A 2 x 2 Matrix | Nasal vs Mouth Breathing, Awake vs Asleep

In his book From 0 to 1, Peter Thiel describes the idea of a “contrarian truth.” For me, the contrarian truth begins with a simple premise: restoring sleep breathing health is the gateway to wellness. More specifically, nasal breathing is central to good quality sleep. The late Dr. Christian Guilleminault, together with my friend Dr. Carlos Torre, described this beautifully.

This central goal can be framed in a 2×2 matrix: nasal versus mouth breathing, and awake versus asleep. Physiologic and anatomic treatments to promote nasal breathing during wakefulness are well established. But restoring nasal breathing during sleep is where maxillary expansion, when properly indicated and executed, can make a profound difference. Many colleagues in the U.S. have advanced this goal, championed by orthodontists such as Dr. Audrey Yoon, Dr. Rebecca Bockow, and Dr. Marianna Evans. Last year at the Vienna Airway Congress (VAC), I also saw firsthand the growing enthusiasm among European colleagues for this evolving field. I am grateful to the VAC faculty, who continue to carry this momentum forward with another dynamic course this year.

Faculty Members from the 2024 Vienna Airway Congress

One of those faculty, Dr. Claudia Pinter, has graciously partnered with me to design a course tailored for colleagues ready to incorporate maxillary expansion into their practice. The course will cover diagnosis, examination, work-up, and delivery, anchored by a live in-clinic observation in Vienna. Dr. Pinter and her colleague Dr. Christian Leonhardt, have enriched the DOME (Distraction Osteogenesis Maxillary Expansion) protocol with their elegant non-diastema, clear-aligner approach—an approach that balances breathing and beauty.

Objectives of the DOME Course

I often reflect on the early days, when Dr. Guilleminault sketched his aligner concepts and adult maxillary expansion concept at Stanford. We were gathered in a small conference room near the Sleep Medicine offices, joined by Dr. Yoon. I wish we had kept his initial sketches!

In the span of a decade, I have witnessed both the exhilaration and the inevitable challenges of pioneering new directions in healthcare. It is with this spirit that I look forward to sharing what I have learned with colleagues around the world.