Surgical cases

Are there any benefits of using aligners in surgical cases?

Orthodontic treatments, whether aligners or braces, have their limits and may not be suitable for all cases. For that reason, some of our patients will need to undergo orthognathic surgery combined with orthodontics in order to solve their problem adequately. In those malocclusions where the patient presents a severe skeletal problem, the possibility of opting for orthodontic-surgical treatment might be the best solution.

Let us not forget that there are patients who, despite understanding the severe problem they have, are not willing to assume the cost or risks of orthognathic surgery and prefer to try to solve or compensate their problem with orthodontic treatment alone. However, there are patients who may opt to undergo surgery. These cases, regardless of their complexity, can also be treated with aligners.

Is there a problem if we treat an orthognathic case with aligners? Generally speaking, there is no clear contraindication for the use of aligners in this type of patient. It will depend mainly on the technique that the orthodontist and surgeon are most comfortable with or have more experience with. There is no one better or worse, each professional will just recommend the method that gives the patient the best guarantee to solve the case successfully. The considerations to be taken into account in a surgical case treated with braces are different to those treated with clear aligners, but the vast majority of them can be solved in a similar way, obtaining satisfactory results.

As with other malocclusions, such as extraction cases, we may think that the treatment of the surgical patient with fixed orthodontics will be easier and more predictable than with clear aligners. This is not always true. The growing demand for clear aligners treatment leads us to treat all types of cases, regardless of how difficult they are, with this technique. Orthognathic surgery treatments with aligners are not always as complex as they seem. Sometimes we need to use mini-screws, it may be necessary to make distalisations... but if we have the objectives of the pre-surgical phase clear in the case planning, we can achieve them just as well with aligners as with brackets.

Fig. 1. Frontal and lateral views of an orthognatic case treated with clear aligners.

Beyond the patient's demands... is there any advantage to treating orthognathic surgery patients with aligners? There are some studies that have found no significant differences in treating these patients with both techniques. But a recent study published by Guntaka et al. did find better results in terms of post-operative swelling in patients treated with aligners versus patients treated with fixed orthodontics.

The results of this study should be taken with a pinch of salt as it has some limitations. For example, the study sample is very small and its retrospective nature means that the results cannot prove a causal relationship between the type of treatment and the level of postoperative inflammation. However, although it is not scientifically proven, it is logical that, as a general rule, a patient with braces will have worse hygiene than a patient with aligners in the first weeks after the surgical procedure. The limited opening and discomfort will cause patients to brush worse, facilitating the accumulation of plaque and the consequent inflammation. If we add to this all the fixed appliances placed on the teeth, good hygiene can become mission impossible.

For this reason, although it is still not a widespread technique and there are professionals who continue to opt for using fixed appliances to treat surgical cases, invisible orthodontics is a completely valid solution that can improve the patient's treatment experience. For this reason alone, it is worth considering it.

Guntaka PK et al. Do patients treated with Invisalign have less swelling after orthognathic surgery than those with fixed orthodontic appliances? Am J Orthod Dentofacial Orthop 2022.

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