Contemporary management of an orthodontic-orthognathic patient with limited time availability in an orthodontic office setting: Case report.

Introduction: This case report describes the treatment of a 21-year-old man who presented in an orthodontic office for treatment but lived in a city 100 miles away and wanted the orthognathic surgery in another state in America. The patient presented with an anterior open bite and skeletal Class III relationship. Methods: The treatment plan included: (1) effective and careful communication of the treatment plan with the patient, orthodontist and oral and maxillofacial surgeon; (2) pre-surgical alignment and levelling of the teeth in both arches with Invisalign; (3) a long-distance communication between the orthodontist and the surgeon for surgical plan with virtual surgical planning (VSP Orthognathics; 3D Systems, www.3Dsystem.com) online; (4) maxillary advancement (LeFort I osteotomy) with mandibular set-back (bilateral sagittal split osteotomy); (5) postsurgical correction of the malocclusion with clear brackets and aligners; and (6) retention and final small tooth movement adjustments with aligners/clear retainers. Results: The anterior open bite was treated, crowding was eliminated in the upper and lower anterior segment, correction of skeletal and dental Class III malocclusion was obtained, mandibular plane angle was reduced and facial profile improved. Conclusions: The results suggest that aesthetic and functional results can be achieved with long-distance communication of two specialties and with the combined use of clear aligners and clear fixed appliances.