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Segmental Multiple-Jaw Surgery without Orthodontia: Clear Aligners Alone

Kankam, Hadyn K. N., B.A.; Gupta, Himank, D.M.D.; Sawh-Martinez, Rajendra, M.D., M.H.S.; Steinbacher, Derek M., M.D., D.M.D.

Plastic and Reconstructive Surgery: July 2018 - Volume 142 - Issue 1 - p 181–184
doi: 10.1097/PRS.0000000000004491
Pediatric/Craniofacial: Ideas and Innovations

Summary: Segmental Le Fort I osteotomy, a complex procedure with many mobile parts, has traditionally required presurgical orthodontics with conventional braces, composed of metal brackets, bands, and archwires. These appliances are not always accepted by patients, particularly older teenagers and professional adults who previously endured traditional orthodontia during adolescence, and now require retreatment because of jaw growth differences necessitating orthognathic surgery. Less obtrusive orthodontic therapies, involving clear aligners (e.g., Invisalign), are becoming increasingly popular, as they are less noticeable and less aesthetically objectionable. They are typically indicated for milder occlusal discrepancies, such as crowding and minor rotations, without significant vertical or transverse problems. Clear aligners in conjunction with orthognathic surgery for severe dentofacial problems are progressive and not widely used. Moreover, the most complicated of orthognathic sequences, segmental double-jaw surgery, has never before been described to be performed using Invisalign. Several potential challenges exist when performing segmental double-jaw surgery with Invisalign (i.e., no bonded or banded appliances, and no archwire). The purpose of this article is to review the feasibility of segmental double-jaw surgery without orthodontia (Invisalign only), report a series of cases, and review the technical steps involved.

New Haven, Conn.

From the Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine.

Received for publication August 10, 2017; accepted January 5, 2018.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. No funding was received for this article.

Derek M. Steinbacher, M.D., D.M.D., 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, Conn. 06520,

©2018American Society of Plastic Surgeons