Mandibular advancement appliances (MAD) have long been used to treat OSA. Most of the international sleep medicine societies recommend MAD in mild and moderate OSA. Most studies with MAD exclude patients with severe OSA and include patients who failed other treatment modalities with significant source of bias .Cephalometric and BMI factors are often not factored while prescribing MAD. So we undertook a pilot study to evaluate the therapeutic efficacy of Thornton adjustable positioner (TAP), a titratable MAD in severe adult OSA cases. We have observed significant (p< .0001) improvement in Apnea-Hypopnea index and Epworth sleepiness scale. We concluded that factoring predictable cephalometric measurements, BMId< < < < <30 Kg/m2, and mandibular protrusion of 70%; severe OSA can be effectively managed with TAP.

Narrowing and collapse of upper airway particularly in sleep has been observed in individuals with retrognathic maxilla, retrognathic mandible, narrow maxillary and mandibular arches, long face syndrome, inferiorly and posteriorly placed hyoid bone, retrogenia and increased over jet. Therefore the above observations can be summed up as risk factor for upper airway narrowing that would lead to potential health risks like obstructive sleep apnea, hypopnea syndrome, upper airway resistance syndrome, intractable snoring, mouth breathing and nasal allergies. In children it is likely to affect academic performance, memory, growth and development per se. Extraction orthodontic treatment used as a of camouflage sometimes could be detrimental by altering the tongue posture and thus compromising the airway. Functional considerations should outweigh purely aesthetic ones. It is important when making an orthodontic surgical or combined diagnosis for a patient, to bear in mind the impact that the treatment would have on the upper airways. Good aesthetics should never be achieved at the expense of diminishing the capacity of their upper airway. The speciality of orthodontics has a crucial role to play in terms of prevention, interception and correction of the potential health risks by accurate diagnosis, dento-facial orthopedic treatment and surgical orthodontics. This presentation would be focusing on the crucial connection between the three and the urgent need to change the existing mind set among orthodontic community in the country in order to redefine and optimize our treatment goals so that we contribute significantly to the general health and well being of our patients.

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