Karen Eich Hammer

Continuous advancements in technology have made it possible to integrate clear aligner therapy (CAT) with orthognathic surgery. This case report presents a novel, individually-planned workflow, combining CAT with a surgery-first orthognathic approach (SFOA) in collaborating with engineers for an in-house production of surgical guides and customized titanium plates. The patient was evaluated subjectively, using the Oral Health-Related Quality of Life-14 (OHIP-14) questionnaire and Orthognathic Quality of Life questionnaire (OQLQ), and objectively with the Peer Assessment Rating (PAR) index. The patient displayed the planned occlusal relationship with no report of discomfort in the temporomandibular joint (TMJ) or post-surgical complications. The surgical and occlusal outcomes have remained consistent and stable after debonding. A decreased score was reported in both questionnaires and the PAR after treatment, thereby indicating improvements in both subjective and objective evaluations. This case report demonstrates that with proper individual planning, satisfactory subjective and objective outcomes can be achieved when combining SFOA with CAT.

Aim of the study: This article introduces an in-house workflow implementing patient-specific surgical cutting guides and spacers combined with pre-adapted osteosynthesis in two Surgery First Orthognathic Approach (SFOA) scenarios. Background: The integration of three-dimensional virtual surgical planning (VSP) in combination with computer aided design and computer aided manufacturing (CAD/CAM) has advanced the field of orthognathic surgery. With the use of surgical guides and patient specific implants (PSI) the accuracy of the surgical outcome could potentially increase. While PSI approaches offer advantages, commercial PSIs are characterized by a prolonged turnaround time and high costs.These drawbacks linked with commercial PSIs might restrict their utilization and acceptance. Technical note: The VSP was completed in Dolphin Imaging software. 3-Matic software was used to design the cutting guides and spacers. The anterior spacers where specifically designed to utilize the wedge-technique during positioning of the anterior segment in segmented Le Fort I osteotomy. The surgical guides and spacers were manufactured in Form 3B 3D printer with BioMed Clear V1 Resin with 0.100 mm layer thickness. Titanium plates 2.0 from Biomet were customized based on a 3D-model of the planned postsurgical outcome based on the VSP. Conclusion: The in-house methodology for developing and employing personalized surgical guides, spacers and pre-adapted titanium plates offers a viable workflow for SFOA, with the potential to enhance the reliability and precision of maxillary repositioning.