Surgery First Bimaxillary Osteotomy for Marked Facial Asymmetry Developed After Aligner Treatment.

A 28-year-old woman with facial asymmetry after aligner treatment visited our hospital. She complained of an asymmetric gummy smile and a deviated mental area developed after clear aligner treatment. On CT examination, occlusal cant was found, leading to facial asymmetry. We made a clinical diagnosis of jaw deformity with an asymmetric face, and recommended her orthognathic surgery using wire orthodontics. She accepted jaw surgery; however, she refused wire orthodontic treatment. Therefore, we selected bimaxillary osteotomy with a surgical-first approach using her clear aligner to correct the inclined occlusal plane and improve the deviated jaw. The functional occlusion could be established, and improvement of facial form could be gained with a proper occlusal plane. This case report is a rare case, in which retreatment of the surgical approach for bimaxillary osteotomy for marked facial asymmetry developed after aligner treatment. We must be aware of the necessity of thorough and careful examination to avoid misdiagnosis.