Sir, I was very concerned by the article written by Professor Johal in a recent BDJ Upfront article (BDJ 2018; 224: 675). For patients with sleep apnoea, he recommends the use of use of mandibular advancement appliances (MAA) 'which work by posturing the lower jaw forward keeping the airway open'. It is well known that in the long term, these appliances pull back the maxilla and increase vertical growth which inevitably further restricts the airway, worsening the very problem they claim to cure.

One of the earlier papers on this subject was in 2003 by Robertson and others,1 'An increase in face height and reductions in overbite and overjet were evident at 6 months'. Similar findings are constantly found in the many references below with no contrary findings.2,3,4,5 The problem seems to be related to vertical facial growth which is a common sequel to orthodontic treatment of almost any kind.

The only system that claims to reduce vertical growth is orthotropics (Fig. 1) which was developed by myself but evidence is hard to obtain since I had my license to practice removed for promoting it.

Figure 1
figure 1

Orthotropics cases – L, Ben aged 8, vertical growth; R, Ben aged 11, after orthotropics

Full size image