Orthognathic Surgery: When Jaw Surgery is Needed
Some orthodontic problems stem from jaw position rather than just tooth alignment. Understanding when surgery is necessary helps you make informed decisions about comprehensive treatment.
What is Orthognathic Surgery?
Orthognathic surgery, commonly called jaw surgery, repositions one or both jaws to correct skeletal discrepancies that cannot be fixed with braces alone. This surgical orthodontic treatment addresses problems with jaw size, position, or symmetry.
The term orthognathic comes from Greek words meaning straight jaws. An oral and maxillofacial surgeon performs the surgery while your orthodontist manages tooth alignment before and after the procedure. This coordinated team approach achieves optimal functional and aesthetic results.
When Orthodontics Alone is Not Enough
Braces and Invisalign move teeth within the jawbone, but they cannot change jaw size or position. When the problem lies with jaw relationships rather than tooth positioning, orthodontic treatment alone produces limited results.
Some patients complete orthodontic treatment with straight teeth that still do not fit together properly because their jaws are misaligned. Others have breathing problems, TMJ issues, or facial asymmetry that persists despite orthodontic correction. These situations often require surgical intervention for complete resolution.
Common Conditions Requiring Jaw Surgery
Severe Underbite
An underbite occurs when the lower jaw protrudes beyond the upper jaw. Severe underbites result from excessive lower jaw growth or underdeveloped upper jaw. This creates difficulty biting, chewing, and speaking clearly.
Mild underbites can sometimes be corrected with braces and elastics, especially in growing children. However, skeletal underbites in adults typically require jaw surgery to move the lower jaw backward or advance the upper jaw forward.
Severe Overbite
A severe overbite means the upper teeth overlap the lower teeth excessively. This can result from an overgrown upper jaw, undergrown lower jaw, or combination of both. Severe overbites cause difficulty biting food, excess wear on lower teeth, and sometimes damage to the roof of the mouth.
Surgical correction typically involves moving the lower jaw forward or moving the upper jaw backward to create proper overlap and function.
Open Bite
An open bite creates a gap between upper and lower teeth when back teeth are together. This makes biting and tearing food difficult. Open bites can result from thumb sucking habits, tongue thrust, or jaw growth patterns.
Habit-related open bites in children may improve with early intervention. However, skeletal open bites often require jaw surgery to reposition the jaws vertically and achieve proper tooth contact.
Facial Asymmetry
Noticeable facial asymmetry where one side of the jaw appears different from the other may result from uneven jaw growth or injury. This creates functional problems with chewing and aesthetic concerns.
Jaw surgery can balance facial proportions by repositioning the jaws symmetrically. The goal is improved function and facial harmony.
Sleep Apnea
Obstructive sleep apnea sometimes results from jaw position restricting airway space. When a recessed lower jaw or small upper jaw contributes to breathing problems, jaw surgery to advance the jaws can open the airway.
Maxillomandibular advancement surgery moves both jaws forward to increase airway space. This can be highly effective for patients whose sleep apnea relates to jaw position.
TMJ Disorders
Temporomandibular joint disorders causing chronic jaw pain, clicking, or limited opening sometimes stem from jaw misalignment. When conservative treatments fail and jaw position contributes to TMJ problems, surgical repositioning may provide relief.
Not all TMJ cases require surgery, but those related to skeletal discrepancies may benefit from orthognathic intervention as part of comprehensive TMJ treatment.
The Surgical Orthodontic Process
Initial Evaluation
Your orthodontist will determine during consultation whether your case requires surgical intervention. This involves clinical examination, X-rays, photographs, and sometimes 3D imaging. If surgery is indicated, you will be referred to an oral and maxillofacial surgeon for surgical consultation.
Treatment Planning
Your orthodontist and surgeon work together to develop a coordinated treatment plan. Computer modeling predicts surgical movements and final results. You will see simulations of expected outcomes before committing to treatment.
Pre-Surgical Orthodontics
Before surgery, you will wear braces for 12 to 18 months to align teeth within each jaw. This preparation phase positions teeth so they fit together properly after jaw repositioning. Your bite may actually worsen during this phase as teeth are moved to pre-surgical positions.
Surgery
Orthognathic surgery is performed in a hospital under general anesthesia. The surgeon makes incisions inside the mouth to access jaw bones, eliminating facial scarring. Bones are cut and repositioned according to the surgical plan, then secured with plates and screws.
Surgery duration ranges from 1 to 4 hours depending on complexity. Most patients stay overnight in the hospital for observation. Some single-jaw procedures allow same-day discharge.
Recovery Period
Initial recovery takes 2 to 4 weeks. Swelling peaks at 48 to 72 hours, then gradually subsides over several weeks. You will follow a liquid diet initially, progressing to soft foods over 6 to 8 weeks. Most patients return to school or work within 2 to 4 weeks.
Complete healing takes 6 to 12 months as bone remodels around the new jaw position. Numbness in the lower lip or chin is common initially and typically resolves over several months.
