Multidisciplinary Approach in Adult Orthodontic Patient Affected by Severe Obstructive Sleep Apnoea: A Case Report

Abstract

This case report describes the successful multidisciplinary treatment of an adult orthodontic patient with severe obstructive sleep apnoea (OSA). The patient presents with class I dental occlusion and lower anterior crowding. Upon comprehensive orthodontic examination, it was suspected the patient had sleep disordered breathing and was sent for a polysomnography (PSG). The sleep physician diagnosed severe sleep apnoea with an apnoea hypopnoea index (AHI) of 54.1. Cone beam computerized tomography (CBCT) scan, which was taken as part of the orthodontic records, revealed airway issues so the patient was referred to an ear nose throat (ENT) doctor with a sub specialty in airway and sleep. ENT surgery was performed resulting in the AHI coming down to 20.4. Orthopaedic expansion was done using removable appliances followed by fixed appliances (braces) using the controlled arch technique and protraction mechanics. The post orthodontic treatment AHI was 14.4 and a Farrar splint was made as the retainer which resulted in an AHI of 6.4. This case report demonstrates why a comprehensive orthodontic examination and multidisciplinary approach is essential to successful treatment of orthodontic patients with obstructive sleep apnoea.