In this clinical presentation, orthodontist Bill Hang examines whether the extraction and subsequent retraction of bicuspid teeth can contribute to obstructive sleep apnea (OSA) and whether reversing that retraction can resolve the condition without surgery. He reviews two patient cases: a young adult with moderate OSA who had four bicuspid extractions in adolescence and whose apnea resolved after the clinician reopened the extraction spaces, advanced the dental arches, and placed implants; and an adolescent who developed joint clicking, headaches, and OSA symptoms during orthodontic retraction, whose symptoms disappeared after the spaces were reopened, requiring bone grafting and veneers. The speaker highlights airway improvements visualized in anteroposterior imaging, compares airway dimensions to a straw versus a garden hose, and discusses facial profile changes relative to the Bolton Norm. He raises ethical questions about how much dental retraction is safe, suggesting that if reversal can cure OSA, excessive retraction might also cause it, prompting clinicians to consider moral responsibilities when planning treatment.
Chapters
Welcome back. This segment is entitled, Can You Cure OSA Nonsurgically? The big issue: is there a relationship between extraction and retraction of teeth and sleep apnea? Well, if we look at the internet, we can see an orthodontist with his website here basically saying, no, there is no relationship. You can read all these words, but he concludes that there is no relationship. Well, you decide for yourself. Let's use an example of a patient of one. Here's a patient who consulted with me, and she said she had a moderate sleep apnea diagnosis, which was confirmed with the sleep report from her sleep doctor. She reported sleeping about 2 hours a night, and she had 4 bicuspid teeth extracted when she was an adolescent. We promised her nothing but— except that we would do our best and reopen her spaces. For her, she actually— part of the treatment plan we proposed for her involved surgery, which she didn't want to do, but she went along with the treatment anyway. In the middle of the treatment, we had her this far forward, and there's spaces where you reopen, when she went and had a sleep test done, and her sleep doctor reported that the sleep apnea was completely gone, merely by us reopening a space large enough for an implant on each side of the upper and barely any space on the lower arch. Here is that sleep report, and here's what he said. Her sleep apnea has completely resolved with orthodontic therapy, despite the 10+ pounds of interim body weight gain. It's quite remarkable how much improvement she has had in her apnea severity, despite the presence of a large tongue and crowded oropharynx. Here's an adolescent child who came to me in the midst of her orthodontic retraction, Because her mother noticed that her daughter's joints had begun to click. And the girl was starting to experience headaches like the mother, who had a severe pain pattern and sleep apnea, and had also had 4 bicuspids extracted. You can see the spaces are completely closed in this case, and she's in her early adolescence. Here she is after we've reopened the spaces. In this particular case, we opened it in the 2nd bicuspid position in the maxilla, 1st bicuspid position in the mandible, There are reasons for that which I won't go into here. Her symptom pattern is completely gone, and she has space for 4 implants. By the time we got the spaces open in the mandible, there was not enough bone, and she required grafting. You can see the knife-edge ridges there. And she already had had such a bruxing pattern that her upper incisors really required veneers because they were so worn. You can see what happened with the Bolton Norm on her face. You can see she was rather retracted relative to the Bolton Norm. when we started her in treatment on the left-hand side. By the time we had reversed all of this, her mandible and maxilla had come forward rather nicely, which was a big surprise to us. And on top of that, she had a rather nice improvement in her airway. You can see in the anteroposterior plane of space, a rather dramatic improvement in her airway as we reopened the spaces for her in this case. You can see, I put this on here, a drinking straw versus a garden hose, and that's about the dimension So, you can imagine what it's like for her to breathe. And the fact is, she and her mother are very happy that she's gone through the treatment. So, you can ask yourself, can you produce sleep apnea by retracting? Think about that, particularly if you're an orthodontist. And then think about how far could you safely retract before you would cause someone to have sleep apnea? Another interesting question. And if you don't know the answer to that, the next question becomes very obvious. If you don't know where safe retraction becomes unsafe retraction, how can you ethically and morally retract at all? So I've shown you 2 patients here who have suffered from extraction retraction regret syndrome and had significant problems because of it. So, I suggest to you and ask you, if reversing retraction can cure OSA, do you think that it can cause it?
