WHAT WE KNOW ABOUT CLEAR ALIGNERS

What_We_Know_About_Clear_Alignersapak

INTEGRATION OF ORTHOGNATIC SURGERY WITH CLEAR ALIGNER THERAPY

Servet Bozkurt

Nevşehir Hacı Bektaş Veli University, Faculty of Dentistry, Department of Orthodontics, Nevşehir, Türkiye

Bozkurt S. Integration of Orthognatic Surgery with Clear Aligner Therapy. In: Hancıoğlu Kırcelli B, editor. What We Know About Clear Aligners 1st ed. Ankara: Türkiye Klinikleri; 2025. p.157-169.

ABSTRACT

Dentofacial deformities can have a profound impact on an individual’s self-esteem, social interactions, and overall well-being. These conditions often result in judgments about a person’s attractiveness, success, and social acceptability. The combination of orthodontics and orthognathic surgery (OGS) is considered an effective approach for addressing both functional and aesthetic challenges. In recent years, clear aligner therapy (CAT) has gained prominence as an essential tool for preparing patients for OGS. CAT is increasingly favored for its ability to align teeth, decompensate dental arches, and improve facial aesthetics, making it a preferred option for many patients, especially adults seeking both functional and aesthetic improvements.

Initially, CAT was not widely used for complex malocclusions, as traditional orthodontic appliances were considered more effective for severe cases. However, advancements in technology, including digital planning tools and improved aligner systems, have made CAT a viable treatment option for patients with more complex needs, including adult patients with significant skeletal anomalies. The use of clear aligners during the pre-surgical phase primarily aims to level and align the dental arches, correct angulations, and position the incisors and molars to ensure optimal occlusion post-surgery. This process is vital for achieving favorable functional and aesthetic outcomes after the surgical procedure.

Surgical planning, when integrating CAT with OGS, requires close collaboration between orthodontists and surgeons, leveraging modern tools such as 3D cone beam computed tomography (CBCT), digital models, and virtual surgical planning. These tools allow for precise surgical outcomes by ensuring the correct placement of the maxilla and mandible during surgery. Clear aligners also offer numerous advantages, such as improved oral hygiene, reduced pain levels, and less disruption to daily activities compared to traditional fixed appliances. Additionally, the digital workflow enables faster treatment times, more accurate planning, and quicker recovery post-surgery.

However, the success of CAT heavily depends on patient compliance, as aligners must be worn for 20-22 hours per day. Despite the many benefits, there are some limitations to CAT, such as the risk of root damage during mini-screw placement and the difficulty in achieving precise tooth movement in certain complex cases, such as those requiring extractions. Nevertheless, CAT has proven to be a highly effective solution for preparing patients for OGS, offering a promising alternative to traditional approaches, especially for adult patients seeking a more aesthetic and comfortable treatment option.

Keywords: Orthodontics; Orthognathic surgery (OGS); Dentofacial deformities; Orthodontic Appliances; Removable; Malocclusion

