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Their Stories - Fiaz - i-CAT™

KaVo Kerr Connections

Written by Dr. Robert Kaspers

Their Stories - Fiaz - i-CAT™

Some people spend their lives trying to make their dreams come true. Others, spend their lives literally just trying to dream. A constricted airway can affect people’s breathing, the quality of their sleep, and cross over into many other aspects of their waking lives. The anatomic details that I obtain through my treatment planning software, TxSTUDIO™ on i-CAT™ scans have led to treatment for teeth and airway conditions that can change these patients’ quality of life. With 3D imaging, I now look at airways and treatment plan not only for the teeth, but with attention to the airway as well. A fine example of this is the experience I shared with my patient, Fiaz, who was primarily unhappy with his appearance and his bite. He was referred to my practice by an oral surgeon for a retruded lower jaw, creating a need for orthognathic surgery. At the time, Fiaz understood that his skeletal make-up caused him to position his jaw forward, but until we examined the information from the i-CAT 3D scan, we did not know that he also had another anatomical problem as well, a constricted airway.

After taking an i-CAT scan and analyzing with the TxSTUDIO, I observed that Fiaz possessed a skeletal Class II malocclusion with a severely retruded lower jaw. When he would bite down in maximum intercuspation (MI), his molars and cuspids occluded in a slight Class II dental relationship. However, both of his condyles were forward in the glenoid fossa when he would bite down in MI. This knowledge of his condylar position, along with the evaluation of his airway assisted by the CBCT scan, led me to an understanding that Fiaz’s airway was severely constricted.

A typical skeletal Class II malocclusion with a severely retruded mandible possesses flared lower incisors. The person’s tongue pushes the lower incisors forward until the incisal edges touch the lingual surface of the upper incisors. In Fiaz’s case, his lower incisors were severely flared forward. Treatment consisted of preparing the position of his teeth within his jaw bones so that they would fit together after the orthognathic surgery.

i-CAT Dr Kaspers - Their Stories

i-CAT Dr Kaspers - Their Stories

In preparation for Fiaz’s orthognathic surgery, I began using Class III elastics with a four loop lower archwire to distalize Fiaz’s lower teeth and upright his severely flared lower incisors. I found uprighting his lower incisors extremely difficult and even questioned Fiaz on how much he was wearing the elastics. I began to realize that Fiaz’s tongue was resting forward during the day to allow him to breathe, and consequently, Fiaz’s tongue was preventing the uprighting of his severely flared lower incisors. For this reason, I asked the oral surgeon to position Fiaz’s lower jaw forward of a socked-in occlusion so that his jaw bones would be properly aligned, and thus, his airway would be significantly improved especially since the daytime tongue position and its damaging effects would be remedied.

At Fiaz’s first orthodontic appointment after his orthognathic surgery, I planned a full examination including a CBCT scan to evaluate the position of his condyles, the position of his jaw bones, and assess the airway. When Fiaz saw me come into the room, he jumped out of his seat to hug me. He informed me, “I now dream in Technicolor!” He said that when I told him that with his treatment, his airway would improve, he had no idea what the results would be because he had nothing to compare with—during his lifetime, he had only breathed in a certain way. The results were dramatic for him.

Post-orthodontic treatment began with the removal of surgical wires and the placement of a four-looped lower archwire and Class III elastics to upright the lower incisors. My assumption that Fiaz’s tongue was preventing the uprighting of his lower incisors due to its compensation for his breathing proved correct; his lower incisors immediately uprighted when Class III elastics were restarted following the surgery.

i-CAT Dr Kaspers - Their Stories

Fiaz defined his treatment as a “life-changing experience.” Having orthognathic surgery to advance his lower jaw and consequently open his airway gave him the capability not only to breathe better but to sleep better, eat better, exercise better and, frankly, live better.

Fiaz came to me because he was biting improperly, but the question still remains, was he biting forward to make his teeth fit together better, or to breathe better? The answer is, probably a little bit of both. When we measured his airway with the i-CAT, and noted that it was deficient, I truly believe that we had taken the first step to improving his quality of life. With just 2D imaging, we would not be able to evaluate a person’s condylar position and the position of the teeth within the alveolus. For many of my TMD cases, it is so much easier to have a 3D radiograph to discern why they have a dual bite, or if I have created a seated condylar position.

Having an i-CAT changes the way that I think as an orthodontist. While reading orthodontic blogs, I routinely find that orthodontists who just use 2D imaging and models are just looking at the teeth. As a result, they may, for example, extract two upper bicuspids and move the upper teeth back so that the teeth will bite properly. While that may work for some conditions, in my view, the CBCT scan gives me more information that helps me achieve the best outcome for the individual patient.

Back to Fiaz. He tells me every time he sees me that he reflects each day about how lucky he is that he received treatment for his airway. Because of the treatment that was planned with i-CAT 3D imaging, he now leads a more energetic, full life and I am glad that I can do that—not just for him, but for all my patients. Making dreams come true is a great goal, but in my view, treating constricted airways is even better because I can give those patients a chance to dream, and to live more fully, and hopefully, in Technicolor. 

i-CAT Dr Kaspers - Their Stories

*The views and opinions expressed are those of the contributing authors and editors and do not necessarily represent the views of i-CAT or the KaVo Kerr Group. The material is not intended to present the only, or necessarily best, methods or procedures for the medical situations addressed, but rather is intended to represent an approach, view, statement or opinion. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each device he or she wishes to use in clinical practice. Therefore, please review the complete prescribing information.
*Any statements about commercial products are solely the opinion(s) of the author(s) and do not represent an i-CAT or KaVo Kerr Group endorsement or evaluation of these products. These statements should not be used in advertising or for any commercial purpose.
* Devices of the i-CAT family comprise a package of software modules capable of handling 2D and 3D data which includes 3D reconstruction, storage, retrieval, viewing, and processing of 2D and 3D-image data. Tx STUDIO imaging processing software, included in the i-CAT system, is a volumetric imaging software designed specifically for dental clinicians and is intended for use as a planning and simulation software in the placement of dental implants, orthodontics and surgical treatment. For full indications for use, visit kavo.com  

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