Orthognathic surgery is used to move the positions of the teeth and the jaws. Orthognathic surgery may be required when the upper and lower jaws are not similar in their positions, for example, if the upper sits back considerably compared to the lower jaw. Orthognathic surgery can be a very rewarding treatment option that a modern orthodontic team can offer. There are two main questions to ask when deciding whether orthodontic treatment is necessary:
- Are the teeth in the right place?
- Are the jaws in the right place?
It is relatively easy to see when the teeth are crowded or protruding, but perhaps not so easy to see if the jaws do not match in size or if one jaw is positioned either too far forward or too far back in comparison to the other.
Another common benefit of jaw repositioning is that it can produce a significant improvement in facial appearance.
ORTHODONTIC CAMOUFLAGE – A mild mismatch in jaw position can normally be treated with orthodontic treatment alone. The orthodontic treatment can camouflage the jaw discrepancy. This is very common treatment. However, a significant mismatch in the positions of the jaws may require the correction of the jaws by repositioning them – this can only be done with orthognathic surgery if there is no ability to modify the growth of the jaws. The teeth can then be moved to a better or ideal position.
THE ORAL AND MAXILLOFACIAL SURGEON – A TEAM APPROACH – If it is desirable to reposition both the teeth and the jaws, the orthodontist will work in collaboration with another specialist, an oral and maxillofacial surgeon. These surgeons are usually fully qualified medical practitioners as well as specialist dentists. The oral and maxillofacial surgeon performs an operation for the patient in hospital to reposition either one or both jaws.
TREATMENT – Treatment is divided into three parts. Part 1 is the pre-surgical orthodontic phase. Braces are placed on the teeth to “de-compensate” them. The teeth are straightened and moved to the correct positions in the supporting bone. Normally this takes 12 to 18 months of active tooth movement. You should be aware that by the end of this phase your facial profile and the position of your teeth will likely look worse rather than better. This is deliberate and unavoidable because your orthodontic treatment is designed to undo nature’s attempt to mask the skeletal discrepancy of your jaws, in preparation for the surgical correction. Part 2 is the surgical phase. With the braces still attached to the teeth, you will be admitted to hospital where your oral and maxillofacial surgeon will make the necessary surgical corrections to your jaws. Part 3 is the post-surgical orthodontic phase, which usually lasts about six months, where the final orthodontic positioning of your bite is performed.