Upper Airway Changes in Diverse Orthodontic Looms: A Systematic Review and Meta-Analysis

Abstract

Upper airway assessment is particularly important in the daily work of orthodontists, because of its close connection with the development of craniofacial structures and with other pathologies such as Obstructive Sleep Apnea Syndrome (OSAS). Three-dimensional cone-beam computed tomography images provide a more reliable and comprehensive tool for airway assessment and volumetric measurements. However, the association between upper airway dimensions and skeletal malocclusion is unclear. Therefore, the current systematic review evaluates the effects of different surgical movements on the upper airway. Materials and Methods: Medline (PubMed, OVID Medline, and EBSCO), Cochrane Library (Cochrane Review and Trails), Web of Knowledge (social science, and conference abstracts), Embase (European studies, pharmacological literature, and conference abstracts), CINAHL (nursing and allied health), PsycInfo (psychology and psychiatry), SCOPUS (conference abstracts, and scientific web pages), and ERIC (education) databases were searched. Two authors independently performed the literature search, selection, quality assessment, and data extraction. Inclusion criteria encompassed computed tomography evaluations of the upper airway spaces with retrospective, prospective, and randomised clinical trial study designs. To grade the methodological quality of the included studies a GRADE risk of bias tool was used. Results and conclusion: In total, 29 studies were included. Among these, 17 studies had a low risk of bias, whereas 10 studies had a moderate risk of bias. A meta-analysis was performed with the mean differences using a fixed-effects model. Heterogeneity was assessed with the Q-test and the I2 index. The meta-analysis revealed significant (p ≤ 0.001, 95% confidence interval) increases in upper airway volume after rapid maxillary expansion and surgical advancement for the correction of Class II.

Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review

“…In this regard, aging could negatively influence the effectiveness of the treatment due to the deterioration of the structure and function of the superior airway. With aging, the hypoxic response during sleep decreases, the breathing muscles have less tensile strength and fatigue resistance [ 31 , 32 ], the ventilatory system during sleep is more unstable [ 33 ], the strength of the upper airway dilatator muscle reduces, and the pharyngeal closing pressure and upper airway resistance and laxity increase [ 34 ]. One study [ 34 ] found a progressive long-term (10 years) reduction of the efficacy of the treatment after the initial reduction of AHI values at 1 year and 2 years follow-up.…”

Comparative Analysis of Pharyngeal Airway Changes Following All Four Versus All Five Premolar Extractions in Orthodontic Treatments: A Cephalometric Study

“…The clinical implications of changes in pharyngeal airway dimensions following premolar extractions warrant careful consideration. Orthodontists must balance the desired dental and skeletal outcomes with potential effects on the upper airway, particularly in patients with preexisting respiratory conditions [ 17 ]. The statistically significant reduction in airway volume in both extraction groups may raise concerns about the potential impact on respiratory function and highlights the importance of thorough patient assessments and collaborative decision-making.…”

Three-Dimensional Assessment of Upper Airway Volume and Morphology in Patients with Different Sagittal Skeletal Patterns

“…It may determine a clockwise rotation of the mandible and a vertical type of growth [17]. Depending on the position of the tongue and its action on the floor of the mouth, two types of anomalies can develop: Angle class II, with the tongue in a lower and posterior position, and Angle class III, with the tongue in a lower and anterior position [17][18][19][20][21]. An enlarged lower floor, dental crowding, difficulties in swallowing and mastication, the upper incisors proclinated and lower ones lingualized, and a deep Diagnostics 2024, 14, 903 2 of 10 palatal vault are also mentioned as complications of the altered tongue position [8,17].…”

“…Their sample consisted of 36 cleft lip and palate subjects and 30 subjects without cleft lip and palate in the control group [22]. A meta-analysis [20] in 2022 aimed to evaluate scientific evidence related to the effects of different orthodontic treatment possibilities on the airways. The authors included in their meta-analysis 66 eligible articles about the CT and CBCT airway evaluation after orthodontic therapy [20].…”

“…A meta-analysis [20] in 2022 aimed to evaluate scientific evidence related to the effects of different orthodontic treatment possibilities on the airways. The authors included in their meta-analysis 66 eligible articles about the CT and CBCT airway evaluation after orthodontic therapy [20]. The orthodontist has a vital role in recognizing a patient's respiratory problem and correlating it with the type of malocclusion to prescribe the correct treatment.…”