Approximately 5 percent to 7 percent of the U.S. population is believed to have facial skeletal deformities that result in incorrect relationships between the jaws. Frequently, orthodontic treatment alone will not provide the stable, ideal jaw and teeth relationship that these patients need. In these cases, orthodontic treatment in conjunction with orthodontic surgery, called orthognathic surgery, is the best solution.

Orthognathic means “changing jaws” and describes the interdisciplinary cooperation between orthodontists and oral surgeons. The upper and lower jaws are the foundations by which teeth are supported. Sometimes, when the jaws are too short or long, too wide or narrow, braces alone cannot completely correct a bad bite. And, in addition to affecting a person’s appearance, an improper bite can lead to serious problems, such as abnormal tooth wear, periodontal disease, and possible joint pain.

Orthodontists correct crooked teeth and bad bites. For problems related to jaw formation and misalignment (skeletal problems), an oral surgeon may be needed. When both conditions come into play, it’s common for an orthodontist and oral surgeon to work together.

Some severe cases can only be corrected with a combination of orthodontics and surgery. The orthodontist, working with the oral surgeon, designs a combined treatment plan. Depending on the problem, treatment by other dental specialists may also be required.

This teamwork between the orthodontist, the family dentist and other dental specialists provides better dental health for thousands of patients who are rewarded with straight teeth, bright smiles and facial symmetry – a beautiful combination of shape, form, position and function.

What problems do orthodontics and surgery best correct?

There are many types of jaw development and alignment problems. Some are inherited, some are growth problems and some are caused by an accident or other trauma.

The most commonly corrected problems include:
- a protruding upper or lower jaw (one that sticks out too far)
- a retruding chin (one that is too far back)
- an unsightly display of gum tissue above the upper front teeth
- an inability to achieve lip contact when the lips are relaxed
- an elongated face
- asymmetry (facial imbalance)
- cleft palate

Which comes first?

Most orthodontic patients undergo an initial period of orthodontic treatment to align the teeth so they will fit properly after surgery is performed. Your orthodontist and oral surgeon will schedule surgery after the teeth have been properly aligned.

Usually, braces or orthodontic devices used to align teeth before surgery are left in place during the surgical procedure to help stabilize the teeth and jaws. After surgery there is usually an additional period of orthodontic treatment to bring the teeth into their final, desired positions, complementing the new facial symmetry.

Just as every patient is a unique individual, every case is different. However, a common case would involve:
- Six months of pre-surgery orthodontic treatment,
- Orthognathic surgical procedure
- Six to 12 months of post-surgical orthodontic treatment

In the last 30 years, since orthognathic surgery was introduced, there has been a continuous improvement in oral surgery techniques, technologies and materials. Orthognathic surgery may be the best way to correct a severe jaw deformity and improve function, appearance and quality of life.

Orthognathic surgery may be unnecessary if orthodontic treatment can correct the problem. With the latest advances in orthodontics, this is sometimes the case. Your orthodontist will determine if orthognathic surgery is the correct treatment option for you.

The rewards of treatment

While the prospect of undergoing surgery as part of your overall treatment plan may seem daunting, it really is not uncommon. The rewards for such treatment can be very dramatic. Following completion of orthodontic treatment and surgery, you will enjoy better dental health and have a better facial appearance.

Best of all, you will have a more beautiful smile that reflects a healthier, happier you for the rest of your life.