Airway-centric Orthodontics: A Narrative Review of Current Evidence and Clinical Implications

Airway-centric orthodontics has been proposed as a conceptual framework that extends the traditional understanding of craniofacial development, functional disturbances, and orthodontic treatment outcomes beyond a purely dental perspective. This approach focuses on the potential interplay among upper airway characteristics, breathing patterns, and orofacial muscle function in influencing facial growth and occlusal relationships. This narrative review aims to outline the theoretical foundations of airway-centric orthodontics and to synthesize current evidence regarding the associations among upper airway characteristics, craniofacial morphology, and orthodontic interventions. A comprehensive search was conducted across major scientific databases, including PubMed, Scopus, Web of Science, ScienceDirect, SpringerLink, and the Cochrane Library, with additional relevant publications identified through Google Scholar to ensure broader coverage of the available literature. Current evidence suggests associations among variations in nasal airflow, breathing patterns, pharyngeal airway constriction, and maxillofacial growth, which would result in class II patterns, vertical disproportions, and various developmental anomalies. Current evidence primarily supports morphologic airway changes following orthodontic and orthopedic interventions, particularly on CBCT-based assessment, whereas consistent functional respiratory improvements remain less clearly established. Although increasing evidence highlights the potential relevance of airway considerations in orthodontic diagnosis, existing findings are characterized by methodological heterogeneity and limited long-term data. Therefore, airway-related treatment effects should be interpreted with caution. Incorporating airway assessment into clinical evaluation may provide additional diagnostic insight; however, further well-designed longitudinal and three-dimensional studies are required to clarify the clinical significance and functional implications of these observations.