Can Orthodontics Help You Breathe Better? The Herbst Appliance and Your Airway
When you think about braces or jaw appliances, you probably think about straight teeth or a better bite. But new research shows that orthodontic treatment may also help open up your airway — which could be good news for snoring and sleep apnea.
A recent study looked at over 500 patients who used a common jaw-correcting orthodontic device called the Herbst appliance, followed by traditional braces. The results? A significant and lasting increase in airway space.
What Is the Posterior Airway Space (PAS)?
The posterior airway space (PAS) is the area behind your tongue and soft palate — the very area that often gets blocked in obstructive sleep apnea (OSA).
When this space is narrow, you’re more likely to:
Snore
Wake up gasping
Struggle with poor sleep quality
The goal of this study was to see if Herbst treatment (which brings the lower jaw forward) could permanently increase that space.
What Is the Herbst Appliance?
The Herbst appliance is a fixed orthodontic device used to:
Correct Class II malocclusion (when the lower jaw sits too far back)
Encourage mandibular growth in teens
Reposition the lower jaw forward, which also affects the airway
Patients typically wear it for about 8–10 months, followed by regular braces.
Study Overview
This large study tracked 503 adolescents with Class II:1 malocclusion using:
Lateral X-rays (cephalograms) taken:
Before treatment (T0)
After treatment (T1)
2+ years after treatment (T2)
The researchers measured:
Airway space in square millimeters
Linear distances behind the soft palate, tongue, and throat
Changes over time
Pre-treatment factors that might predict improvement
Key Results
PAS area increased by 22.9% during treatment — and stayed stable after
Linear airway distances improved by 6–19%
The gains were maintained 2+ years after treatment
Patients with younger age and more severe jaw discrepancy (based on “Wits appraisal”) showed the greatest improvement
No signs of relapse
This means that bringing the lower jaw forward can permanently widen the airway, potentially reducing snoring and improving breathing at night.
Why This Matters for Sleep Health
Orthodontic airway studies are often small — but this one was the largest of its kind. It supports the growing idea that orthodontics isn't just cosmetic — it can also have a profound effect on:
Airway volume
Breathing during sleep
Long-term health outcomes
While this specific study didn’t track sleep apnea or snoring directly, the link between narrow airways and sleep-disordered breathing is well established.
Does This Replace CPAP or Oral Appliances?
Not exactly. The Herbst appliance is used in growing teens, while CPAP and oral appliances are treatments for adults with diagnosed sleep apnea.
But for adolescents with airway concerns, crowding, or Class II jaw positioning, early orthodontic intervention may offer preventive benefits for sleep later in life.
TL;DR
The Herbst appliance increases the airway size by ~23%
These improvements are maintained after treatment ends
Best results were seen in younger patients with more severe jaw retrusion
Orthodontics may offer long-term benefits for airway health, not just straight teeth
Source:
Bock NC, Sonntag G, Klaus K, Ruf S. Posterior Airway Changes During and After Herbst Appliance Treatment. Clinical Oral Investigations (2025) 29:114.
https://doi.org/10.1007/s00784-024-06129-9