Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances.

2000 by Boyd, Vlaskalic, and Miller.1 Since then, a number of case reports1-19 and two clinical trials20-22 have demonstrated the applications of this system in many different types of orthodontic treatment. To date, more than 250,000 patients around the world have had Invisalign treatment23—a remarkably high number considering the appliance has been available to clinicians for less than five years. One of the longitudinal clinical trials found that Invisalign had limitations in terms of tooth movement, with tipping movements being the most predictable.20,21 The appliances in this study, however, were made of materials that are no longer used, and they were changed at two different time intervals (one or two weeks), before the current protocol of two weeks for each aligner was established. Another longitudinal study has been reported only as an abstract.22 One of the primary advantages found in both studies was a statistically significant reduction in plaque and gingivitis.21,22 With fixed appliances, patients typically show an increase in plaque and gingivitis throughout orthodontic treatment; in fact, some patients experience irreversible bone loss,24,25 especially on banded molars,26 as well as decalcification.25,27-29 The present article demonstrates the use of Invisalign appliances in two of the most difficult types of orthodontic patients—skeletal Class III cases requiring singleor two-jaw multiple-segment orthognathic surgery.