Referanslar

  1. Elnagar MH, Aronovich S, Kusnoto B. Digital Workflow for Combined Orthodontics and Orthognathic Surgery. Oral Maxillofac Surg Clin North Am. 2020;32(1):1-14. [Crossref]  [PubMed]
  2. Naini FB, Moss JP, Gill DS. The enigma of facial beauty: esthetics, proportions, deformity, and controversy. Am J Orthod Dentofacial Orthop. 2006;130(3):277-82. [Crossref]  [PubMed]
  3. Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Kusnoto B, Evans CA. Three-dimensional assessment of soft tissue changes associated with bone-anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop. 2017;152(3):336-47. [Crossref]  [PubMed]
  4. Kwon T, Alshehri A, Palo L, Kuo CL, Mu J, Blanck N, et al. Assessment of the occlusal outcomes in patients treated with orthognathic surgery and clear aligners. Orthod Craniofac Res. 2023;26(3):371-7. [Crossref]  [PubMed]
  5. M.D.S. HDK. The philosophy of the tooth positioning appliance. American Journal of Orthodontics and Oral Surgery. 1945;31(6):297-304. [Crossref]
  6. Weir T. Clear aligners in orthodontic treatment. Aust Dent J. 2017;62 Suppl 1:58-62. [Crossref]  [PubMed]
  7. Shalish M, Cooper-Kazaz R, Ivgi I, Canetti L, Tsur B, Bachar E, et al. Adult patients’ adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign. Eur J Orthod. 2012;34(6):724-30. [Crossref]  [PubMed]
  8. Kankam H, Madari S, Sawh-Martinez R, Bruckman KC, Steinbacher DM. Comparing Outcomes in Orthognathic Surgery Using Clear Aligners Versus Conventional Fixed Appliances. J Craniofac Surg. 2019;30(5):1488-91. [Crossref]  [PubMed]
  9. Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJ, et al. Braces versus Invisalign(R): gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health. 2015;15:69. [Crossref]  [PubMed]  [PMC]
  10. Pagani R, Signorino F, Poli PP, Manzini P, Panisi I. The Use of Invisalign(R) System in the Management of the Orthodontic Treatment before and after Class III Surgical Approach. Case Rep Dent. 2016;2016:9231219. [Crossref]  [PubMed]  [PMC]
  11. Womack WR, Day RH. Surgical-orthodontic treatment using the Invisalign system. J Clin Orthod. 2008;42(4):237-45.
  12. Kankam HKN, Gupta H, Sawh-Martinez R, Steinbacher DM. Segmental Multiple-Jaw Surgery without Orthodontia:Clear Aligners Alone. Plast Reconstr Surg. 2018;142(1):181-4. [Crossref]  [PubMed]
  13. Kook MS, Kim HM, Oh HK, Lee KM. Clear Aligner Use Following Surgery-First Mandibular Prognathism Correction. J Craniofac Surg. 2019;30(6):e544-e7. [Crossref]  [PubMed]
  14. Caminiti M, Lou T. Clear Aligner Orthognathic Splints. J Oral Maxillofac Surg. 2019;77(5):1071 e1-e8. [Crossref]  [PubMed]
  15. Lou T, Caminiti M. Orthognathic Surgery Combined with Clear Aligner Therapy. J Clin Orthod. 2021;55(1):44-58. [Crossref]  [PubMed]
  16. Kau CH, Wang Z, Wang J, Krishnan DG. Contemporary management of an orthodontic-orthognathic patient with limited time availability in an orthodontic office setting: Case report. J Orthod. 2020;47(3):257-64. [Crossref]  [PubMed]
  17. Giancotti A, Garino F, Mampieri G. Use of clear aligners in open bite cases: an unexpected treatment option. J Orthod. 2017;44(2):114-25. [Crossref]  [PubMed]
  18. Guntaka PK, Kiang K, Caprio R, Parry GJ, Padwa BL, Resnick CM. Do patients treated with Invisalign have less swelling after orthognathic surgery than those with fixed orthodontic appliances? Am J Orthod Dentofacial Orthop. 2023;163(2):243-51. [Crossref]  [PubMed]
  19. Zhang W, Yang H. Orthognathic Surgery in Invisalign Patients. J Craniofac Surg. 2022;33(2):e112-e3. [Crossref]  [PubMed]
  20. Cong A, Ruellas ACD, Tai SK, Loh CT, Barkley M, Yatabe M, et al. Presurgical orthodontic decompensation with clear aligners. Am J Orthod Dentofac. 2022;162(4):538-53. [Crossref]  [PubMed]  [PMC]
  21. Kassas W, Al-Jewair T, Preston CB, Tabbaa S. Assessment of Invisalign treatment outcomes using the ABO Model Grading System. J World Fed Orthod. 2013;2(2):E61-E4. [Crossref]  [PubMed]
  22. Krieger E, Seiferth J, Saric I, Jung BA, Wehrbein H. Accuracy of Invisalign(R) treatments in the anterior tooth region. First results. J Orofac Orthop. 2011;72(2):141-9. [Crossref]  [PubMed]
