Download Surgical Orthodontics with Invisalign Treatment

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:
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Maxillomandibular fixation during surgery
Arch Bars
Eyelet wires – Caplan stems/hooks
Direct bonded arch bars or archwires
TADs
Hybrid arch bars
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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
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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
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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
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Why Orthognathic surgery with Invisalign (not braces)
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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
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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
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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
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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
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Jaw Surgery + G Invisalign
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