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. If you need to learn more about surgical options, book your free consultation and Dr. Amin and Dr. Vaziri will help you find a path to your future smile.

Intro to Surgical Ortho

Treatment Sequence

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 therapists, and psychologists 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 undergo a surgical procedure with the braces on. Bite and facial appearance will improve significantly right after the surgery.

Finishing
The orthodontist continues to finalize the bite with braces.

Facts

The best time for most orthognathic surgeries is when the patient is done growing. For females: 13-15 years old, for 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.
  • The 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.

Mandibular Advancement

This procedure is performed on a patient with an underdeveloped lower jaw. Typical facial findings on these cases are convex profiles and severe overbite (overjet). The surgeon will make incisions on both sides of the lower jaw and will advance it to an ideal position.

Overbite Treatment by Mandibular Advancement

Overbite Treatment by Mandibular Set Back

Mandibular Setback

This procedure is performed on a patient with an overdeveloped lower jaw. Typical facial findings on these cases are concave profiles and severe underbite (anterior crossbite). This procedure is not as common as the Maxillary Advancement, because most of the time the underbite is caused by an underdeveloped upper jaw.

Maxillary Advancement

This procedure is performed on a patient with an underdeveloped upper jaw or mid-face. Typical facial findings on these cases are concave profile and severe underbite (anterior crossbite). Depending on which segment of the mid-face that needs advancement, the surgeon will make incisions somewhere between the base of the nose to the lower border of the eye sockets and replace the entire segment.

Underbite Treatment by Maxillary Advancement

Overbite Treatment by Maxillary Set Back

Maxillary Setback

This procedure is performed on a patient with an overdeveloped upper jaw. Typical facial findings on these cases are convex profile and severe overbite (overjet). This procedure is not as common as the Mandibular Advancement, because most of the time the overbite (overjet) is caused by an underdeveloped lower jaw.

Maxillary Impaction to Correct Openbite

This procedure is performed on a patient with a vertically overdeveloped back segment of the upper jaw. Typical facial findings on these cases are long face, convex profile and severe anterior openbite. Dentally, upper front teeth do not cover lower front teeth and the patient is unable to bite into anything. The surgeon will remove a wedge out of the back segment of the upper jaw and set it higher.

Maxillary Impaction to Correct Openbite

Maxillary Impaction to Correct Gummy Smile

Maxillary Impaction to Correct Gummy Smile

This procedure is performed on a patient with a vertically overdeveloped front segment of the upper jaw. Typical facial findings in these cases are gummy smiles (excessive exposure of the gum while smiling). The surgeon will remove a wedge out of the front segment of the upper jaw and set it higher.

Double Jaw Surgery

Any combination of the upper and lower jaw surgeries are possible. For example, a Maxillary Impaction for open bite correction and Mandibular Advancement for overbite (overjet) can be done at the same time.

Double Jaw Surgery

Chin Advancement

Chin Advancement

This procedure is performed on a patient with a weak chin projection. The surgeon will make incisions on the chin and move it forward. If the bite is ideal, this surgery is one of the unique orthognathic surgeries that does not require orthodontic treatment.

Asymmetric Chin Advancement

This procedure is performed on a patient with an asymmetric chin. Similar to the Chin Advancement surgery if the bite is ideal, this surgery does not require orthodontic treatment.

Asymmetric Chin Advancement