Practicing from an evidence-based foundation is something I take seriously. The fields of orthodontics and dental sleep medicine are evolving quickly, and staying current with modern research directly shapes how I treat patients and which options I offer. These are the studies I find most relevant to the work we do at Aligned Orthodontics, organized by topic.
— Dr. Amanda Vanderstelt, Board-Certified Orthodontist, Aligned OrthodonticsA Roadmap of Craniofacial Growth Modification for Children with Sleep-Disordered Breathing: A Multidisciplinary Approach
This review outlines how early changes to jaw and facial development can reduce breathing problems during sleep in children, and why a team approach — involving orthodontists, ENTs, and sleep specialists — leads to better outcomes than treating each issue separately.
Impact of Rapid Palatal Expansion on the Size of Adenoids and Tonsils in Children
This study found that widening the palate in children not only creates more room in the mouth, but can also reduce the size of adenoids and tonsils — two of the most common causes of nighttime breathing problems and snoring in kids.
Craniofacial Anatomical Determinants of Pediatric Sleep-Disordered Breathing: A Comprehensive Review
A detailed look at how the shape and size of a child’s jaw, nasal passages, and airway structures directly contribute to sleep-disordered breathing. Understanding these physical factors helps clinicians identify which children need early intervention beyond just removing tonsils.
Determinants of Probable Sleep Bruxism in a Pediatric Mixed Dentition Population: Mouth vs. Nasal Breathing, Tongue Mobility, and Tonsil Size
This research found that children who breathe through their mouths, have restricted tongue movement, or enlarged tonsils are significantly more likely to grind their teeth at night — connecting airway function to what many parents assume is just a stress or habit issue.
Determinants of Sleep-Disordered Breathing During the Mixed Dentition: Development of a Functional Airway Evaluation Screening Tool (FAIREST-6)
Researchers developed a simple six-item screening tool — the FAIREST-6 — to help clinicians identify children at risk for sleep-disordered breathing during the window when both baby and adult teeth are present. Early identification means earlier, less invasive treatment.
The Role of Rapid Maxillary Expansion in the Promotion of Oral and General Health
A landmark review by Dr. James McNamara demonstrating that widening a narrow upper jaw does more than straighten teeth — it improves nasal breathing, reduces mouth breathing, and can have measurable effects on sleep quality and overall health.
Nasal Breathing Improvement Following Palatal Expansion
This study documents measurable improvements in nasal airflow following palate expansion treatment, supporting the clinical rationale for using orthodontic expansion as part of a breathing-focused treatment plan — not just for bite correction.
Maxillary Expansion in the Management of Pediatric Obstructive Sleep Apnea
This study reviews the evidence for using palate expansion to treat obstructive sleep apnea in children, finding that widening the upper jaw reduces airway obstruction and can meaningfully improve sleep apnea symptoms — sometimes eliminating the need for surgery.
The Effect of Rapid Maxillary Expansion on Children with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis
Combining data from multiple studies, this meta-analysis confirms that rapid maxillary expansion consistently reduces apnea severity in children. The authors conclude it should be considered a first-line treatment option for pediatric sleep apnea in cases involving a narrow palate.
Expansion of the Nasal Passageway: RME (Tooth-Borne)
This study examines how traditional tooth-anchored rapid maxillary expansion affects nasal airway dimensions, demonstrating that orthodontic palate widening produces real, measurable increases in the space available for nasal breathing.
Expansion of the Nasal Passageway: Nasal Airflow Changes with RME
A companion study measuring actual airflow changes following palate expansion. Patients showed significant improvements in nasal breathing capacity after treatment, reinforcing that expansion is as much an airway intervention as it is an orthodontic one.
Skeletal and Dentoalveolar Effects Using Tooth-Borne and Tooth-Bone-Borne RME Appliances: A Randomized Controlled Trial with 1-Year Follow-Up
This randomized controlled trial directly compared traditional tooth-anchored expanders with hybrid tooth-and-bone-anchored expanders, tracking skeletal and dental changes over one year. Bone-anchored designs produced more skeletal expansion with less unwanted tooth tipping.
Impact of Rapid Palatal Expansion on the Internal Nasal Valve and Obstructive Nasal Symptoms in Children
This study zeroes in on the internal nasal valve, a key chokepoint for airflow, and shows that palate expansion increases the cross-sectional area of this valve, directly reducing nasal congestion and obstruction symptoms in pediatric patients.
MARPE vs. Regular Expander on Nasal Airflow Changes
A direct comparison of MARPE (mini-screw assisted expansion) and traditional tooth-borne expanders on nasal airflow. MARPE produced superior airway improvements because it opens the skeletal suture more fully, rather than just tipping the teeth outward like a conventional expander.
Mini-Implant Assisted Rapid Palatal Expansion (MARPE) Effects on Adult Obstructive Sleep Apnea and Quality of Life: A Multi-Center Prospective Controlled Trial
This multi-center trial is one of the strongest studies supporting MARPE for adults with sleep apnea. Participants showed significant reductions in apnea severity and reported meaningful improvements in sleep quality, daytime energy, and overall quality of life after treatment.
Treatment Outcomes of 3D-Printed Custom and Conventional Mini-Implant Assisted Rapid Palatal Expanders (MARPE)
This study compares 3D-printed custom MARPE devices against conventional ones, finding that both are effective but that custom-designed expanders offer better fit and comparable outcomes. A useful look at how digital technology is improving appliance precision without compromising results.
Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea: A Meta-Analysis
This JAMA meta-analysis pooled results from multiple studies on jaw advancement surgery for sleep apnea and found it to be among the most effective surgical interventions available, with high success rates even for patients who have not responded to CPAP. Relevant context for cases where orthodontic treatment alone is not sufficient.
Long-Term Results for Maxillomandibular Advancement to Treat Obstructive Sleep Apnea: A Meta-Analysis
Following up on short-term surgical outcomes, this meta-analysis looks at whether jaw advancement surgery holds up over time. Patients maintained significant reductions in apnea severity years after surgery, supporting it as a durable solution for the right candidates.
Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis
This systematic review found that targeted exercises for the tongue, throat, and oral muscles reduced sleep apnea severity by approximately 50% in adults and 62% in children. It established myofunctional therapy as a legitimate, evidence-based adjunct to orthodontic and airway treatment.
This research informs the treatments Dr. Vanderstelt offers and how she approaches care for every patient. If you’re curious whether any of these findings apply to your situation, a consultation is the place to start.
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