Comparing Outcomes in Orthognathic Surgery Using Clear Aligners Versus Conventional Fixed Appliances

Abstract

Purpose: Orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic hardware is secured to the dentition to allow dental movement and stabilization. Clear-aligner therapy (eg, Invisalign) provides an aesthetic alternative, consisting of a series of transparent trays. Its use has not been described in complex triple-jaw orthognathic surgery. The purpose of this study is to evaluate perioperative outcomes and 3-dimensionally quantify postoperative edema in Invisalign patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional fixed appliances. The surgical approach to patients with clear-aligners is also outlined. Methods: The authors conducted a retrospective chart review and 3-dimensional morphometric study of Invisalign patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). An identical assessment of demographically matched patients treated with conventional fixed appliances was performed and compared with the Invisalign group. Results: Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign and 20 with conventional fixed appliances. No significant difference was observed in operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement, and use of narcotic analgesics between the 2 groups. Nine patients had sufficient 3-dimensional images for volumetric analysis (4 with Invisalign and 5 with conventional fixed appliances). Postoperative edema was not significantly different (P = 0.712) when comparing conventional fixed appliances (44.29 ± 23.16 cm3) to Invisalign (37.36 ± 31.19 cm3). Conclusion: The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign patients. Perioperative and short-term clinical outcomes are not compromised.

Clear Aligner Orthognathic Splints (CAOS) and Custom Maxillary Fixation Plates for Surgery-First or Surgery-Only Cases

“…Further outcome studies are required to compare traditional versus clear aligner orthognathic splints. 3 Traditional and virtually planned splints have been used with great success for the repositioning of the maxilla, with vertical position set intraoperatively on the basis of clinical assessment and, in some cases, external or internal reference points. The advent of custom maxillary fixation plates eliminates the need for intermediate splints and reference points and achieves a very accurate positioning of the maxilla especially in the vertical position.…”

Advanced Digital 3D Technology in the Combined Surgery-First Orthognathic and Clear Aligner Orthodontic Therapy for Dentofacial Deformity Treatment

“…The obtained outcomes show that the combination of Invisalign and SF, without adversely affecting the patient's quality of life, offers a minimally invasive alternative to the clinician for managing severe dentoskeletal discord. Kankam et al stated that when implementing clear aligner therapy instead of traditional fixation devices, there is no significant effect on postoperative edema and perioperative outcomes [20].…”

“…The combination of orthognathic surgery and clear-aligner therapy (e.g., Invisalign) is a novel idea, but with limited evidence thus far [9,20]. To date, knowledge of clear aligners with OGS is minimal, with most being case reports [8,[21][22][23][24].…”

Surgery-First Maxillomandibular Advancement for Obstructive Sleep Apnea with Post-Operative Sequential Clear Aligner Orthodontic Treatment

“…4 They also require good patient compliance, as these removable appliances require consistent use for 20 to 22 hours each day. 5 And because SCAs are readily removable, additional intraoperative measures like Erich arch bars are required to facilitate MMF. Arch bars may be similarly unhygienic and likely more uncomfortable when compared to traditional orthodontics, though their use is typically limited to less than 6 weeks of total treatment.…”

“…4 In fact, these aligners have demonstrated efficacy in aiding orthognathic surgery for dentofacial deformities, which share some technical similarities with MMA for OSA. 5 The average MMA and orthognathic patient cohorts nonetheless differ in key areas such as age, medical comorbidities, average BMI, and the degree of surgical repositioning.…”