Simplifying intermaxillary fixation in orthognathic surgery using customized surgical archwire with clear aligners: a technical note and exemplifying case.

BACKGROUND

Clear aligners are increasingly integrated into orthognathic surgery workflows. However, the lack of rigid intraoperative anchorage limits their use to mild or moderate cases, as aligners alone cannot ensure stable intermaxillary fixation.

OBJECTIVE

To describe a simplified, reproducible, and cost-effective technique using a customized cobalt-chromium surgical archwire that enables stable intermaxillary fixation in patients treated with clear aligners.

TECHNICAL NOTE: A 47-year-old woman with skeletal Class III malocclusion underwent bimaxillary orthognathic surgery under aligner treatment. A CAD-designed cobalt-chromium archwire with interdental posts was bonded using a conventional three-step adhesive protocol. The procedure required approximately 25 min and allowed precise intraoperative traction without detachment or deformation. The optional use of a silicone positioning key improved bonding accuracy and reproducibility.

CONCLUSION

This technique provides rigid and evenly distributed anchorage without removing aligner attachments or adding brackets or screws. By enabling stable intra- and postoperative fixation, it removes a key limitation of aligner-based surgical planning. This expands the applicability of clear aligners to more complex orthognathic cases, such as segmental osteotomies or asymmetrical corrections, and improves the integration of aligners into modern surgical workflows.