Orthodontics has undergone a transformative shift over the past decade, with digital workflows, clear aligner technology, and sleep awareness redefining patient care. The integration of customized treatment modalities is accelerating improvements in efficiency, predictability, and patient comfort. As the field evolves, the focus remains on non-invasive solutions that enhance long-term outcomes. This article offers a comprehensive overview of the state of orthodontics, aligners, and sleep appliances, with a forward-looking perspective on future innovations.
The Evolution of Orthodontics
Orthodontic treatment has historically relied on fixed appliances, including metal and ceramic brackets with archwires. However, the landscape has changed dramatically with the introduction of clear aligners, which have gained widespread acceptance due to their improved capabilities combined with esthetic appeal, comfortability, and patient compliance. Today, digital workflows, intraoral scanning, and advanced treatment planning represent the new standard, enabling precise tooth movements with fewer adjustments.
Nobel Biocare Global Symposium 2025
Aligner therapy has expanded beyond simple alignment correction to include complex cases such as open bites, crossbites, and deep bites. Innovations like aligner-based palatal expansion have further broadened its clinical applications, offering an alternative to traditional rapid maxillary expanders. Research supports that with proper case selection and protocol adherence, aligners can achieve results comparable to conventional orthodontics.
Advancements in Clear Aligner Technology
Clear aligners have evolved significantly since their inception. Modern aligner systems utilize proprietary material compositions that enhance force delivery while minimizing discomfort. The combination of high-performance polymer blends and precision fabrication techniques allows for more predictable and controlled movements. Key advancements include:
Direct 3D-printed palatal expander: This development (Align Technology, Inc., aligntech.com) represents a major leap in orthodontics, allowing for a seamless digital workflow from scanning to appliance fabrication. Unlike traditional expanders that require physical models and laboratory fabrication, direct 3D printing enables precise, patient-specific designs that optimize skeletal and dental expansion.
Refined force application: Newer aligners provide optimized force systems that promote more efficient movement, particularly in challenging cases involving posterior intrusion or transverse expansion.
Remote monitoring with AI integration: Mobile applications and remote tracking devices allow clinicians to assess treatment progress without requiring frequent in-office visits. Artificial intelligence (AI) enhances this process by automatically analyzing intraoral scans, tracking tooth movement, and comparing it to the treatment plan. AI-driven monitoring systems can detect deviations from the expected progress and generate alerts for clinicians, allowing for timely intervention. Additionally, AI-powered chatbots and automated response systems can provide patients with guidance on aligner wear compliance, troubleshooting issues, and scheduling necessary follow-ups, further improving efficiency and patient adherence.
These innovations are shaping a new era in orthodontic care, emphasizing convenience without compromising outcomes.
The Intersection of Orthodontics and Sleep Medicine
Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA), has emerged as a significant health concern with profound implications for orthodontic treatment. The correlation between craniofacial development and airway function has spurred interest in orthodontic interventions aimed at improving airway dimensions.
Orthodontic appliances designed to address airway issues include:
Mandibular advancement devices (MADs): Commonly used for mild to moderate OSA, MAD appliances reposition the mandible to maintain airway patency.
Palatal expansion for airway enhancement: Studies suggest that maxillary expansion can lead to increased nasal airflow, benefiting pediatric and adolescent patients with airway constrictions. In adult patients, maxillary skeletal expansion (MARPE) has emerged as a nonsurgical alternative to improve transverse deficiencies, with potential benefits in airway volume and nasal resistance reduction, contributing to better breathing and overall health. Customized expansion appliances based on the patient's CBCT enable precise bicortical engagement and facilitate more predictable sutural opening.
Myofunctional therapy integration: Correcting oral posture and tongue positioning through orthodontic intervention has been suggested to have a positive impact on airway health. However, studies on the effectiveness of myofunctional therapy in improving airway function remain inconclusive. While some research indicates potential benefits in promoting nasal breathing, reducing oral habits, and enhancing orofacial muscle tone, other studies suggest that the long-term efficacy of these interventions requires further validation. Given the variability in study outcomes, myofunctional therapy should be considered a complementary approach rather than a definitive treatment for airway concerns, emphasizing the need for more robust clinical trials and interdisciplinary collaboration.
