Segmental maxillary osteotomy in cleft lip and palate patients: a stepwise planning in the orthodontic pre-surgical preparation with Invisalign.

Aim: To show the potential of Invisalign in multi-segmental Le Fort I preparation with the aid of an occlusogram-like method.

Methods: Nine patients treated with Invisalign before segmental osteotomy of the maxilla (study sample) were matched for diagnosis, surgical procedure, and complexity of orthodontic preparation with nine patients treated with fixed appliances (control sample). A superimposition technique was adapted to complement the Invisalign software to carry out an appropriate ClinCheck in segmental pre-surgical treatments. The correct pre-surgical positions of the maxillary teeth were guided with the use of virtual added curves that followed the lower arch. The number of impressions needed in both groups to reach adequate pre-surgical coordination of the segmented arches was compared.

Conclusion: With the aid of the proposed superimposition method, during the digital simulation of presurgical movements, clear aligner therapy appears to be an effective treatment even in patients with skeletal discrepancies and craniofacial anomalies involving the need for segmental Le Fort I osteotomies. More sophisticated software will certainly be implemented in the future.