Dentaltown July 2018 - 46

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Expander Before 6s Have Erupted?
A Townie wonders whether his 5-year-old son's sleep apnea can be solved with ortho treatment

CLT-DMD
Member Since: 12/07/09
Post: 1 of 46

My 5-year-old son was recently diagnosed with sleep apnea and the sleep physician recommended looking into having T&A removed and an expander placed. We have an ENT consult
set up in two weeks. I spoke with the orthodontist I refer to (I am a GP) and he said that he can
do a bonded expander, but would really prefer to wait until the 6s have erupted so he could get
more anchorage.
Based off my son's level of sleep apnea, the sleep physician did not want us to delay treatment, but the orthodontist seems hesitant, because he thinks he will get more dental expansion
than skeletal at this point. The orthodontist has not seen my son yet for consult, though, but
since it is a case for sleep apnea, is it best to go ahead and expand what we can at this time, or
wait for the 6s to erupt? ■
3/28/2018

orthopaul
Member Since: 07/22/10
Post: 2 of 46

I would have my lab fabricate bands on the E's with extension arms touching the palatal
surface of the D's and C's. If for whatever reason this is not an option, then a bonded RPE
should be OK.
It's always easier to wait for 6s to erupt, but it sounds like that is not the best option in this
case, based on what the physician is advising. ■
3/28/2018

drsaul
Member Since: 10/12/12
Post: 3 of 46

I would listen to your orthodontist. You can reassess after tonsils removed. Probably wait
until 6s full erupted before RPE. You may want to ask the ortho about a Bionator or other
functional appliances. These will cause jaw advancement and open the airway while sleeping,
like a sleep apnea appliance. ■
3/28/2018

davidharnick
Member Since: 08/28/02
Post: 4 of 46

This is a very interesting post, because it brings up several issues. Why is a sleep doc prescribing dental treatment? What is the order and best approach for your son? Is an RPE supported
by primary teeth effective in skeletal issues? Would one do an RPE if not indicated dentally for
the treatment of sleep apnea? Are there any issues with putting an RPE on a young child? Are
there other approaches?
My thoughts for what it's worth:
1. A sleep doctor should never be telling a dentist what to do, no more than we would tell
them what to do. It should be only for an evaluation.
2. Your first line of treatment normally would be a T&A. Furthermore, you wouldn't want
both at the same time, anyway. Kids heal from a T&A fairly quickly. This will give you
time to assess his response.
3. Primary teeth can be used for an RPE and achieve skeletal response. Rosa from Italy has
published regarding this.
4. An RPE should be done only as part of an overall treatment plan and not an isolated
treatment.
5. Proffit recorded a case of facial collapse on a young child who was treated with an RPE. I

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