Can we use aligners together with orthognathic surgery?

As the fascination for aesthetics and preference for elevated comfort slither their way into the patient’s lookout for suitable treatment, clear aligners have become indelible options in the wide scope of orthodontic scaping. Aligners like Invisalign® have indeed stood the test of time, only improving with advancements in virtual computer planning and artificial intelligence. Because of these huge leaps in orthodontics over the past several years and the high promotion of temporary anchorage devices (TAD), the need for combined orthodontic/surgery treatment has significantly reduced particularly in adults.

Orthognathic surgery or corrective jaw surgery is an invasive dental procedure that is often a necessity in malocclusions that are too severe to be corrected by orthodontic appliances alone. Jawbones grow as part of the general growth and development of the body. Sometimes, however, abnormal jaw discrepancy or dentofacial abnormalities can result, making the process of correction more difficult and complex.

malocclusions arise not because the teeth are in malaligned positions but because the jaws are. Examples would be an overgrown lower jaw or a small upper jaw, both of which can cause abnormal jaw relationships. Mild to moderate jaw discrepancies can now be camouflaged with tooth movements. However, if the jaw discrepancies are too severe, adjunctive orthodontic/surgical treatment might be necessary.

When is orthognathic surgery necessary?

Orthognathic surgery is solely employed for adult patients who are too old for normal growth modification or when dentofacial conditions are too severe for surgical or orthodontic treatment to cover up.

Class I malocclusion does not require surgery. But some other bite issues may warrant corrective jaw surgery to resolve:

• Overbite: You are said to have an overbite or a Class II malocclusion when the upper teeth sit significantly in front of the lower teeth when you bite down. In extreme cases, you’re faced with an overbite so severe that lower teeth may be in contact with the soft tissues behind the upper teeth when you bite down. In such cases, you may need comprehensive appliance therapy in adjunct to orthognathic surgery.
• Underbite: A Class III malocclusion, an underbite happens when the lower teeth and jaw are positioned in front of the upper teeth. If significant underbite isn’t addressed early on, jaw surgery may be mandatory in adulthood.
• Open bite: If your upper and lower teeth do not meet at all, you most likely have an open bite. You can either have an anterior or posterior open bite, both of which can be fixed with the help of aligner therapy. Very rarely do open bites require orthognathic surgery to correct.
• Crossbite: A crossbite is when some of the bottom teeth sit in front of the top teeth when you bite down. A majority of crossbites can be fixed without corrective jaw surgery using braces or aligners. In certain cases, surgery may be needed to fix a crossbite.

Can aligners be used with orthognathic surgery?

The objective of orthognathic surgery is to achieve ideal dental occlusion with the jaws in a way to optimize facial aesthetics, using a combination of orthodontics and surgery. In the past, orthognathic surgery was widely used with fixed appliances. However, with the increasing demand for better cosmetic relief, more patients are requesting clear aligners even in cases that involve severe jaw malformations or dentofacial abnormalities. So, is it possible to utilize the aesthetic benefit of clear aligners with the multiplex system of orthognathic surgery? Yes.

New advances in technology particularly in the realm of 3-d computer-aided virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) have been adapted for orthognathic surgery.

Thorough orthodontic records are extracted for diagnosis and treatment planning of predicted dental and surgical movements using treatment software. The multidisciplinary team then tests the soft tissue outcomes of proposed surgical procedures before finalizing the treatment plan and appliance fabrication. Maxillomandibular repositioning is done based on the facial and occlusal goals during the virtual planning phase.

Based on the confirmation of movements from the VSP, decompensation is pursued using the first set of aligners. After surgery, the patient will be requested to wear the aligners as soon as possible, ideally no more than two days after surgery.

Orthognathic surgery can potentially improve the patient’s appearance as well as occlusal function. However, many orthodontists may not recommend the use of clear aligners for the treatment of orthognathic surgery as many patients lack familiarity with the appliance for the specific use. Other than the slight learning curve associated with clear aligners, they work brilliantly with orthognathic surgery.