However, like many trends in healthcare, airway-focused orthodontics can sometimes be applied too broadly. Not every patient presents with an airway issue, nor does every child have a significantly restricted lingual frenum. While expansion has documented benefits in improving nasal airflow and reducing resistance, it is not a universal solution for all patients. Proper diagnosis and individualized treatment planning remain critical.
Airway Orthodontics: A Proper Balance
The growing emphasis on airway-friendly orthodontics is promising but must be approached with caution. While maxillary expansion has been shown to have positive effects on nasal breathing, it is not a panacea for all airway-related concerns. Overdiagnosing airway issues without comprehensive evaluation can lead to unnecessary interventions.
Clinical indications for airway-focused expansion should include: a narrow maxilla with associated functional limitations, documented nasal obstruction or habitual mouth breathing, or sleep-related breathing disorders diagnosed by a sleep physician. A multidisciplinary approach involving orthodontists, sleep physicians, and otolaryngologists is crucial for effective diagnosis and management of airway-related concerns. Rather than applying a one-size-fits-all philosophy, orthodontists must balance airway considerations with traditional functional and esthetic goals.
Looking Ahead
The future of orthodontics and sleep medicine will likely be shaped by continued technological advancements and a growing emphasis on personalized treatment strategies. Some anticipated developments include:
Smart aligners and direct 3D-printed aligners: Next-generation aligners embedded with microsensors could track wear time and exertion forces, providing real-time feedback for both patients and clinicians. Additionally, direct 3D-printed aligners will further streamline the manufacturing process, offering improved precision, faster production times, and fully customized treatment plans without the need for traditional thermoforming techniques, reducing material waste and enabling on-demand production for a more efficient and patient-specific orthodontic experience.
Gene-guided orthodontics: Research into genetic predispositions for malocclusions and skeletal development may lead to individualized treatment plans based on a patient's genetic profile.
Combination therapy for sleep apnea: Orthodontics will continue to play a vital role in SDB management, with hybrid approaches integrating surgical, orthodontic, and behavioral interventions.
Bioadaptive materials: Materials capable of adapting to intraoral conditions, reducing treatment times, and improving comfort are in development.
Conclusion
Orthodontics is at the forefront of digital innovation, with clear aligners and sleep appliances leading the charge in transforming patient care. While airway considerations and expansion techniques have gained traction, it is essential to approach each case with a balanced perspective. The integration of direct 3D-printed palatal expanders, remote monitoring, and evidence-based airway interventions will continue to shape the future of the specialty. A commitment to individualized treatment and interdisciplinary collaboration will be essential in navigating these advancements for optimal patient outcomes.
About the Author
Andrew Ferris, DDS, MS
Private Practice, Santa Barbara, California
BIBLIOGRAPHY
1. Lione R, Franchi L, Huanca Ghislanzoni LT, et al. Treatment and posttreatment effects of rapid maxillary expansion evaluated with computed tomography: a systematic review. Angle Orthod. 2013;83(1):76-82.
2. Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health.2019;19(1):24.
3. Marklund M, Legrell PE, Persson M, et al. Treating obstructive sleep apnea with a mandibular advancement device. Sleep Breath. 2001;5(2):79-90.
4. Camacho M, Chang ET, Song SA, et al. Rapid maxillary expansion for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope. 2017;127(7):1712-1719.
5. Mehta S, Gandhi V, Vich ML, et al. Long-term effects of mini-screw-assisted rapid palatal expansion on airway: a three-dimensional cone-beam computed tomography study. Angle Orthod. 2021;91(2):195-205.
6. Liu C, Wang K, Jiang C, et al. The short- and long-term changes of upper airway and alar in nongrowing patients treated with Mini-Implant Assisted Rapid Palatal Expansion (MARPE): a systematic review and meta-analysis. BMC Oral Health. 2023;23(1):820.
