Features of Aligners and Artificial Intelligence in Surgical-Orthodontic Protocol: A Narrative Communication

Background and Objectives: Dentofacial deformities require a multidisciplinary surgical-orthodontic protocol (SOP) in which orthodontic preparation, orthognathic surgery, postoperative finishing, and retention are closely coordinated to achieve stable functional and aesthetic outcomes. The increasing adoption of clear aligners, digital workflows, and artificial intelligence (AI) has profoundly modified this therapeutic pathway. This communication examines the role of clear-aligner therapy and AI throughout the contemporary surgical-orthodontic protocol, with particular emphasis on their integration into clinical practice. Discussion: From the surgical perspective, clear aligners provide treatment outcomes comparable to those achieved with conventional fixed appliances while offering greater predictability of treatment duration through digital treatment planning. However, their use requires careful management of specific clinical aspects, including surgical timing, intraoperative anchorage, postoperative dentoalveolar stabilisation, transverse dimension management, and retention, all of which demand close collaboration between the orthodontist and the maxillofacial surgeon. The communication also summarises current AI applications in orthodontics and orthognathic surgery, including automated cephalometric analysis, image segmentation, treatment-decision support, virtual patient construction, clear-aligner setup, soft-tissue prediction, refinement-risk assessment, and remote monitoring. Although AI has significantly improved the efficiency, reproducibility, and standardisation of diagnosis and treatment planning, current evidence supports its use as a clinician-supervised decision-support technology rather than as an autonomous system capable of managing the entire orthodontic-surgical pathway. Conclusions: The integration of clear aligners, digital planning, and AI represents an important step toward a more personalised and efficient workflow, while continued clinical validation and multidisciplinary expertise remain essential for achieving predictable long-term outcomes.