Orthognathic surgery for the Invisalign patient

Orthognathic surgery has continued to evolve, with increasing utilization of digital imaging and software to facilitate both the pre-surgical orthodontics via Invisalign therapy, as well as virtual surgical planning (VSP). While offering the advantage of comprehensive and patient-specific analysis, these novel technologies have also inadvertently introduced challenges in execution of the surgical plan, causing select providers to question their utility in surgical cases. Through elimination of traditional orthodontic appliances, which have historically served to provide anchoring hardware for intraoperative splint stabilization, patients managed pre-surgically with Invisalign necessitate modification of the operative techniques. Here we provide an overview of several alternative methods to facilitate maxillomandibular repositioning and stabilization, including utilization of Erich arch bars, Ivy loops, intermaxillary fixation (IMF) screws and hybrid arch bar systems. Application of these techniques in orthognathic surgery, expanded and adapted from arena of maxillofacial trauma, allows optimization of scope of indications for the Invisalign system and may increase case acceptance for surgical patients seeking esthetic and minimally invasive orthodontic options.