CATEGORY AUSTRALASIAN DENTIST53 u Muscle-tooth con ict: advancing teeth into zones dominated by perioral musculature invites relapse and discomfort. u Excessive reliance on re nements: aligner-based attempts to execute large anterior movements often underexpress, prolonging treatment and reducing predictability. Rather than improving safety, a rigid airway-driven mandate can force teeth into biologically unfavourable positions. The airway myth applied to extractions and expansion Airway-driven advancement is often framed as a necessary alternative to extractions or as justi cation for maximal arch “development.” Yet systematic reviews consistently show: u Premolar extractions do not cause clinically signi cant airway compromise in otherwise healthy individuals. u Dental expansion does not reliably produce functional airway improvement in adults. Using airway fear to justify aggressive dental advancement replaces evidence with aspiration – and exposes clinicians to medico-legal risk if promised outcomes are not realised. Adults are not growing patients Some proponents cite paediatric data to support airway-oriented orthodontic interventions. is extrapolation is inappropriate. In children, growth modi cation can transiently in uence nasal resistance or airway dimensions; in adults, growth is complete. Attempting to reproduce paediatric airway e ects via dental movements in adults is biologically implausible. An OrthoED position: airway-aware, not airway-driven At OrthoED, we advocate a disciplined hierarchy: 1. Facial balance and aesthetics 2. Occlusal function and stability 3. Periodontal safety and biological limits 4. Growth modi cation when appropriate 5. Airway considerations as context, not a primary orthodontic objective When airway concerns are suspected, referral to sleep medicine is appropriate. Orthodontic treatment should avoid claims of airway therapy it cannot reliably deliver. Conclusion e controlled arch variant that advances maxillary and mandibular dentitions to “improve the airway,” as described by Dr Steve Gallella, rests on unproven assumptions and non-predictive diagnostics. In adults, it is clinically unpredictable and potentially unsafe, risking periodontal harm and occlusal instability without credible evidence of durable airway bene t. For general dentists, the message is clear: Do not allow airway aspirations to override orthodontic biology. Ethical, predictable adult orthodontics prioritises stability, periodontal health, and realistic outcomes – not dental proxies for airway therapy. u Bibliography (peer-reviewed) 1. Pliska, B. T., et al. Relationship between upper airway volume and obstructive sleep apnoea. Sleep Medicine Reviews, 25, 46–54. 2. Kim, Y.-J., et al. Upper airway changes following orthodontic treatment: a meta-analysis. Angle Orthodontist, 80(5), 959–967. 3. Chen, Y., et al. E ects of premolar extraction on upper airway dimensions: a systematic review. Journal of Oral Rehabilitation, 45(10), 798–810. 4. Janson, G., et al. Airway changes in extraction vs non-extraction orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 138(5), 567–573. 5. Zhao, Y., et al. Reliability of CBCT airway measurements. Dentomaxillofacial Radiology, 46(2), 20160214. 6. Handelman, C. S. e anterior alveolus and limits of orthodontic treatment. Angle Orthodontist, 66(2), 95–109. 7. Pro t, W. R., Fields, H. W., & Sarver, D. M. Contemporary Orthodontics (6th ed.). Elsevier. CLINICAL Master Aligner Therapy the Way Specialists Do In Just 3 Days st 3 Days Learn from two leading Orthodontic Specialists REGISTER OR LEARN MORE 2026 Course Dates: 19-21 March in Melb 23-25 July in Syd 7-9 Oct in Perth Dr Geoff Hall & Dr Martin Poon For general dentists ready to take their first step into orthodontics. Aligner Essentials is a 3-day intensive course from Australia’s awardwinning OrthoED Institute, led by Dr Geoff Hall. In just 3 days, gain the confidence to plan and deliver aligner cases using sound biomechanical principles not system-specific shortcuts. AaāeͲtŜͲAaāe Ŝr aiƵestreaő Aligner Essentials THE SMILE YOUR PATIENTS HAVE ALWAYS WANTED™ Australia's Best Orthodontic Educator (Australian Dentistry Awards 2025) ƶƶƶ͟ ortĮoeĈ͟ āoő͟ auͥ aliħners χ 00 0̌̈ 2̌ χ infoοortĮoeĈ͟ āoő͟ au
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