  23. Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Periodontal health during clear aligners treatment: a systematic review. Eur J Orthod. 2015;37(5):539-43. [Crossref]  [PubMed]
  24. Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofac. 2009;135(1):27-35. [Crossref]  [PubMed]
  25. Djeu G, Shelton C, Maganzini A. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop. 2005;128(3):2928; discussion 8. [Crossref]  [PubMed]
  26. Zhang XJ, He L, Guo HM, Tian J, Bai YX, Li S. Integrated three-dimensional digital assessment of accuracy of anteri or tooth movement using clear aligners. Korean J Orthod. 2015;45(6):275-81. [Crossref]  [PubMed]  [PMC]
  27. Bowman SJ. Improving the predictability of clear aligners. Semin Orthod. 2017;23(1):65-75. [Crossref]  [PubMed]
  28. Ren LH, Liu L, Wu ZQ, Shan D, Pu LL, Gao YZ, et al. The predictability of orthodontic tooth movements through clear aligner among first-premolar extraction patients: a multivariate analysis. Prog Orthod. 2022;23(1). [Crossref]  [PubMed]  [PMC]
  29. Fonseca RJ, Robert D. Marciani Timothy Turvey. Oral and Maxillofacial Surgery, 2nd Edition. Volume III.: St. Louis: Saunders 2008.
  30. Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery. J Maxillofac Surg. 1973;1(2):79-84. [Crossref]  [PubMed]
  31. Hakan ELa GA, Cenk Ahmet AKCAN. Şeffaf plaklarla cerrahi tedavi planlamalarında dikkat edilecek prensipler. In: C T, editor. Ortodontide Şeffaf Plak Uygulamaları Ankara: Türkiye Klinikleri. 2023; p.45-54.
  32. Xia JJ, Gateno J, Teichgraeber JF. New Clinical Protocol to Evaluate Craniomaxillofacial Deformity and Plan Surgical Correction. J Oral Maxil Surg. 2009;67(10):2093-106. [Crossref]  [PubMed]  [PMC]
  33. Swennen GRJ, Mollemans W, Schutyser F. Three-Dimensional Treatment Planning of Orthognathic Surgery in the Era of Virtual Imaging. J Oral Maxil Surg. 2009;67(10):2080-92. [Crossref]  [PubMed]
  34. Xia JJ, Gateno J, Teichgraeber JF. Three-dimensional computer-aided surgical simulation for maxillofacial surgery. Atlas Oral Maxillofac Surg Clin North Am. 2005;13(1):25-39. [Crossref]  [PubMed]
  35. Levrini L, Mangano A, Montanari P, Margherini S, Caprioglio A, Abbate GM. Periodontal health status in patients treated with the Invisalign(R) system and fixed orthodontic appli ances: A 3 months clinical and microbiological evaluation. Eur J Dent. 2015;9(3):404-10. [Crossref]  [PubMed]  [PMC]
  36. de Leyva P, Eslava JM, Hernandez-Alfaro F, Acero J. Orthognathic surgery and aligners. A comparative assessment of periodontal health and quality of life in postsurgical orthodontic treatment with aligners versus traditional fixed appliances: a randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2023;28(3):e208-e16. [Crossref]  [PubMed]  [PMC]
  37. Miller KB, McGorray SP, Womack R, Quintero JC, Perelmuter M, Gibson J, et al. A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment. Am J Orthod Dentofacial Orthop. 2007;131(3):302. [Crossref]  [PubMed]
  38. Caniklioglu C, Özturk Y. Patient discomfort: A comparison between lingual and labial fixed appliances. Angle Orthod. 2005;75(1):86-91. [Crossref]
  39. Karkhanechi M, Chow D, Sipkin J, Sherman D, Boylan RJ, Norman RG, et al. Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy. Angle Orthod. 2013;83(1):146-51. [Crossref]  [PubMed]  [PMC]
  40. Gu JF, Tang JSY, Skulski B, Fields HW, Beck FM, Firestone AR, et al. Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index. Am J Orthod Dentofac. 2017;151(2):259-66. [Crossref]  [PubMed]
  41. Kau CH, Feinberg KB, Christou T. Effectiveness of Clear Aligners in Treating Patients with Anterior Open Bite: A Retrospective Analysis. J Clin Orthod. 2017;51(8):454-60. [Crossref]  [PubMed]  [PMC]
  42. Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. 2015;85(5):881-9. [Crossref]  [PubMed]  [PMC]
  43. Chang J, Steinbacher D, Nanda R, Uribe F. “Surgery-First” Approach with Invisalign Therapy to Correct a Class II Malocclusion and Severe Mandibular Retrognathism. J Clin Orthod. 2019;53(7):397-404. [Crossref]  [PubMed]