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PURPOSE: Successful execution of orthognathic surgery is technique sensitive. A critical component is pre-operative coordination of dental arches with orthodontic appliances and intra-operative guidance with occlusal splints indexed maxillary-mandibular fixation (MMF) to guide the skeletal movements. The MMF is achieved with surgical hooks secured to conventional orthodontic appliances. However, today a significant number of patients are electing to chose clear aligner orthodontic management (Invialign ®) because of the visibility of conventional orthodontic appliances. We present pitfalls and tricks we learned to adapt to the intra-operative and post-operative management of patients with clear aligner therapy. METHODS: This is a retrospective clinical review. 63 patients underwent orthognathic surgery with clear aligner orthodontic management. 7 patients intra-operative MMF with conventional arch bars, 11 with Temporary Anchorage Devices (TAD) and in the remaining 45 patients with a modified 3d printed splint alone. To date 47 patients have completed their treatment and are in retention. The occlusal outcomes were scored for comparison to historical control. RESULTS: The average age was 28 (24-35) with 27 Lefort I, 19 Lefort I/BSSO and 16 BSSO. 1 return to the OR for repositioning of the maxilla/mandible, 5 of 7 with arch bars required returning to the OR for removal, 3 of 11 TAD patients required returning to OR for removal. CONCLUSION: The trend toward the use of clear aligners has shifted the paradigm in orthodontic treatment and as a consequence intra-operative management in patients needing orthognathic surgery. With modifications, equivalent surgical outcomes can be achieved with clear-aligner convenience to the patient.
Yang et al. (Wed,) studied this question.