Clear aligners versus fixed orthodontic appliances in surgery first orthognathic surgery

Abstract

espanolObjetivos: La cirugia ortognatica esta tradicionalmente ligada a la ortodoncia con brackets, siendo estos un complemento casi indispensable en la correccion quirurgica de las deformidades dentofaciales. En los ultimos anos las nuevas tecnologias han permitido desarrollar sistemas de ortodoncia mucho mas comodos y atractivos para los pacientes, pero estos avances no han sido trasladados aun al campo de la cirugia ortognatica de forma rutinaria. El objetivo de este estudio es determinar las ventajas de los alineadores transparentes en cirugia ortognatica, en pacientes tratados mediante un protocolo de cirugia primero o ?surgery first? (SF), en cuanto a salud periodontal y calidad de vida. Material y Metodos: Se diseno un estudio prospectivo en el que 28 pacientes candidatos a cirugia ortognatica SF fueron aleatoriamente asignados al grupo de alineadores transparentes (AT) (n=14) o al grupo de brackets (n=14). Se evaluo la salud periodontal y la calidad de vida en ambos grupos a lo largo del tratamiento. Resultados: Dieciseis mujeres y 12 varones fueron incluidos en el estudio. La edad media en el momento de la cirugia fue de 30,75 anos (rango 18-52). Se obtuvieron mejores valores de salud periodontal en el grupo AT para los tres parametros evaluados, Para los cuestionarios de calidad de vida se observo una diferencia significativa a favor de AT tanto para el OHIP-14 (p=0.014) como para el OQLQ-22 (p=0.011). La duracion total de tratamiento fue similar para ambos grupos (p=0.575). Conclusiones: En comparacion con el tratamiento tradicional de ortodoncia con brackets, los pacientes tratados con alineadores transparentes tras cirugia ortognatica (SF) han obtenido mejores resultados de calidad de vida y salud periodontal. EnglishPurpose: Orthognathic surgery is traditionally linked to orthodontics with brackets. These fixed appliances are almost always an essential complement for the surgical correction of dentofacial deformities, but they have many disadvantages and can be regarded as an inconvenience by patients. In the last years, new technologies have enabled the development of more appealing and convenient orthodontic devices, but they are still scarcely used in the orthognathic surgery field. The aim of this study was to determine the advantages of removable clear aligners in orthognathic surgery, in patients managed with a surgery-first approach, in terms of periodontal health and quality of life (QoL). Materials and Methods: A prospective study was designed. Twenty-eight patients undergoing surgery-first orthognathic surgery were randomly assigned to either the clear aligner group (n=14) or the fixed appliances group (n=14). Plaque index, probing depth and bleeding on probing were assessed as periodontal health indicators. Patients in both groups completed two questionnaires: the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral Health Impact Profile (OHIP-14). Pain intensity was measured with a numerical rating scale (1 to 10). All these data were analyzed at T0 (before surgery) and T2 (end of orthodontic treatment). An intermediate control was performed 1 month after surgery (T1) to the first 15 patients in order to check internal consistency of data. Total duration of treatment was also recorded. Results: Sixteen women and 12 men were enrolled. Mean age at the time of surgery was 30,75 years (range 18-52). Periodontal assessment showed better periodontal health results for the clear aligner group, reaching significance at T2 for the bleeding on probing (p=0.013), the plaque index (p=0.001) and the probing depth (p Conclusions: Compared to traditional orthodontics with fixed appliances, patients managed with clear aligners after orthognathic surgery (surgery-first approach) had better periodontal health and quality of life results