Orthotown January/February 2020 - 17

The major issues with airway analysis are validity and reliability.
Both of them have been found to be lacking. So at this point, "pushing" airway is really
pseudoscience, bordering on quackery. ■

Fenrisúlfr
Member Since: 02/25/09
Post: 7 of 12

12/18/2019

I agree with this. I would place a LLHA with a spur distal to LL2 to prevent lower midline
drift. I would also closely monitor the U3s' eruption path and have UCs out early if ectopic
eruption occurs. I say this because U2s look undersized to me, which has an increased risk for
ectopic permanent canine eruption.
As for airway analysis: Again, it's important to remember the patient is upright in a CBCT,
and we do not know if the CBCT is taken on inspiration or expiration of breath. We also do
know if the patient had just swallowed. The upper airway is dynamic and changes constantly
because it is just muscle. As such, making determinations about airway on an awake, upright
patient does not tell you much. Sleep studies are needed for this very reason. All a ceph or CBCT
should tell you is, "Hmm, that airway looks narrow." Time to get out a sleep questionnaire and
screen for sleep apnea.
For this patient, the appropriate steps have already been taken. Sleep study and adenotonsillectomy
(T&A). If models show a need for upper arch expansion-fine, the maxilla could be expanded.
But here is the key: Once T&A is done and expansion completed, a sleep study has to be redone.
This information is from the Moyers symposium I went to a few years back.
For me, it's an LLHA and a recall in 6-12 months. Did anyone notice the root of the LR1? ■

justinudm
Member Since: 09/29/14
Post: 8 of 12

12/19/2019

danbraces

These are great thoughts, observations and plans.
I plan on uploading the CBCT info later and posting my plan. ■

Member Since: 11/09/08
Post: 9 of 12
12/19/2019

I'd go with slow upper expansion with your poison of choice plus monitoring on the lower.
IMHO, the lower lingual arch is unnecessary in this type of cases of natural early loss of
lower canines due to lack of space. ■

scottalberto
Member Since: 07/24/17
Post: 10 of 12

12/19/2019

I think she is postured forward in the photos and it does not reflect the underlying mandibular
retro but shows in the ceph. There is no real dental/skeletal reason to treat her now. You did not
mention her age. As a parent, I would like to know all of the possible options. And that maxillary
expansion may improve her breathing. I see the lower arch lingually inclined. If you upright
the posterior lower teeth, you would have a crossbite. This would allow the 8-10mm of max
expansion that is necessary in this case. Since I see her as a more severe CL2, you could use a hg
or fx appliance post-expansion. Personally, nowadays I would switch to Invisalign. I can correct
the CL2, control vertical, align teeth and manage the lower arch. Just need to get it done in five
years. Only after parents choose and sign appropriate informed consent. Otherwise, recall. ■

davidharnick
Member Since: 08/28/02
Post: 11 of 12

12/19/2019

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Orthotown January/February 2020

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