Severe Skeletal Class III Correction with Invisalign and Two-Jaw Surgery

For this patient’s severe skeletal Class III bite, I chose Invisalign combined with two-jaw surgery to address both tooth alignment and the underlying jaw discrepancy. My goal was to achieve a well-balanced, functional bite while giving the patient an alternative to wearing braces throughout treatment. To make this approach possible, I developed the "Bella Smile surgical appliance" in collaboration with Felice O'Ryan. The idea grew out of our work with Kaiser’s surgical team, which required bands on the teeth for surgery. We needed a way to provide the tooth-supported attachments the surgeons required while allowing our patients to complete most of their orthodontic treatment with Invisalign. The appliance is secured to the teeth with bands and provides attachments for surgical stabilization and elastics. We typically cement it one to two weeks before surgery, coordinated with the surgical team’s planning and splint fabrication. It stays in place during early healing and is generally removed around six weeks afterward, once the patient can open comfortably and the surgeon approves. One of the reasons I value this design is that it allows us to work on the bite during recovery. When cleared by the surgeon, patients can wear vertical elastics to help the upper and lower teeth settle together, without aligner plastic covering the biting surfaces. This lets us support healing and refine the fit of the teeth during the same phase of treatment. For suitable patients, the appliance also offers an alternative to placing temporary anchorage devices, or TADs, solely for surgical support. In my previous cases, these added expense, and I occasionally encountered gum recession around their placement sites. I wanted another option that used the teeth for support and allowed elastics to help settle the bite. Patients have often told me that the appliance and elastics feel reassuring, almost like a “lovey”, because their bite feels supported during recovery. By the time we remove it, the teeth may already fit together closely, and we can scan for Invisalign refinements to complete the remaining details. We individualize interim aligner or retainer use to the postoperative tooth positions; a three-piece upper-jaw procedure may require a newly made retainer immediately afterward. Developing this appliance reflects my philosophy: give patients more options without compromising the treatment their bite requires.** For someone who needs jaw surgery but is reluctant to wear braces, this approach can make a comprehensive treatment plan feel more achievable.