Traditional orthodontic care has historically been retractive in nature. If you have not yet come to understand that any form of retraction has the potential to be highly detrimental to both the face and the airway, this is something you must learn before proceeding. You cannot avoid a problem—or provide truly successful treatment—if you don’t recognize that the problem exists.

I encourage you to read an article I co-authored with Dr. Michael Gelb, “Airway Centric® TMJ philosophy/Airway Centric® orthodontic ushers in the post-retraction world of orthodontics,” published in the Journal of Craniomandibular Practice (2017). You may be surprised to learn that many appliances claiming to grow the mandible—such as the Herbst, MARA, Forsus, and Twin-Block—actually cause retraction. Similarly, wearing Class II elastics to “fix” a Class II malocclusion may bring the mandible forward, but it retracts the maxilla.

Traditional orthodontic treatments prioritize perfect tooth alignment—like gears fitting together—eliminating any overjet. However, even minute retraction associated with these treatments can negatively impact the airway. I’ve learned this lesson the hard way. If you truly want to be an Airway Dentist, you need to understand this.

Successful airway-focused treatments must never include any form of retraction. However, advancing teeth in either arch is often frowned upon by many in the profession due to outdated concerns about tooth loss and recession. In reality, there are at least seven articles in peer-reviewed literature proving this concern to be incorrect, yet these findings are often ignored. In many cases, advancing teeth is necessary to optimize the airway.

Class II patients can have their jaws successfully advanced, but in most cases, this must be done before age 10. For adolescent Class II patients, if they reject surgical advancement of both jaws, they may need to remain Class II rather than compromise their airway. Camouflage treatment, which we teach in our mentorship program, may help—but it is not a guaranteed solution. We make no promises to any patient and teach our students to do the same.

Bloodletting was once the Standard of Care—but you would be hard-pressed to find someone performing it today. Hopefully, retraction in any form will soon follow that fate, making way for a new standard of care focused on forward facial development.