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Airway Orthodontics » 32 Dental Solutions

Extraction in conventional orthodontics causing reduced airway

Our bodies are reacting to stresses caused by our modern diets, lifestyle and industrial environment. These adaptive responses have a genetic component and that is why families still share similar appearances. Crooked teeth and misaligned jaws are signs of significant issues that our brain and body are trying to cope with. If we evaluate and eliminate deficiencies during the developmental years then we can change these genetical features running in families and can help develop teeth in most ideal manner.

CONSTRICTED AIRWAY : Reason for future TMJ problem

Proper positioned tongue is actual physical scaffolding for wider upper jaw and well aligned teeth. When there is alteration in position of tongue then upper jaw narrows or collapses leading to crowding and this in turn affects position or size of lower jaw. Bones of face are interconnected to each other. Poor development of one bone has domino effect on other bone and structures. Our palate (roof of mouth) is also floor of nose. Narrow palate cases due to mouth breathing, directly affect, shape, size and space of nasal cavity. Constricted nasal cavities make breathing through nose even more difficult and to compensate this patient tries to change posture. The altered position of lower jaw strains the muscles and further causes TMD associated with headaches, neck and shoulder pain.


Traditional orthodontics concentrates on teeth alignment and  extracts  teeth to gain space for alignment and to correct crowding. Which is one of the reason of Temporomandibular disorders TMD in future. However, Airway orthodontics focuses on function and elimination of root cause of problem.
Airway orthodontics focuses on :
  • Protecting &enlarging size of airway which further prevent any harm to TMJ.
  • Creating enough space for tongue.
  • Achieving optimum facial balance and aesthetically pleasing facial appearance.
  • Creating broad beautiful smile.
  • Healthier jaw joints

Deficient Airway

Excellent Airway


Pranayama, Yoga, Vedic culture all enhances on breathing exercises, as they were aware about importance of nasal breathing. When we breathe through our nose, oxygen gets mixed with nitric oxide and well received by our tissues than when we breathe through our mouth. Our nasal passage and airway is very important in helping nasal breathing.
Tongue is a very powerful muscle, when it is positioned properly then it helps in shaping our upper jaw and nasal cavity, also helps in forward growth of upper jaw. But if tongue is tied and positioned low, it promotes mouth breathing and face does not develop forward properly. This reduces size of airway. A undersized airway can lead to sleep disordered breathing, TMD and further chronic health conditions.


TMJ clicking, snoring, sleep apnea, clenching/grinding of teeth, headaches, neck aches, shoulder pain, improper head posture, ringing in ear, severe migraine or tooth pain , they all contribute in causing Temporomandibular Disorder (TMD). Our Neuromuscular Dentist Dr. Manisha who has done her fellowship from ICCMO(USA)is trained in treating TMD. Neuromuscular orthodontics first focuses on treating TMJ disorders successfully. This includes evaluating the root cause of TMD which can be improper bite, constricted airway, nasal obstruction, hyperactive muscles or combined factors. Our neuromuscular dentist first relieves the patients TMJ issues by first deprogramming the muscles and later reprogram those muscles in correct position so thereafter they are not in hyperactive state. For correcting muscles first patient is given special Orthotic customized for him/her. Once TMD symptoms are treated teeth are aligned in that position where muscles are happy.



Dr. Manisha is the only Neuromuscular Orthodontist in North India. After correcting TMD issues, she aligns the teeth with the help of specially customized brackets and wires. These brackets and wires are pre-programmed to reach the desired position. So that patient is relieved from his TMJ problems and muscles and teeth are in physiological balanced position.


Symptoms which indicates that there is underlying airway issue and which need to be corrected as early as possible as constricted airway and associated problems can  be the cause for heart disease, stroke, hypertension, diabetes and depression.
  • Mouth breathing
  • Frequent infections
  • Long face
  • Crooked teeth
  • Narrow upper palate
  • Lower jaw -short/large
  • Snoring or sleep apnea
  • Grinding / clenching at night
  • Dark circles under the eye
  • ADHD/ hyperactive kid, poor concentration
  • Thumb sucking, tongue thrusting
  • TMJ or jaw joint clicking
  • Frequent headaches/migraines, neck and shoulder pain
  • Tinnitus
  • Increased blood pressure


When the focus of treatment is airway centric and not only alignment then following advantage we get over conventional orthodontics.
  • Wider upper arch and smile
  • Creates room for correct tongue posture
  • Eliminates need for extraction
  • Improved nasal breathing
  • Improved airway
  • Forward development of upper and lower arches
  • Reduces chances of sleep apnea/ TMD
  • Improved body posture


  • Orthotropic
  • MSE
  • ALF
  • DNA
  • Neuromuscular orthodontics
  • Neuromuscular functional appliances
  • Reverse orthodontics


It is treatment focused on proper and harmonious facial development. Its primary objective is correcting unfavourable growth pattern of jaws. It helps in developing better facial features and wider airways. It is carried on from young age so that developing kids will have wider arches and equal and forward development of both jaws.

