Surgery-first approach combined with clear aligner therapy for skeletal Class III malocclusion

Abstract

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  The surgery-first approach can be successfully combined with clear aligners to treat skeletal Class III malocclusion.
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  A fully digital workflow can enable precise surgical-orthodontic coordination.
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  Immediate transition to clear aligners after surgical wafer removal appeared to shorten the treatment duration and facilitate the continuity of orthodontic control.
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  Various types of attachments can be used to achieve precise control of tooth movement during postsurgical orthodontic treatment.

The objective of this case report was to introduce the concept of combining the surgery-first approach (SFA) with clear aligner therapy for the treatment of skeletal Class III malocclusion, using 3-dimensional (3D) virtual surgical planning and 3D virtual setup technology. A 36-year-old male presented with a retrusive maxilla (SNA, 78.3°), a slightly prognathic mandible (SNB, 81.3°), skeletal Class III malocclusion (ANB, −2.9°), and menton deviation to the left (2.7 mm). He sought immediate improvement in facial esthetics at the start of treatment and preferred an esthetic appliance. In stage 1, SFA was performed to achieve a skeletal Class I pattern and correct the midline discrepancy. The 3D virtual surgical planning involved Le Fort I osteotomy for advancement and total impaction of the maxilla, as well as bilateral sagittal split ramus osteotomy for asymmetrical mandibular setback. Intermaxillary fixation was achieved using orthodontic miniscrews and 3D-printed wafers. At 6 weeks after surgery, stage 2 commenced with 30 clear aligners to align the teeth, coordinate the maxillary and mandibular arches, and improve occlusal interdigitation, facilitated by the regional acceleratory phenomenon. Stage 3 involved 12 additional clear aligners for occlusal detailing. A skeletal Class I pattern (SNA, 80.7°; SNB, 79.3°; ANB, 1.5°), normal overbite/overjet, and midline correction were achieved. The total treatment duration was 11 months. The treatment outcome was well maintained at the 6-month retention follow-up. Accurate prediction of postsurgical mandibular rotation and immediate transition to clear aligners appeared to shorten the treatment duration and facilitate continuity of orthodontic control.

The objective of this case report was to introduce the concept of combining the surgery-first approach (SFA) with clear aligner therapy for the treatment of skeletal Class III malocclusion, using 3-dimensional (3D) virtual surgical planning and 3D virtual setup technology. A 36-year-old male presented with a retrusive maxilla (SNA, 78.3°), a slightly prognathic mandible (SNB, 81.3°), skeletal Class III malocclusion (ANB, −2.9°), and menton deviation to the left (2.7 mm). He sought immediate improvement in facial esthetics at the start of treatment and preferred an esthetic appliance. In stage 1, SFA was performed to achieve a skeletal Class I pattern and correct the midline discrepancy. The 3D virtual surgical planning involved Le Fort I osteotomy for advancement and total impaction of the maxilla, as well as bilateral sagittal split ramus osteotomy for asymmetrical mandibular setback. Intermaxillary fixation was achieved using orthodontic miniscrews and 3D-printed wafers. At 6 weeks after surgery, stage 2 commenced with 30 clear aligners to align the teeth, coordinate the maxillary and mandibular arches, and improve occlusal interdigitation, facilitated by the regional acceleratory phenomenon. Stage 3 involved 12 additional clear aligners for occlusal detailing. A skeletal Class I pattern (SNA, 80.7°; SNB, 79.3°; ANB, 1.5°), normal overbite/overjet, and midline correction were achieved. The total treatment duration was 11 months. The treatment outcome was well maintained at the 6-month retention follow-up. Accurate prediction of postsurgical mandibular rotation and immediate transition to clear aligners appeared to shorten the treatment duration and facilitate continuity of orthodontic control.