Clear Aligner Therapy in Orthognathic Surgery

Clear aligner therapy (CAT) is becoming a modality of choice among orthodontists and patients alike. In this chapter that includes illustrative clinical cases, we want to show that the challenges involved should not preclude orthodontists from using CAT in orthognathic surgery, even in patients undergoing maxillary segmentation. There are several benefits for the patient and orthodontist in choosing CAT to facilitate the orthognathic surgical correction of skeletal malocclusions. The process may be better tolerated by many adults in comparison with fixed appliances, especially because most of them have previously experienced it at an earlier age. Moreover, oral hygiene during treatment, especially in the postsurgery period, is more attainable with aligners than with fixed appliances. Fewer appointments are generally needed to treat patients with CAT, and less overall chair time is thus needed. Nonetheless, important elements need to be considered in these patients. Preoperatively, it is critical for the virtual setup to be designed with proper decompensation of the malocclusion. Intraoperatively, an effective method of maxillomandibular fixation must be selected, and postoperatively, refinement scans are necessary. The experience of the orthodontist in both conventional orthognathic surgery and CAT is extremely important for a good result, in the same way as expertise on the part of the maxillofacial surgeon.