Title: Interrelationships between orthodontics, orofacial function, airway, sleep and posture
Abstract:
Background: Orthodontics has traditionally focused on dental alignment, occlusal relationships, and facial esthetics as primary treatment objectives. Contemporary literature-based evidence indicates that craniofacial morphology is associated with broader functional domains, including airway characteristics, breathing patterns, orofacial muscle function, sleep quality, and postural adaptation. Conventional orthodontic assessment may overlook clinically relevant interactions that influence the development of malocclusion, treatment stability, and overall patient long-term outcomes. Increasing attention has been directed toward a more integrated, function-oriented approach that emphasizes the role of interdisciplinary considerations in orthodontic diagnosis and treatment planning.
Aim: This study aims to evaluate and synthesize contemporary peer-reviewed evidence on the interrelationships among orthodontics, orofacial function, airway characteristics, sleep, and postural adaptation, and their implications for diagnosis, treatment planning, and long-term stability in orthodontic care.
Materials and Methods: A structured literature review was performed using the PubMed, Scopus, and Web of Science databases. Systematic reviews, meta-analyses, clinical studies, and consensus statements published between 2015 and 2026 were identified based on keywords. Extracted data were qualitatively synthesized to identify consistent patterns and clinically relevant associations.
Results: The reviewed evidence demonstrated complex interrelationships between craniofacial morphology and multiple functional domains relevant to contemporary orthodontic care. Patients presenting with transverse maxillary deficiency, mandibular retrusion, increased vertical facial pattern, and chronic oral breathing frequently exhibited altered airway characteristics, impaired nasal respiration, and dysfunctional orofacial muscular patterns. Functional disturbances, including atypical swallowing, altered tongue posture, lip incompetence, neuromuscular imbalance, and restricted lingual mobility associated with ankyloglossia, were consistently associated with malocclusion development, impaired craniofacial growth patterns, compromised treatment stability, and increased susceptibility to post-treatment relapse. Current evidence also indicates that craniofacial structure, tongue posture, and upper airway morphology may influence sleep quality and predisposition to sleep-disordered breathing, including obstructive sleep apnea, particularly during active growth and development. In parallel, adaptive cranio-cervical postural compensations have been described in selected orthodontic populations, reflecting broader biomechanical and functional interactions between craniofacial structures and body posture. However, substantial heterogeneity persists across study methodologies, diagnostic protocols, and outcome measures, limiting definitive causal interpretation and universal clinical extrapolation. The current evidence supports integrating airway evaluation, orofacial functional assessment, considerations of lingual mobility, and interdisciplinary collaboration into orthodontic diagnosis and treatment planning, extending therapeutic objectives beyond conventional dental alignment and occlusal correction alone.
Conclusions: Current evidence supports a broader interdisciplinary perspective in orthodontics, recognizing the complex interactions between craniofacial morphology, airway characteristics, orofacial function, sleep-related factors, and postural adaptation. Integrating functional assessment, airway evaluation, lingual mobility analysis, and sleep-related screening into orthodontic diagnosis and treatment planning may improve treatment stability, enhance patient-centered outcomes, and enable more comprehensive long-term care. Nevertheless, substantial heterogeneity across existing studies highlights the need for standardized diagnostic protocols, prospective longitudinal research, and stronger interdisciplinary evidence to clarify causal relationships further and optimize clinical decision-making in contemporary orthodontics.
