Clear Aligners in Orthognathic Surgery Flavio Uribe
Use of aligners
· 57% – questionnaire from JCO Keim 2020
o Previously 2014 22%, 2008 12%
· 90% of orthodontists satisfied with outcomes of aligners
· Type of case
o Most malocclusions
Challenges with aligners and orthognathic surgery
· Intermaxillary fixation
o Conventional IMF In surgery = brackets
o Aligners – difficult as no fixed dental component
§ Use TADs for IMF Potential root damage – can be prevented using a stent
§ Positioner type surgical splint / wafer – Caminiti 2019
· Transitioning into and out of surgery
o Scan 2 weeks prior to surgery
§ Fit 2 weeks after surgery
o Segmental maxillary procedure
§ Scan 4-5 weeks after surgical splint removed / Hawley type retainer
§ Wait 4 weeks to deliver aligners
Occlusal outcomes in orthognathic surgery and aligners
· ABO-OGS: Invisalign = 41 Vs 28 with conventional Robitaille 2016
· Flavio study
o PAR: 89% reduction to 3.5
o ABO-OGS: Average 33 (failure of ABO-OGS)
§ Cases – mainly issue with rotations on 7s
Cases
· AOB case
o 3 part maxilla
o 5 clinic appointments
Conclusion
· Surgery 1st is amenable to aligner treatment