MSE (Maxillary Skeletal Expander)

MSE is a non-surgical device for adults who has narrow and high palate, upper and lower jaw discrepancy, breathing issues from nose/mouth breathers, upper airway resistance syndrome(UARS)and sleep apnea. It is a non-surgical, minimally invasive and non-extraction treatment approach in which upper jaw is expanded. This increases jaw size , nasal cavity space and eliminates the need for extraction.

Benefits of an MSE

  • Improved airway and respiratory function
  • Open nasal cavity spaces
  • Allow room for the tongue
  • Relieve crowding issues and crossbites
  • Alleviated symptoms of sleep apnea
  • Alternative to surgery

(Improved airway and nasal passages with MSE treatment )


Who needs MSE?

Conventional orthodontics focuses on alignment of teeth by extraction. In that case narrow maxilla and nasal passage remains same, also it causes facial changes after extraction.

MSE appliance is useful for skeletally mature patients, meaning teenagers or adults whose teeth and jaw bones are fully developed but who also have a narrow upper jaw. Maxillary suture fuses by the age of 11-14 years. There after expansion of upper jaw only flares the posterior teeth.
Surgical intervention has historically been the only means for correcting narrow upper jaw problems among adults. Thanks to advancements in orthodontic treatment, an alternative non-surgical treatment option is now available for adults who have a narrow upper jaw.

ALF (Advanced Lightwire Functionals)

ALF works to improve patients posture and repositions the jaws, dental arches and teeth. It works on principal of cranial osteopathy. It promotes proper swallowing patterns, narrowed upper palate, other issues that can impact development , breathing and posture. In young kids it works of achieving  balanced facial growth.

DNA (Day & Night Appliance)

It gradually, naturally and painlessly stretches the upper arch and increases its volume. This increases the nasal cavity. Short lower jaw moves along with widened upper jaw and pulls tongue along with it, thus increases airway. Bones are remodeled over time and makes functional correction in airway

Neuromuscular Functional Appliances

TENS application on a young patient

Misaligned jaws causes improper bite positioning which is one of the triggering factor to start TMJ disorders as muscles are in hypertrophy. Hypertrophic muscles creates trigger points.
In Neuromuscular functional appliance Dr. Manisha repositions jaws in myotrajectory on which patients jaw wants to grow. Once the muscles are in harmonious relation and teeth are in balanced bite, then both the jaws grow in harmony.


Frankel’s appliance made in Neuromuscular bite

Reverse Orthodontics

In conventional orthodontics, focus is only on alignment and to achieve that orthodontists do extractions. Extraction has been a common practice from almost 5 to 6 decades for alignment and retraction in patients requiring braces treatments. However as time as gone by there have been more and more evidence to show that these patients who underwent extraction of the 4 premolar teeth for cosmetic and other reasons have significantly reduced their airway volume.
This airway compromise has caused migraines, sleep apnoea, snoring, gastric issues and often associated systemic disorders. Reduced airway, improper tongue positioning, hanging cusps can lead to TMJ problems.
With the advent of Neuromuscular dentistry, orthodontists are now realising the errors in the past extraction protocols and therefore the emphasis is on holistic management of orthodontic patients. In this effort firstly extractions are avoided and in patients who have been previously extracted, many a times these extraction spaces are reopened and that is Reverse Orthodontics.
These spaces can be managed with implants, cosmetic dentistry etc to camouflage the spaces and address the patient’s airway and cosmetic concerns at the same time

Composite bonding for closing the spaces

Extraction spaces reopened

Here in 32 Dental Solutions. We believe in helping our patients to not only look better- Smile wise, BUT make them help, feel better and BREATHE BETTER.

For this we focus on holistic treatment which improves their breathing, tongue and body posture, sleep, physical and mental well-being.

215, 2nd Floor, Sector 57, Gurgaon , Haryana, India

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