NEPA Vital Signs - Summer Fall 2019 - 7

SUMMER/FALL 2019

biologically-friendly forces. This innovative delivery system
is a fraction of the size it used to be, smooth, comfortable
and sometimes even nearly invisible. The most challenging
task is for the orthodontist to make the proper diagnosis and
treatment plan; from there the doctor can craft an orthodontic protocol to attain a beautiful and healthy smile while the
patient carries on daily activities with no disruption. Given
the advancements in image capturing, a precise orthodontic
scan for comprehensive treatment can happen in less than two
minutes and, with a doctor's guidance and clinical preferences,
a simulation of accurate treatment outcome in less than five
minutes is possible.

BEFORE TREATMENT
PATIENT A: LEFT:
RIGHT: AFTER EXPANSION

While orthodontic treatment usually yields a very beautiful
esthetic result, enhanced function is also a very desirable outcome. Currently, a directed effort is concentrated on the global
function of the craniofacial complex and airway. What's more,
neurocognitive impairment and sleep disorders have been linked
to insufficient airway function. World-renowned sleep physician
Dr. Christian Guilleminault advocates "saving the children"
from future sleep-disordered breathing and airway issues. He
supports a multidisciplinary approach to improving the craniofacial complex early in development to improve long-term
functional airway capacity. In a combined effort with the sleep
medicine community, the American Association of Orthodontics
has focused research efforts in the area of expansion treatment
to eliminate a constricted skeletal maxillary arch-form which
not only treats malocclusion but also has been shown to have an
impact on the supporting structures associated with the airway.

BEFORE TREATMENT
PATIENT B: LEFT:
RIGHT: AFTER EXPANSION

The working orthodontic theory has been that increasing the
width of the maxilla subsequently increases nasal floor dimensions thereby decreasing resistance to air flow and improving
respiration. While this finding may be statistically significant,
even better results are observed with skeletal maxillary expansion combined with tonsillectomy and adenoidectomy. This
collaborative treatment approach has shown over 90% efficacy;
improving airway dimension and function in treated children.
Without the cooperative approach of otolaryngologists and
orthodontists, children in a similar cohort experienced only
50% improvement in airway from expansion or tonsillectomy
and adenoidectomy alone.

(12-MONTH TREATMENT)

See our patient's untouched center and occlusal photos; two different
cases of maxillary insufficiency (Patient A and Patient B) show dental
efficacy associated with maxillary expansion treatment. Presumed
associated nasal volume changes should be evaluated.

improved dental health has benefits that span the entire human
microbiome. Balanced craniofacial skeletal proportions impact
airway function leading to enhanced breathing patterns. With
this in mind, I find it to be a very exciting time in medicine and
dentistry! Multidisciplinary approaches to wellness can truly help
our patients to be healthy and perhaps even change their ideas
of healthcare. A mindful evolution is underway, transforming
the way providers work together and changing the way patients
seek care to optimize health.

Clearly, the contribution of the craniofacial complex to airway
structure and function is a field that requires additional examination, but it is one that may be worthy of such research as it
may be truly beneficial for all patients.
In summary, evolution and change have influenced thinking
in our respective fields since the advent of medical investigations. In 2019 we have the advantage of looking back on years of
research and now we can formulate better treatment plans from
past and present study benefits and limitations. With continued
exploration and understanding, we can help our patients with
the most efficient and effective treatment modalities. Arguably,
N E PA

(11-MONTH TREATMENT)

SAMANTHA R. ABOD, DMD, MPH, a native of
Harvey's Lake, has been practicing orthodontics in Northeastern
Pennsylvania since 2008. She earned her D.M.D. from the
University of Pittsburgh where she studied biochemistry and
also earned a Multidisciplinary Masters in Public Health and a
Certificate in Orthodontics & Dentofacial Orthopedics.
7

VITAL SIGNS
NEPA Vital Signs - Summer Fall 2019

Table of Contents for the Digital Edition of NEPA Vital Signs - Summer Fall 2019
