The influence of obstructive sleep apnea syndrome on the orthodontic treatment decision in children and adolescents. Part 2 : Which orthodontic treatments for children with apnea?

Introduction: Sleep-disordered breathing could affect 10% of an orthodontic population. The integration of obstructive sleep apnea syndrome (OSAS) diagnosis could influence the choice of orthodontic techniques or their implementation, with the aim of improving ventilatory function.

Material and method: The author summarizes the clinical studies using dentofacial orthopedics, alone or in combination with other interventions, in pediatric OSAS or the repercussions of orthodontic interventions on upper airways.

Results: For the same orthodontic anomaly, in particular, transverse maxillary deficiency, the temporality and the modality of treatment could be modified by a diagnosis of OSAS. It could be recommended to propose early orthopedic maxillary expansion, seeking to potentiate its skeletal effect, to reduce the severity of OSAS. Class II orthopedic devices have shown interesting results but the evidence value of the studies is not yet sufficient to recommend them widely and as an early treatment. Extractions of permanent teeth do not significantly reduce the upper airway.

Discussion: OSAS in children and adolescents includes several endotypes and phenotypes for which orthodontics may or may not be indicated. It is not recommended to orthodontically treat an apneic patient with no significant malocclusion, for the sole purpose of having an effect on the respiratory tract.

Conclusion: The orthodontic therapeutic decision is likely to be modified by a diagnosis of sleep-disordered breathing underlining the interest in systematic screening.