# Digital planning of orthognathic surgery with aligners: ortho-facial-driven, a viable protocol for surgery-first treatment

## TL;DR

This paper introduces a new digital protocol for orthognathic surgery using aligners that reduces treatment time while maintaining safety and effectiveness.

## Contribution

A novel digital planning protocol for early benefit orthognathic surgery using aligners is presented and validated.

## Key findings

- Most planned cephalometric measurements matched postoperative results across x, y, and z axes.
- The protocol showed good clinical predictability and safety in treating dentofacial deformities.
- Only minor statistically significant differences were found in specific anatomical points.

## Abstract

Traditionally, orthodontic-surgical treatment is performed in three stages: presurgical orthodontics, orthognathic surgery and post-surgical orthodontics. Though predictable and stable, this protocol requires a long treatment time and can temporarily compromise the patient’s aesthetics. Early benefit surgery eliminates or reduces the initial stage of orthodontic treatment, providing more immediate aesthetic and functional improvement.

To present a virtual diagnosis and planning protocol, combining cone beam computed tomography (CBCT) and digital models applied to early benefit surgeries using orthodontic aligners.

Ten patients with dentofacial deformities underwent the proposed protocol. The accuracy of virtual planning was assessed by comparing 30 planned cephalometric measurements with those achieved postoperatively, on the “x” (transverse), “y” (anteroposterior) and “z” (vertical) axes, using anatomical reference points.

Most measurements did not present statistically significant differences between planning and the surgical outcome. The exceptions were the incisive foramen on the z axis (mean difference = -1.79, P=0.045) and the left gonion on the x axis (mean difference = -1.52, P=0.029).

The proposed early benefit surgery protocol with aligners proved to be a viable, safe and effective approach to conventional orthodontic-surgical treatment, with good clinical predictability rates.