S07: How orthodontic treatment approaches can improve long term outcome of children with OSA
Saturday, April 28 | 2:15pm-3:45pm | Room Bordeaux
Chair: Christian Guilleminault (USA)
Usage of multislice 3D CT to evaluate skeletal effect of RME and to perform regular long-term follow-up
Paola Pirelli (Italy)
OSA and treatment with orthodontist approach: Usage of Bollard implants, who to consider and what are current-outcomes
Stacey Quo (USA)
Bone anchored appliances in pubertal and post pubertal individuals: Difficulties and outcomes
Kasey Li (USA)
Neutral supporting mandibular advancement device with tongue bid for passive myofunctional therapy: Immediate and long-term follow-up
Yu-shu Huang (Taiwan)
Summary of Symposium:
More and more treatment of pediatric OSA is shown to need a multidisciplinary approach. Rapid-Maxillary- Expansion-RME has been shown to be helpful in dealing with OSA children, particularly those with clear maxillary deficiencies. Introduction of 3 dimensional-CT, brings a new tool investigating results of expansion and when performing long term follow-up. But RME may have limited impact when maxillary deficiency is marked, Treatments that target midface deficiencies that result from abnormal breathing may need a different approach: Utilizing bimaxillary widening and/or maxillary protraction with bone anchored appliances can be implemented as a “ stand alone” therapy or in combination with other treatments. Few places have utilized such approaches. However they should be considered in the multi-disciplinary treatment approach to sleep-disordered-breathing: PAP treatment not only may not be well accepted by teen-agers and at any age will worsen the anatomic deficiencies very commonly seen I pediatric OSA, thus there is a need to find new therapeutic approaches addressing anatomical deficiencies that have been shown to either induce or worsen SDB. Such treatment approaches exist in the orthodontic world, but often have not been used in the field of sleep-disordered breathing until recently. Presentation will show results obtained with such techniques in pubertal-post-pubertal individuals where little is often offered than CPAP. Finally, myofunctional therapy-MFT- has been recommended as an adjunct treatment to all treatment approaches dealing with pediatric OSA. One recurrent problem, however is compliance with treatment which is highly variable. An appliance placed at night in mouth of children, aiming at inducing muscle tongue contractions as been built and tested. In a prospective study, such appliance was used for 12 months and shown to obtained much greater compliance than performing MFT in an age matched control group. Polysomnographic results at end of usage and 12 months after termination of usage of appliance will be presented in a group of 5 to 12 years old children diagnosed with OSA and with residual events after T&A as well as long term (2-3 years) prospectively acquired clinical and PSG data.
Upon completion of this CME activity, participants should be able to:
1 Recognize children in need of further associated orthodontic treatment
2 Select the appropriate orthodontic treatment needed in relation with age and anatomic findings
3 Understand the mechanisms by which such adjunct treatment works
4 Recognize success and failure of the proposed treatment and council families in the following steps to apply.
Sleep Specialists, sleep researchers, pediatric dentists and orthodontists. Oral surgeons, sleep technologists, sleep medicine instructors, allied health professionals, myofunctional therapists, public health specialists.