Surgical Orthodontics with Invisalign Treatment
- 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
- 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
- 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
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