Suggestions for Systematic Treatment of Orthognathic Surgical Patients with Clear Aligners Maz Moshiri. AAO June 2021. Episode 90

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Hosted by
Farooq Ahmed

Suggestions for Systematic Treatment of Orthognathic Surgical Patients with Clear Aligners Dr. Maz Moshiri  


Advantages of Clear Aligner Therapy with orthognathic surgery

·      Preference of patients

·      Digital planning

·      Arch coordination, elimination of interferences

·      Less chance of infection, better oral hygiene


Aligners and surgery


·      Diagnosis from cephalogram, clinical and patient analysis – (conventional)

·      2-3 set ups with surgeon to ensure align in goals

·      Bite jump: virtual occlusal set up after proposed decompensation of occlusion, allows simulation of coordination

·      Records: CBCT for model and intra oral scan

·      Surgical planning 1: decide on 3 piece, SARPE, extractions


Pre surgery

·      Pre surgical orthodontics, decompensate to achieve pre surgical goals

·      Levelling of arches

o   If not address levelling, AP correction incomplete, limitation of full surgical correction

o   Achieved through attachment chose for anchorage and over correction

o   Smartforce hierarchy does not place intrusion attachments as priority, it is 5th after attachments for extraction, expansion, root movement (mesio-distal), single tooth vertical, Orthodontist has to place

·      Intrusion of 7s to avoid interferences




·      Passive aligners with cut outs 3-6 to easily bond buttons post surgery

·      2 months prior to surgery allow lag catch up with aligner, or use a vivera retainer, stiffer to express torque and prescription

·      Surgical planning 2


Post surgery

·      Patient seen at 3 weeks

·      Physical therapy at 4 weeks

·      Refinement 2-3 months after surgery

·      Eliminate interferences

·      Inter-arch elastics

·      Posterior openbite, assess cause, if anterior interferences, address via aetiology


TADs and surgery

·      TADS placed at the time of surgery between 3-6 upper and lower

·      Used to for intermaxillary fixation with ligature

·      Removed at 1 month – patients can find uncomfortable


·      Intermediate splint – position lower jaw against the upper jae. Correct pitch, yaw anf roll. Rigid fixation of proximal site

·      Final splint – Final position of maxilla to mandible

·      Palatal splint. 3-4 part maxilla. Kept 3 months post surgery, Holes to allow ligature during intermaxillary fixation

·      Invisalign guiding splint. Used 2-3 weeks. Reduced retention. Holes in occlusal aspect



Class 2, 3 case


TMD case

·      Class 1 on presentation

·      Stabilsation splint, patient drops to having an increased overjet ½ class 2

·      Decompensate with Invisalign, IPR lower arch and class 3 elastics

·      Decompensate to class 2 molars

·      Simulation of orthognathic surgery with 3D systems, custom made plates



Jaw joint replacement COMBO

·      AOB and arthritic changes to jaw joint

·      Plan

o   Bimaxillary advancement

o   Total jaw replacement

o   Decompensation – Invisalign

o   Speech therapy

·      In treatment

o   AOB improved during decompensation (my opinion bite plane effect)

o   Reduced surgery


Notes available via website:





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