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.
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.
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.