Surgical Orthodontics with Invisalign Treatment

Surgical Orthodontics with Invisalign Treatment

1. Barriers to orthognathic surgery with Invisalign:

• Surgeon’s unfamiliarity with techniques
• Orthodontist’s unfamiliarity with techniques
• Orthodontist’s inability to convince and assist their surgeon of the advantages

 

2. Traditional surgeon requests for orthognathic surgery patients:
   • Brackets must be placed, all orthodontic tooth movement must be completed, and arch wires must be rigid and passive
   • Wire ties throughout
   • Banded molars
   • Hooks on all brackets

 

3. Invisalign/surgery challenges:

 

• Maxillomandibular fixation during surgery

Arch Bars

Eyelet wires – Caplan stems/hooks

Direct bonded arch bars or archwires

TADs

Hybrid arch bars

 

• Advantages of TADs

Secure maxillomandibular fixation during surgery

Use of elastics will not cause tooth mobility/extrusion

Minimal soft issue irritation

Can begin refinement of occlusion with aligners sooner because

nothing is ok to the teeth

 

• Stabilization of multi-segment surgery

Segments must be sufficiently mobile to be completely passive

Establish the final occlusion precisely

Robust rigid internal fixation

Bony buttressing, grafting, and strategic placement of fixation

 

• Preventing undesired tooth movement after surgery

Bonded tension band with stress breaker across interdental

osteotomy sites

Bonded lingual archwires

Custom fabricated trays

Early mobilization and start of refinement

 

• Refining the occlusion after surgery (two options)

Retain occlusion with custom tray until ready to refine with aligners

Take advantage of RAP and allow vertical occlusal refinement