Surgical Orthodontics: When Bite Correction Needs More Help

When most people think of orthodontic treatment, they picture braces or clear aligners moving teeth into straighter positions. In many cases, orthodontic treatment alone is all that is needed to create a healthy, functional bite and a beautiful smile.

However, sometimes the underlying issue is not just the position of the teeth but also the position, size, or relationship of the jaws. When the jaws do not grow in the proper relationship to one another, orthodontic treatment alone may not be enough to fully correct the bite. In these situations, surgical orthodontics, also known as orthognathic surgery, may be recommended. While most people think of jaws being "wired shut", modern jaw surgery no longer relies on this technique, making the healing process a lot less uncomfortable.

What Is Surgical Orthodontics?

Surgical orthodontics is a treatment approach that combines orthodontic treatment with jaw surgery to correct significant skeletal discrepancies. Orthodontic treatment, such as braces, moves the teeth. Jaw surgery changes the position of the underlying jawbones. Together, these treatments can improve:

• The way the upper and lower teeth fit together

• Chewing and biting function

• Facial balance and symmetry

• Speech in some cases

• Certain breathing or airway concerns

• The overall stability of the bite

  
  

Surgical orthodontics is generally considered once jaw growth is complete. This is because the jaws need to finish growing before surgery can be performed in a predictable and stable way.

Why Might Someone Need Jaw Surgery?

Some bite problems are caused primarily by the position of the teeth. These issues can often be corrected with braces or clear aligners alone. Other problems are caused by a significant difference in the size or position of the upper and lower jaws. Examples may include:

Severe Underbite

An underbite occurs when the lower teeth sit in front of the upper teeth. In some patients, this is caused by the lower jaw being positioned too far forward, the upper jaw being positioned too far back, or a combination of both.

For mild to moderate cases, orthodontic treatment may be enough. However, when the jaw discrepancy is more significant, surgery may be required to achieve the best possible result.

Severe "Overbite" or Overjet

An excessive overjet occurs when the upper front teeth sit significantly ahead of the lower teeth. In some cases, this is related to the position of the teeth. In others, the underlying jaw relationship contributes significantly to the problem.

When the jaw discrepancy is substantial, orthodontics and jaw surgery may be combined to correct the underlying skeletal imbalance.

Open Bite

An open bite occurs when certain teeth do not come together when the mouth is closed. This can make biting and chewing difficult.

Open bites may be influenced by tooth position, jaw growth, tongue habits, or other factors. In more severe skeletal open bites, jaw surgery may be recommended as part of treatment.

Significant Facial Asymmetry

When the upper and lower jaws develop unevenly, it can result in noticeable facial asymmetry. Orthodontic treatment can align the teeth, but surgery may be necessary to correct the underlying jaw imbalance.

Why Can't Braces Alone Fix Every Problem?

Imagine trying to fit two puzzle pieces together when one piece is significantly larger or positioned differently. You may be able to move the teeth to compensate for the difference, but there are limits to how much compensation is possible.

In some cases, moving the teeth too far to compensate for a jaw discrepancy may actually compromise the health and stability of the teeth. Surgical orthodontics addresses the underlying skeletal problem rather than simply trying to camouflage it with tooth movement.

What Does Treatment Involve?

Surgical orthodontic treatment is usually completed in several stages.

1. Orthodontic Treatment Before Surgery

Braces are typically placed before surgery to align the teeth and prepare them for the procedure. Interestingly, the bite will appear to get worse temporarily during this stage. This is because the orthodontist is often removing dental compensations and positioning the teeth properly within their respective jaws.

This preparation allows the surgeon to move the jaws into the correct relationship during surgery.

2. Jaw Surgery

Once the teeth have been properly prepared, the patient undergoes jaw surgery with an oral and maxillofacial surgeon.

Depending on the individual case, surgery may involve:

• The upper jaw

• The lower jaw

• Both jaws

• The chin in some cases

The specific procedure depends on the patient's unique skeletal and dental needs.

3. Orthodontic Treatment After Surgery

After surgery, orthodontic treatment continues to fine-tune the bite and ensure the teeth fit together properly. The final stage of orthodontic treatment focuses on achieving the best possible function, alignment, and stability.

Is Surgical Orthodontics Only About Appearance?

No. Although surgical orthodontics can create significant improvements in facial balance and appearance, the primary goal is often to improve function.

A properly aligned bite can make it easier to:

• Bite and chew food

• Maintain good oral hygiene

• Speak clearly in certain situations

• Protect the teeth from excessive wear

• Achieve a stable bite

The improvement in facial balance and smile aesthetics is an important additional benefit for many patients.

What If I Am Still Growing?

For children and teenagers, early orthodontic evaluation is particularly important when there is a significant jaw discrepancy. Some growth-related problems can be improved or redirected while a child is still growing. For example, certain underbites may benefit from early treatment with appliances such as a facemask and expander.

Early treatment does not always eliminate the need for future treatment or surgery. However, identifying a jaw discrepancy early allows the orthodontist to monitor growth and determine the best timing and approach for treatment.

The Importance of a Team Approach

Surgical orthodontic treatment involves close collaboration between the orthodontist and the oral and maxillofacial surgeon.

The orthodontist focuses on the position of the teeth and the bite, while the surgeon focuses on repositioning the jaws. Careful communication and planning between both specialists are essential to achieving the best possible outcome.

The Bottom Line

Surgical orthodontics is a carefully planned treatment approach for patients whose bite problems are caused, at least in part, by the position or relationship of the jaws.

While the idea of jaw surgery can seem overwhelming, it can provide meaningful improvements in both function and facial balance for patients with significant skeletal discrepancies. Treatment is highly individualized, and the best way to determine whether surgical orthodontics may be appropriate is through a comprehensive orthodontic evaluation.

If you or your child has a significant underbite, overbite, open bite, facial asymmetry, or another complex jaw-related concern, an orthodontic consultation can help you understand your options and determine the best path forward.