CATEGORY 52 AUSTRALASIAN DENTIST In recent years, a variant of the Controlled Arch Technique has been promoted in which the maxillary and mandibular dentitions are advanced dentally – sometimes substantially – with the stated aim of improving the airway. As described by Dr Steve Gallella, this approach attempts to leverage dentoalveolar advancement as a proxy for orthopaedic or surgical airway change. While the intent to consider airway health is understandable, the routine use of dental arch advancement to “improve the airway” is biologically speculative, clinically unpredictable, and potentially unsafe – particularly in adults. is article provides a critical, evidence-based appraisal for general dentists, distinguishing what orthodontics can reasonably in uence from what it cannot. The central problem: conflating dental movement with airway therapy e conceptual leap underlying airwaydriven controlled arch advancement is the assumption that moving teeth forward will produce a meaningful, durable improvement in upper airway patency. e evidence does not support this assumption. e upper airway is a dynamic, neuromuscular structure in uenced by head posture, tongue tone, pharyngeal dilator muscle activity, adiposity, sleep state, and craniofacial morphology. Static increases in airway volume on imaging – especially those inferred from dental movements – do not reliably translate into improved airway function or sleep outcomes. Systematic reviews show weak or inconsistent associations between orthodontic dentoalveolar changes and clinically meaningful improvements in obstructive sleep apnoea (OSA) metrics, particularly in adolescents and adults. In short, orthodontics is not airway medicine, and dentoalveolar advancement is not a substitute for skeletal advancement or sleep-medical management. CBCT airway measurements: descriptive, not predictive Much of the rationale for airway-driven dental advancement relies on CBCT airway analysis. However, CBCT captures a single static snapshot, heavily in uenced by tongue position, respiratory phase, and head posture. Multiple studies demonstrate poor correlation between CBCT-measured airway dimensions and polysomnographic indices of OSA severity. Planning orthodontic treatment to chase CBCT-measured airway volume – particularly by advancing dental arches – rests on non-predictive metrics. is is especially problematic in adults, where neuromuscular collapsibility, not bony boundaries, is often the dominant determinant of airway obstruction. Dental advancement ≠ skeletal advancement It is essential to distinguish dentoalveolar advancement from skeletal advancement. Maxillomandibular advancement surgery increases airway size by repositioning the skeletal framework and associated soft tissues en bloc. Dental advancement, by contrast, primarily repositions teeth within the alveolar housing. In adults, advancing the dentition without advancing the basal bones risks: u Pushing incisors beyond the alveolar envelope u Increasing lip strain and soft-tissue imbalance u Exacerbating periodontal dehiscence and recession u Creating unstable occlusal relationships Critically, there is no high-quality evidence demonstrating that dental advancement alone produces durable improvements in adult airway function. Unpredictability in adults: biology sets hard limits Adult orthodontics is constrained by reduced bone adaptability, established occlusion, and periodontal vulnerability. In this context, airway-driven dental advancement is particularly unpredictable. Key risks include: u Periodontal compromise: advancing incisors and canines in thin biotypes increases the risk of labial bone loss and recession. u Occlusal instability: forward positioning of both arches dentally can disrupt overjet/overbite relationships and increase relapse risk. CLINICAL A critical evaluation of airway-driven Controlled Arch techniques involving dental advancement of the maxillary and mandibular segments Dr Geoff Hall By Dr Geoff Hall, Specialist Orthodontist, OrthoED Institute
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