Invisalign and surgery

[Lala082008]

Does anyone have experience with having Invisalign and getting jaw surgery? My orthodontist said he does this but it isn't that common. I'm still trying to get an appointment with the orthognathic surgeon who works with my Ortho in these Invisalign cases. I have an overbite so I'm thinking I would need a BSSO.

I'd love to hear any advice about people who have experience with this type of thing. Thanks!

[snapdresser]

Woah, I'd be interested to hear about this too. I wonder what he does for post-op elastics. I didn't need braces so they put archbars on so the elastics have something to hook on to. I guess you'd do the same, with maybe a regimen of Invisalign before and after the archbars?

[sirwired]

Off-hand, I don't see any absolute bar to using Invisilign (if otherwise appropriate for the case), but I have the impression the surgeon would probably prefer brackets. The hooks on the brackets, and "surgical hooks" attached to the archwire, are used to wire your jaw shut during surgery, and for elastics afterwards. It's certainly possible to fit a temporary appliance just before/during surgery (after all, people who have surgery due to trauma need something) but the ordinary approach is for the patient to just use conventional braces.

[Lala082008]

Thanks for the responses. My orthodontist mentioned that some oral surgeons require you to get braces right before the surgery, but the one I'll be meeting with doesn't do that. So I guess there must be some way to attach the hooks directly to your teeth or something. Are these hooks used to band your mouth shut after surgery? Or does the surgeon use them during the surgery? I'm still trying to figure out how all of this works.

[snapdresser]

My understanding is that archbars are typically what's used for trauma patients. There was a gunshot victim on here a month or two ago talking about his archbars. They're applied during the surgery and I think surgeons consider them a "temporary appliance" tho I had mine on for 8 weeks. Still, it's much better than braces. If it was possible to do the surgery with just some sort of hook attached directly to just a couple of my teeth that can be removed immediately post-op, I think my surgeon would have used that instead. If there's another way, avoiding archbars and braces altogether, I'd certainly be interested in hearing about it!

I believe sirwired is correct, the hooks are used during the surgery to match up the top and bottom jaws and make sure the bite fits perfectly when they're deciding where exactly to place the plates and screws. After they break your lower jaw (your upper jaw having already been completed at this point), they'll place a little piece of custom-made plastic called a surgical splint between your upper and lower teeth. Your teeth fit into little grooves that were made special for you and reflect a perfect bite. Your jaws will then be stuck together (either with wires between the hooks on the top and bottom, or elastics between the hooks, I'm not really positive which), kind of sandwiching the splint in there between your teeth. Then they'll place the plates and screws in your mandible. Because your teeth were matched up perfectly in the splint, your lower jaw should now be fixed in a position that will give you a perfect bite. If you didn't have hooks, they'd have to manually hold your jaws in the surgical splint. That seems somewhat unlikely to me, but I suppose it's possible. Or maybe there's some other way to hold the jaws in position, but like I said, if something like that existed, I think they would have opted to use that on me.

The hooks are certainly used to band your mouth shut after surgery tho. I think almost all of us used elastics to some degree after surgery, whether they were applied to hooks on braces or archbars. You have to remember that this surgery moves the bones. The attached muscles have to stretch into their new positions. The elastics help keep your bite in the correct position so that you develop new muscle memory for your new bite. If you didn't have archbars or braces, I'm not sure what your surgeon's approach would be for this. They could ignore the muscle memory issue and just hope your bite comes together fine afterwards, I suppose.

So it seems likely to me that you'll at least need archbars, but keep us posted!

[sirwired]

Thanks for the responses. My orthodontist mentioned that some oral surgeons require you to get braces right before the surgery, but the one I'll be meeting with doesn't do that. So I guess there must be some way to attach the hooks directly to your teeth or something. Are these hooks used to band your mouth shut after surgery? Or does the surgeon use them during the surgery? I'm still trying to figure out how all of this works.

The process usually goes like this: Your otrtho does "pre-surgical ortho" which puts your teeth into the approximate positions they'll need to be in AFTER surgery (this is why pre-surgical ortho often makes for an awkward bite.) The surgeon will then perform "model surgery". (It's exactly what it sounds like; the surgeon mounts your final models in a special "articulator" which simulates jaw movement, cuts them up, shifts them around, and then notes what movements he/she had to make (taking note of things like midlines, and fabricates a splint, if applicable.)

Once the bones have been cut, your teeth will naturally shift into the bite your ortho has prepared into your permanent "natural" bite (with the help of the splint, if applicable). To put your jaws as pair in the correct spot, a "reference pin" is actually lightly screwed into the spot between your eyebrows, and a straight bar extends down to your jaw; this helps the surgeon keep things where they are supposed to be. (This apparatus comes out before you wake up; your only evidence of it a small scab between your eyebrows.)

The hooks (either on braces or a temporary appliance) are used to wire your arches shut after the bones have been cut. While they are wired in place, the surgeon then attaches plates and screws to your bones to "fix" them in place. (In the US, the plates usually stay in permanently, in Europe they are usually removed several months later...)

Usually before you wake up the wires are removed, and rubber bands are attached. For upper-only, the bands are usually pretty light (for me, they were the lightest bands I ever had) because a wired-in splint does most of the work. For patients having the lower done, the bands are usually quite heavy (far heavier than bands you would ever get from an ortho office.)

A VERY few patients must remain wired after surgery.

I without braces you will keep the "arch bar" until the heavy bands/splint are no longer needed; usually 6-ish weeks. (If you had regular braces, it's at this time that the surgical hooks would be removed.) It might be a little longer on Invisilign because I imagine new aligners will have to be made after surgery to finish things up.

[Lala082008]

I FINALLY met with my oral surgeon and he did recommend a BSSO and genioplasty. He said that the best outcome would be if I had braces for the surgery. I suggested that I might get Invisalign now but have braces put on before the surgery and he agreed that that would be possible. It sounds like without the braces the only option is for the jaw to be wired shut (with wires that wrap around the teeth). He showed me a model of what the wires looked liked, and it seemed pretty awful, so I definitely think braces w/ bands for a short time will be better.