As an orthodontist, I have the opportunity to change lives. I have another facet to my practice as well — evaluating both young and adult patients for airway issues.
An i-CAT™ 3D scan is the perfect adjunct in airway screening, giving clinicians a full picture of the head and neck anatomy. With i-CAT’s 3D imaging software, Tx STUDIO™, I can view the airway areas, obtain precise anatomical views and measurements, and even see airway volumes with color-coded constriction values. I can share these scans with other dental and medical professionals to help create a multi-disciplinary approach to treatment planning.
My orthodontic workup often overlaps the treatment plan for a deficient airway. When I treat a child with a Herbst appliance to help stimulate growth of the lower jaw, I not only improve the skeletal alignment of the jawbones, but I also facilitate opening up the patient’s airway. While every patient is different, treating a deficient lower jaw at an early age can help to avoid orthognathic surgery later in life.
Using an i-CAT 3D scan, I analyze the condylar position in a way not possible with 2D radiography. I can calibrate the Herbst appliance to properly obtain the optimal amount of mandibular growth. In the past, I had to rely on hand manipulation to make an educated guess as to how far to advance the mandible utilizing the Herbst appliance. Unfortunately, muscle manipulation is an inaccurate science and many times would produce unpredictable results when using the Herbst.
Adults with deficient mandibles and constricted airways have also benefited from the i-CAT 3D scan. An older patient came to my office with TMD symptoms and soreness from holding her lower jaw forward. My diagnosis of her CBCT scan showed she had an incredibly narrow airway. Her general dentist had made a splint to help with her TMD problems, and she used a CPAP machine. A new scan with her splint in place showed the dentist had made an excellent night guard because her condyles were nicely seated within the glenoid fossa; however, her airway was significantly worse.
The CBCT scan disclosed that approximately 40mm of her airway was now completely closed off when she wore her splint. The results from a second sleep study showed she never achieved REM sleep. Her physician had no way of knowing what the airway was doing with the splint in place and had planned to prescribe a stronger medication to make her achieve a deeper sleep.
With the perfect storm of her extremely narrow airway, the splint in place, and the stronger medication, there was a strong chance the patient could have died in her sleep. She now has a better, safer treatment plan and is working toward a resolution.
Implementation of i-CAT FLX and the full 3D information it provides changed the way I diagnose and treatment plan today.
About the Author: Dr. Robert Kaspers received his DDS with honors from the University of Michigan Dental School and then completed specialty training in orthodontics at the Northwestern University Dental School and earned a Master of Science degree in radiology. He has worked and lectured extensively in the field of temporomandibular dysfunction and orthodontic treatment. Dr. Kaspers is the founder of the Five Condylar Positions which has helped make diagnosing and treatment planning easier for the clinician. Currently, Dr. Kaspers maintains a private orthodontic and TMD practice in Northbrook, Illinois. He has no financial interests in i-CAT.