Complex triple-jaw orthognathic surgery: A comparison between clear-aligner therapy and conventional braces.
Haydn Kankam, BA, MB, BCHIR, Sarika Madari, Rajendra Sawh-Martinez, MD, MHS, Karl Bruckman, MD, DDS, Derek Steinbacher, MD, DMD.
Yale University, New Haven, CT, USA.
Background: Effective orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic therapy with stainless steel brackets and wires is performed presurgically in an effort to decompensate, level, and align the dentition, as well as position the teeth within basal bone. Clear-aligner therapy (e.g. Invisalign®) provides an aesthetic alternative to bonded brackets and wires, and consists of a series of transparent trays. However, in comparison to traditional orthodontia, its outcomes with use in complex triple-jaw orthognathic surgery have not been published. This study evaluates the perioperative outcomes and three-dimensionally quantifies postoperative edema in Invisalign® patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional braces. Methods: We conducted a retrospective chart review and three-dimensional morphometric study of Invisalign® patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy (BSSO) and genioplasty). An identical assessment of demographically-matched patients treated with conventional braces was performed and compared to the Invisalign® group. Three-dimensional photographs were captured with the Vector 3D imaging system and volumetric analysis was undertaken with Mirror medical imaging software. Statistical tests performed include χ2 and Student's t-tests. Results: Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign® and 20 with conventional braces. No significant difference was observed in any of the measured perioperative factors, including operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement and use of narcotic analgesics between the two groups. Nine patients had sufficient 3D images for volumetric analysis (4 with Invisalign® and 5 with conventional braces). Postoperative edema was greater with conventional braces (44.29 ± 23.16 cm3) compared to Invisalign® (37.36 ± 31.19 cm3), however, this was not significant (p=0.712).Conclusions: The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign® patients. Perioperative and short-term clinical outcomes are not compromised. Given the reported advantages of clear-aligner therapy, use of the technique described herein is likely to become more popular.
Back to 2018 Abstracts