

I’ve said for years that we are truly in our infancy understanding sleep disordered breathing, quantifying it, and having easy to do and highly successful, predictable treatments.

FAQs About Airway Orthodontic Innovations That Have Transformed Patient Care

What are the latest innovations in airway orthodontics?
CBCT is probably the biggest innovation in airway orthodontics. It probably doesn’t qualify as an airway innovation and is not orthodontic care, but it is a tool to visualize and quantify the airway along its length from the nostrils to the level of the larynx.
CBCT has not transformed patient care actually but has transformed the way we visualize the airway and how we can quantify changes made to the airway
The major “tools” we have to use in airway-focused orthodontics really are in three groups. One group involves ways of measuring and quantifying changes to the airway. CBCT, rhinometry, HRV, and DISE are ways to measure changes. Then there are the techniques we use to develop the airway both in the lateral and anteroposterior plane of space – actual physical appliances. The third tool is myofunctional therapy which is the training of the facial and pharyngeal muscles.
There are really no tools that are specific to the pediatric airway. The same tools used for treating the pediatric population are generally usable in the adolescent and adult population. Surgery to develop both jaws forward is probably used only in teens or adults and not generally in most pediatric patients.

Patient outcomes are better when we focus on improving the size of the airway in the anteroposterior plane of space. Lateral expansion is necessary as part of virtually all treatments being rendered, but the chances of success go up significantly when we operate in the A-P plane of space as well. Myofunctional therapy to tone the pharyngeal muscles to prevent collapse is an important advancement as well.

Digital tools like CBCT are used to measure and quantify the airway size. Scanning of the dental arches is a digital tool which can be used to construct appliances used to change the size of the jaws and the airway.

The future of airway-focused orthodontics is actually very rosy. The demand for services has grown dramatically with public awareness being very high. Books like James Nestor’s “Breath” have put this subject on the front page for many people worldwide, particularly mothers that I refer to politely as “mama bears”. I don’t believe the profession has embraced the airway issue the way it should and many orthodontists will suffer because of this. Unless and until the airway is put at the top of the list of things to optimize with treatment the focus will continue on aligning teeth and making them fit like gears. Currently I see more interest in airway-focused orthodontics in general dentists who do ortho and pediatric dentists than orthodontists. Pediatric dentists on the forefront of change have wisely embraced this problem and are transforming their practices away from fighting the sugar wars (treating preventable tooth decay) and learning approaches which can help children be nasal breathers at the earliest possible age.