Dr. Kenneth Lew

Appointed as Invisalign USA Keynote Speaker in Asia. Started National University of Singapore Postgraduate Orthodontic Masters Program. Provider of Orthodontic and Invisalign Courses for Asian Dentists. Invisalign Specialist Orthodontist with cases featured in Invisalign international scientific kit. Author of multiple articles in international high impact dental journals. Original dental research on soft tissue cephalometric facial points and TMJ research

Orthodontic treatment as part of orthognathic surgery (OGS) is frequently required to obtain effective dentofacial aesthetics for patients suffering from severe skeletal malocclusions.

Traditionally, brackets and wires are utilized for patients seeking orthognathic correction of malocclusion. Over the last 20 years clear aligners (CA) have been introduced to the orthodontic community as an alternative means to correct malocclusions. Initially these CA could only treat simple Class I malocclusions non extraction. However, in recent years with the advent of digital dentistry and CA technology, CA have been used to treat extraction cases and OGS cases, as the interest in CA spikes.

The demographics of OGS patients are usually adults from 20-40 years seem to favour CA treatment as CA provide aesthetic benefits, deceased discomfort to patients, reduced doctor visits and chairside time. CA ability to straighten teeth and digitally prepare case for arch co-ordination following OGS within a stipulated time has been one of the primary advantages of CA.

Several issues have arisen with the use of CA as opposed to fixed braces. Adequate Intermaxillary fixation (IMF) is a crucial factor following OGS. Braces, associated surgical hooks, continuous ligature ties and 19X25ss arch wires are the traditional and most common method of applying IMF. With the lack of Brackets and wires, CA treatment of OGS cases would require another method of ensuring intermaxillary fixation (IMF). As such, the quest for a more viable and cost-effective method has been explored using Erich Arch Bars or IMF Screws.

Another challenge is the timing of post-surgical aligner treatment. In the initial weeks following OGS, mouth opening is extremely limited, making placement of aligners or Intraoral scan for a refinement aligner order difficult.

This presentation will address some of the above issues as well as showing cases illustrating our treatment approach.