A 20-year-old patient with Angle Class III malocclusion, anterior open bite, mandibular asymmetry and maxillary transverse deficiency (Fig. 1) underwent bimaxillary orthognathic surgery with three-piece maxillary segmentation after presurgical CAT, maxilla ostheosynthesis was achieved with four plates and screws. Six intermaxillary fixation (IMF) screws were placed at the beginning of the surgery.

Fig. 1The alternative text for this image may have been generated using AI.

Preoperative intraoral scan used for 3D planning of orthognathic surgery. Note the anterior open bite, transverse deficiency, uneven maxillary occlusal plane and Angle’s Class III malocclusion

After confirmation of final occlusion and prior to extubation, the conventional surgical splint was temporarily removed.

Maxillary and mandibular full-arch scans, including occlusal contacts, were obtained intraoperatively by the treating orthodontist using a portable intraoral scanner (iTero® Flex, Align Technology, San Jose, USA) following the sequence: maxillary arch, mandibular arch, bite registration. Scanning time was ~ 4 min (Fig. 2). A Molt mouth gag, a Wieder tongue retractor and continuous suction, were used to facilitate oral access during scanning.

Fig. 2The alternative text for this image may have been generated using AI.

Intraoral scan obtained intraoperatively. Note the IMF screws, placed to keep the occlusion during surgery and to support the final splint until clear aligners were available

The splint was repositioned and secured to the IMF screws with stainless-steel wire to preserve transverse stability. Scan files (STL/PLY) were uploaded on the same day (Fig. 3). Aligners arrived 14 days later. The splint was removed and postoperative CAT began. At 6 months, Class I occlusion, stable overjet and overbite, and maintained transverse dimension (intermolar palatine mesial molar cusp distance 39.2 mm, compared with the planned distance of 40.4 mm).

Informed consent for intraoperative scanning and use of clinical images was obtained preoperatively.

Fig. 3The alternative text for this image may have been generated using AI.

Sequency of the workflow described: preoperatively, the day of the surgery and the day of the postoperative CAT arrival

This report demonstrates that intraoperative full-arch scanning is feasible and can expedite the postoperative aligner manufacture (Fig. 4). Although workflows linking aligners and orthognathic surgery have been described [3], intraoperative scanning to eliminate the postoperative scanning delay has not been reported. This may allow earlier orthodontic activation during the Regional Acceleratory Phenomenon (RAP) phase.

Fig. 4The alternative text for this image may have been generated using AI.

Schematic comparison of conventional and intraoperative intraoral scanning workflows. In the conventional approach, intraoral scanning is delayed for 2–4 weeks due to limited mouth opening, postponing aligner fabrication and orthodontic reactivation. The intraoperative approach acquires digital records at the time of surgery, eliminating this initial delay and enabling earlier initiation of postoperative clear-aligner therapy

Presurgically manufactured passive aligners are suitable after non-segmented procedures. However, intraoperative changes in arch form in segmented cases can impair fit and require advanced aligner planning [4]. Consequently, prolonged use of the final occlusal splint to preserve transverse dimension is still common. Earlier availability of postoperative aligners may allow earlier splint removal, provide transverse stabilization and dental retention while improving patient comfort [5].

Limitations include its single-case design, scanning before full postoperative skeletal stability; the need for a scanner and trained personnel in theatre, modest additional operative time, only 6 months of follow-up, and a residual interval without active treatment remains while aligners are fabricated.

Main intraoperative challenges were limited access and contamination of the optical field by blood and saliva, managed with a Molt mouth gag, Wieder tongue retractor, and continuous suction and irrigation.

Intraoperative intraoral scanning is a feasible adjunct to orthognathic surgery in CAT-treated-patients, particularly in segmented maxillary procedures, and may improve early orthodontic control, reduce reliance on occlusal splints and enhance patient comfort. This workflow may be particularly useful in segmented Le Fort I procedures where transverse stability must be preserved until early orthodontic control is achieved. Prospective series and comparative studies are required to confirm objective benefits and long-term stability.