Clear aligner therapy combined with orthognathic surgery: A scoping review

It is uncertain whether using perioperative clear aligner therapy (CAT) for orthognathic surgery (OGS) is a suitable alternative to conventional fixed appliances, which has traditionally been the mainstay of orthodontic preparation and refinement. This scoping review assesses the nature of current evidence regarding the use of CAT with OGS.

The review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Two reviewers conducted a systematic search and independent screening process across 5 electronic databases until April 2024. Types of included studies were all peer-reviewed journal papers reported in English, excluding literature reviews, animal studies, and congenital syndromes. Risk of bias was conducted using the Risk Of Bias In Nonrandomized Studies of Interventions tool and the Cochrane risk-of-bias tool.

A total of 31 studies comprising 298 participants were included. A heterogeneous array of orthodontic-first and surgery-first protocols were reported. Patients frequently had Class III malocclusions with minimal crowding, used Invisalign aligners, and underwent virtually planned bimaxillary surgery. The main outcomes measured included quality of posttreatment finishing, treatment duration, accuracy of virtual planning, postoperative swelling, stability, periodontal health, and quality of life.

Existing evidence on CAT in OGS reported satisfactory outcomes. However, the available evidence should be cautiously interpreted on account of retrospective study designs, unclear patient selection, and underuse of objective measures. Prospective studies with fixed appliance control groups are indicated before CAT is routinely used with OGS for complex dentofacial deformity.