Surgical orthodontics or Orthognathic surgery is the surgical correction of jaw abnormalities when orthodontics alone cannot fix the underlying causes. In these types of procedures an orthodontist and a maxillofacial surgeon work as a team to achieve the best potential outcome. The orthodontist places the teeth in the correct position and the surgeon will reposition the jaws.
- Treatment Sequence
- Mandibular Advancement
- Mandibular Setback
- Maxillary Advancement
- Maxillary Setback
- Maxillary Impaction to Correct Openbite
- Maxillary Impaction to Correct Gummy Smile
- Double Jaw Surgery
- Chin Advancement
Treatment Planning: The orthodontist and oral surgeon coordinate their treatment plans. The two specialists do a mock surgery on a computerized 3D model or plaster models. It’s not uncommon to have other specialists involved, too. Plastic and ENT Surgeons, speech therapist and psychologist are amongst the most common.
Braces: Treatment starts with braces. The goal is to create a point of reference for the surgeon to perform the surgery. Most often, the outcome is an exaggerated initial malocclusion or facial appearance.
Surgery: The patient will go under surgical procedure with the braces on. Bite and facial appearance will improve significantly right after the surgery.
Finishing: The orthodontist continues with braces to finalize the bite.
- The best time for most orthognathic surgeries is when the patient is done growing, for females: 13-15 years old and males: 16-18 years old
- Surgery is performed in a hospital setting under general anesthesia.
- All surgical cuts are inside the mouth, not on the skin.
- Repositioned bone will be stabilized by titanium plates.
- There is no need to tie the jaws together or perform another surgery to remove the titanium plates.
- Most patients are able to move their jaw within a normal range right after the surgery.
- Surgeons advise sticking to a soft diet for a while.
- Most patients will leave the hospital in two days.
- Full recovery is within three to six weeks.
Below are the most commonly performed orthognathic surgeries.
It is performed on a patient with an under-developed lower jaw. A typical facial finding on these cases are convex profiles and severe overjet which is commonly known as overbite. The surgeon will make incisions on both sides of the lower jaw and will advance it to an ideal position.
It is performed on a patient with anterior crossbite, AKA underbite, which is caused by over-growth of the lower jaw. The surgeon will make incisions on both sides and sets the jaw back in to an ideal position.
It is performed on a patient with anterior crossbite, AKA underbite, which is caused by under-growth of the upper jaw or mid-face. The location of the incision varies somewhere between the upper jaw to the lower border of the eye sockets. It depends on the segment of the mid-face that needs advancement.
It is performed on a patient with overjet, AKA overbite, which is caused by over-growth of the upper jaw. The surgeon will set the upper jaw back in to an ideal position. This surgery is not as common as the Mandibular Advancement, because most of the time the overjet is caused by undergrowth of the lower jaw.
It is performed on patients with an anterior openbite. In other words, it is to correct the space between front teeth while back teeth are in contact. The surgeon removes a wedge of bone from the upper jaw in order to replace it in a higher position. The amount of repositioning is relatively more on the back part. As a result, the lower jaw will be over closed in order to reach the upper teeth.
It is performed on a patient with gummy smile. The surgeon removes a wedge of the bone from the upper jaw in order to replace it in a higher position. The amount of repositioning is relatively more on the front part.
Any combination of the upper and the lower jaw surgery is possible. For example, a maxillary impaction and mandibular advancement can be done at the same time.
It is performed on a patient with a weak chin projection. A typical finding is a convex facial profile. The surgeon makes incisions on the chin and replaces it into a more advanced position. If the bite is ideal, this surgery is one of the unique orthognathic surgeries that doesnt require orthodontic treatment.
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