Clear Aligners and Patient-Specific Plates in Orthognathic Surgery for a Periodontally Compromised Patient

Orthognathic surgery in patients with severe dental and periodontal compromise represents a significant clinical challenge, particularly in the presence of a history of prolonged compensatory orthodontics and suboptimal initial diagnosis. This report presents the case of a patient with a class III dentofacial deformity, 3-dimensional maxillary deficiency, mandibular prognathism, multiple tooth loss, and advanced periodontal disease. Management included periodontal therapy, initial dental rehabilitation, and the use of clear aligners as an orthodontic alternative, given the limited potential for conventional decompensation. An early orthognathic surgery approach was selected after a short aligner phase, with the aim of correcting the skeletal discrepancy and facilitating subsequent dental movements. The surgical procedure was performed using fully customized osteosynthesis systems in the maxilla, mandible, and chin, along with specific surgical guides, allowing precise execution without the need for intermediate or final splints. Surgery was completed without complications, and postoperative evaluation demonstrated skeletal stability and absence of dental or periodontal deterioration. This case demonstrates that the combination of aligners and patient-specific plates represents an effective and predictable strategy for the management of complex dentofacial deformities, particularly in scenarios with biological limitations, optimizing functional outcomes and reducing risks associated with prolonged conventional treatments.