## 4 Discussion
Even though the clear aligner was developed in 1999, it has evolved considerably, and many patients are receiving orthodontic treatment using the clear aligner approach [3, 12]. A systematic review on orthodontic treatment using clear aligners found no significant difference in stability and occlusal characteristics compared to conventional orthodontic appliances [13]. Orthodontic treatment with clear aligners has the following advantages, including aesthetics, patient convenience, reduction in the number of visits to the dental clinic, decreased chair time, removable device, convenience in oral hygiene management, saving time required for wire replacement or bracket installation, and ease of taking impressions [2, 14]. In addition, the patient is well accustomed to maintaining the device after surgery because they have experience with the device. In addition, there is no interference from braces during surgery (Figure 10), so there is no hindrance during surgery, and there is no risk of the bracket falling off during surgery. Another advantage of orthodontic treatment using clear aligners is that the brackets physically interfere with tooth brushing, making oral hygiene management difficult, but clear aligners do not. These removable clear aligners can also reduce the incidence of white spot lesions on teeth [15]. In a similar vein, according to [PERSON] et al., there was no significant difference in periodontal and \begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline \multirow{2}{*}{**Sex**} & \multirow{2}{*}{**Age**} & \multicolumn{2}{c}{**Preoperative Orthodontic**} & \multirow{2}{*}{\begin{tabular}{c} **Extracted** \\ **Treatment Period** \\ **(Months)** \\ \end{tabular} } & \multirow{2}{*}{\
\begin{tabular}{c} **Impacted** \\ **Teeth (ea.)** \\ \end{tabular} } & \multirow{2}{*}{
\begin{tabular}{c} **Amount of Surgical** \\ **Movement** \\ \end{tabular} } & \multirow{2}{*}{**Plate Removal**} \\  & & & & & & Vertical reduction & \\  & & & & & (3.5 mm) & Was performed \\
1 & Male & 24 & 8 & 0 & 0 & Le Fort I osteotomy, & 23 months \\  & & & & & Mn. setback BSSO & after surgery. \\  & & & & & (Rt.: 10 mm, Lt.: 9 mm) & \\ \hline
2 & Male & 20 & 11 & 0 & 0 & Mn. setback BSSO & Was performed \\  & & & & (Rt.: 12 mm, Lt.: 5 mm) & 5 months \\  & & & & & after surgery. \\ \hline
3 & Male & 23 & 12 & 2 & 0 & Mn. setback BSSO & 11 months \\  & & & & & (Rt.: 6 mm, Lt.: 1 mm) & after surgery. \\ \hline
4 & Male & 22 & 10 & 0 & 0 & Mn. setback BSSO & Was performed \\  & & & & & (Rt.: 9 mm, Lt.: 11 mm) & 4 months \\  & & & & & & after surgery. \\ \hline
5 & Male & 22 & 17 & 0 & 0 & Mn. setback BSSO & Was performed \\  & & & & & (Rt.: 9 mm, Lt.: 7 mm) & 8 months \\  & & & & & after surgery. \\ \hline \hline \end{tabular} (Mn.: mandible, BSSO: bilateral sagittal split osteotomy, Rt.: right, Lt.: left).  
\end{table} 
Table 4: Information on five patients with clear aligners. microbiological parameters in patients undergoing correction with a clear aligner for two months compared with patients who did not receive orthodontic treatment [16]. According to [PERSON] et al., there was no significant difference in postoperative edema in orthodontic patients treated with clear aligners [17]. On the other hand, disadvantages include the need to install a screw to anchor the elastics during surgery [18], and the patient's cooperation during orthodontic treatment is important. According to a large cohort of clear aligner therapy patients, 45.5% of patients wore the aligner for 22 h or more a day, while 25.7% wore it for less than 11 h [19]. Since orthodontic treatment is required after surgery [20], the dentist and the patient must communicate in order to cooperate with the patient, and sometimes the doctor must induce the patient to show better compliance [21]. It must be replaced with the next device according to the requirements, and there is a risk of losing the orthodontic device. Furthermore, braces may be attached during the postoperative orthodontic period.