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
Planning
· 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
Peri-surgery
· 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
Splints
· 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:
https://www.alignerfellowship.com/
