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Surgical Orthodontics with Invisalign Treatment 1. 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 2. 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 3. 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 Jaw Surgery + G Invisalign Page 1 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 Jaw Surgery + G Invisalign Page 2 Why Orthognathic surgery with Invisalign (not braces) Our patients are demanding it Orthodontists have learned that what we refuse to master will e sought down the street by a competent competitor…or an incompetent one Orthodontists must be the experts in all orthodontic disciplines Play catch up if you have to Our OMS Colleagues Reluctance to participate Not much competition No necessity to adapt to our demands -Fear? Orthodontists will create the demand Those surgeons willing to become the experts in these techniques will gain the referrals Those surgeons who refuse will be left behind Barriers to Orthognathic Surgery with Invisalign Surgeon’s unfamiliarity with techniques Orthodontist’s unfamiliarity with same Orthodontist’s inability to demonstrate and assist their surgeon of the advantages of Invisalign surgical treatment Challenges for the Surgeon to Overcome Maxillomandibular fixation during surgery Stabilization of surgical arch segmentation during and after surgery “Landing” the occlusion after surgery Preventing surgical/dental relapse after surgery It is time for routine Invisalign surgery. I seek to co-treat the orthognathic surgery patient with my competent and confident OMS colleague who is completely comfortable with surgery without intermaxillary fixation, buttons on teeth or even a surgical stent postoperatively. Jaw Surgery + G Invisalign Page 3 Jaw Surgery + G Invisalign Page 4