What is orthognathic surgery?

For some people, especially those with severe overbites or underbites, orthodontics alone cannot adequately achieve the esthetic or functional desires of the patient. This is because the relative positions of the jaws are such that the teeth cannot be moved within the jaws to the degree necessary to produce the desired result. For these individuals, a combination of braces and jaw surgery is necessary. This surgery to reposition the jaws is called orthognathic surgery.

What is surgical orthodontics?

Just as orthodontics repositions teeth, surgical orthodontics moves teeth to prepare individuals for orthognathic surgery. Orthognathic surgery corrects jaw irregularities to improve the patient’s ability to chew, speak, and breathe and for improved facial appearances. In the vast majority of cases, if the surgery is performed first, the teeth will not fit well at the time of surgery, making the stability and predictability of the final result less than desirable. The overall goal of orthodontics prior to surgery is to make the teeth fit better at the time of surgery so the surgeon can do a better job. Moving the jaws also moves the teeth, so braces are always performed in conjunction with jaw correction. This helps make sure teeth are in their proper positions during and after surgery.

Who needs surgical orthodontics?

Your orthodontist will consider surgical orthodontic treatment for non-growing adult patients with improper bites and those with facial esthetic concerns. Depending on the type of problem, surgery can be done after most growth is completed, but frequently must be postponed until all growth is completed. Jaw growth is usually completed by age 17 for girls and 20 for boys. The pre-surgical tooth movements can begin up to one to two years prior to these ages.

How does it work?

During your orthodontic treatment, which usually lasts 12–24 months, you wear braces and will visit your orthodontist for scheduled adjustments to your braces. As your teeth move with the braces, you may think that your bite is getting worse rather than better. However, when your jaws are placed into proper alignment during orthognathic surgery, the teeth will then fit into their proper positions.

Surgery is performed in the hospital by an oral and maxillofacial surgeon and can take several hours, depending on the amount and type of surgery needed. In lower jaw surgery, the jawbone behind the teeth is separated and the tooth-bearing portion is moved forward or backward, as needed. In upper jaw surgery, the jaw can be repositioned forward or backward, or the jaw can be raised or lowered. Certain movements may require the jaws to be separated, with bone added or removed to achieve the proper alignment and stability. Other facial bones that contribute to alignment may also be repositioned or augmented.

When you have completed surgery, you should be able to return to school or work within two weeks. After the necessary healing time (about 4–8 weeks), your orthodontist "fine-tunes" your bite. In most cases, braces are removed within 6–12 months following surgery. After your braces are removed, you will wear a retainer to maintain your beautiful new smile.