Post-Surgical Orthodontics
After healing, orthodontic treatment continues for 6 to 12 months to finalize tooth positions and perfect your bite. This finishing phase ensures optimal function and stability. Once orthodontic treatment is complete, you will wear retainers to maintain results.
Types of Jaw Surgery
Upper Jaw Surgery
Maxillary osteotomy repositions the upper jaw. This can move the upper jaw forward, backward, up, down, or rotate it to improve facial balance. Upper jaw surgery addresses issues like gummy smile, open bite, or midface deficiency.
Lower Jaw Surgery
Mandibular osteotomy repositions the lower jaw. The lower jaw can be moved forward to correct underdeveloped chin and improve airway, or moved backward to correct protruding lower jaw. This surgery addresses severe underbite or overbite.
Chin Surgery
Genioplasty reshapes the chin without moving the entire jaw. This can augment a weak chin or reduce a prominent chin. Chin surgery is often combined with jaw surgery for optimal facial balance.
Two-Jaw Surgery
Bimaxillary osteotomy repositions both upper and lower jaws. This comprehensive approach addresses complex skeletal discrepancies and provides maximum correction for facial balance and function.
Benefits of Surgical Orthodontic Treatment
Improved Function
Proper jaw alignment enhances chewing efficiency, reduces abnormal tooth wear, and can improve speech clarity. Many patients report easier eating and better digestion after treatment.
Better Breathing
Jaw advancement can significantly improve airway space, potentially resolving or reducing sleep apnea symptoms. Better nasal breathing and reduced mouth breathing often result from improved jaw position.
Pain Relief
Correcting jaw misalignment can relieve TMJ pain, headaches, and neck tension related to poor jaw position. Many patients experience significant reduction in chronic pain after successful treatment.
Enhanced Facial Aesthetics
Balanced jaw position improves facial harmony and profile. A stronger chin, better lip position, and improved facial proportions often result from orthognathic surgery. While these are secondary to functional improvements, many patients appreciate the aesthetic benefits.
Considerations and Risks
Orthognathic surgery is major surgery with associated risks including infection, bleeding, nerve injury, and relapse. However, serious complications are rare when surgery is performed by experienced oral and maxillofacial surgeons.
The time commitment is substantial, requiring 18 to 30 months of total treatment. The recovery period disrupts normal activities for several weeks. However, for patients with significant functional problems, the long-term benefits typically outweigh the temporary challenges.
Surgical Orthodontics in Douglas County
Douglas County orthodontists regularly coordinate with oral and maxillofacial surgeons in the Denver metro area for surgical cases. Your orthodontist will refer you to qualified surgeons experienced in orthognathic procedures.
Many insurance plans cover medically necessary jaw surgery when documented functional problems exist. Your orthodontist and surgeon work together to provide insurance documentation supporting medical necessity.
Looking for General Dentistry?
Orthodontic treatment works best alongside regular dental care. For cleanings, checkups, and general dentistry in Douglas County, visit our partner site Douglas County Dentist.
Frequently Asked Questions
How do I know if I need jaw surgery?
Your orthodontist will identify if you need jaw surgery during your initial evaluation. Signs include severe underbite or overbite, facial asymmetry, difficulty chewing or breathing, chronic jaw pain, or large gaps between upper and lower teeth when biting. X-rays and facial analysis help determine if jaw position is causing your orthodontic issues.
What is the recovery time for orthognathic surgery?
Initial recovery takes 2 to 4 weeks when most swelling subsides and patients return to school or work. Complete healing takes 6 to 12 months. Most patients resume normal eating gradually over 6 to 8 weeks, starting with liquids and soft foods. Orthodontic treatment continues during recovery to finalize tooth alignment.
Does insurance cover jaw surgery?
Many insurance plans cover orthognathic surgery when it is medically necessary to correct functional problems like breathing difficulties, chewing problems, or TMJ disorders. Purely cosmetic jaw surgery is typically not covered. Pre-authorization is required and your orthodontist and oral surgeon will provide documentation of medical necessity.
How long does combined orthodontic and surgical treatment take?
Total treatment typically takes 18 to 30 months including pre-surgical orthodontics (12 to 18 months), surgery and recovery (2 to 4 weeks initial), and post-surgical orthodontics (6 to 12 months). Your orthodontist and surgeon create a coordinated timeline based on your specific case.
Is jaw surgery painful?
Modern orthognathic surgery techniques and pain management protocols minimize discomfort. You will be under general anesthesia during surgery and feel no pain. Post-operative pain is managed with prescription medications. Most patients describe pressure and discomfort rather than severe pain. Swelling causes more concern than pain for many patients.
Will my face look different after jaw surgery?
Yes, orthognathic surgery changes your facial profile and appearance, usually improving facial balance and harmony. Changes can include a stronger or less prominent chin, improved facial symmetry, and better lip position. Your surgeon will show you predicted outcomes before surgery so you understand the expected changes.