Clear Aligner Orthognathic Splints (CAOS) and Custom Maxillary Fixation Plates for Surgery-First or Surgery-Only Cases

The surgical management of dentoskeletal deformities is a core part of oral and maxillofacial surgery. Traditional orthognathic surgery relies on presurgical orthodontic set up (traditional orthodontics), planning, occlusal splint fabrication, and fixation with stock titanium plates. However, technological advances such as in-office cone-beam computed tomography (CBCT), 3D printing, and intraoral scanning have allowed for orthognathic virtual surgical planning (VSP), as well as the development of patient specific osteosynthesis implants. 1 Heufelder M Wilde F Pietzka S et al. Clinical accuracy of waferless maxillary positioning using custom surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery. J Craniofac Surg. 2017; 45: 1578-1585 Crossref Scopus (70) Google Scholar Just as advances in virtual surgical planning and custom fixation plates have facilitated the evolution of surgical therapies offered by oral and maxillofacial surgeons, surgery-first approaches and clear aligner technology are becoming popular therapies in the orthodontic armamentarium. All these technological advances have been successfully incorporated at our institution; modifications such as the use of clear aligner orthognathic splints (CAOS) 2 Caminiti M Lou T Clear aligner orthognathic splints. J Oral Maxillofac Surg. 2019; 77 (E1-e8): 1071 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar in combination with custom maxillary fixation plates have been applied for surgery-first and surgery-only patients. The aim of the following step-by-step discussion is to present our institution's workflow using this technical modification of the use of CAOS and custom maxillary fixation plates.