Digitally planned surgery-first orthognathic treatment combined with clear aligner therapy: a clinical case series

The purpose of this case series is to describe the clinical application and outcomes of a digitally planned surgery-first orthognathic protocol integrated with clear aligner therapy for the comprehensive management of dentofacial deformities. Three patients with dentofacial deformities were treated using a digitally planned surgery-first approach without presurgical orthodontic decompensation. Virtual surgical planning was performed to coordinate skeletal movements and establish the intended postoperative occlusion. Clear aligner therapy was used as the primary orthodontic modality and integrated with the surgical plan from the outset. Postoperatively, aligners guided comprehensive tooth movement and occlusal coordination. The digitally planned surgery-first protocol resulted in consistent improvement in facial balance, skeletal relationships, and occlusal function across all cases. Clear aligner therapy enabled comprehensive orthodontic tooth movement, achieving coordinated arch relationships, correction of transverse discrepancies and occlusal cant when present, and establishment of functional overjet and overbite. Treatment objectives defined during digital planning were achieved in all patients, who completed therapy with high satisfaction with overall short treatment durations. Digitally planned surgery-first orthognathic treatment combined with clear aligners represents an efficient and predictable interdisciplinary workflow that enables predictable skeletal correction, efficient treatment progression, and stable occlusal outcomes when appropriate case selection and interdisciplinary coordination are ensured.