What is orthodontic jaw surgery and when is it needed?

In this video Dr. Dt. Kıvanç Türkoğlu and Dr. Dt. Pınar Demir Türkoğlu discuss treatments in which orthodontics and jaw surgery are planned together. This article summarises the video and describes what someone considering this treatment can expect.

What the video covers

• How orthodontic problems fall into two groups: crowding of the teeth and the position of the jaws relative to each other.
• How some skeletal problems can be guided with appliances during growth, and why surgery comes up for marked skeletal differences once growth has finished.
• When camouflage, which changes only the position of the teeth, may be considered.
• The role of lateral cephalometric measurements in the surgical decision, and how the lower jaw, the upper jaw or both may be treated.
• How orthodontic treatment before and after surgery can also be done with clear aligners, and what recovery after surgery involves.

A tooth problem or a skeletal problem?

Crowded or spaced teeth can usually be corrected with orthodontics. A lower jaw that sits forward, an upper jaw that sits back, or the reverse, comes from the position of the jaw bones and is called a skeletal problem.

While growth continues, some skeletal problems can be guided with appliances. Once growth is complete, surgery may be considered to reposition the jaws when the skeletal difference is marked.

What is camouflage?

In some patients the skeletal difference is limited and the person does not want surgery. The bite can then be improved by changing the angle of the teeth. This approach is called camouflage.

Camouflage does not change the position of the jaw bones. Its suitability depends on the size of the skeletal difference, the bone supporting the teeth and the person's expectations.

How is the surgical decision made?

Assessment includes an examination of the mouth and face, a lateral cephalometric X-ray and, when needed, three-dimensional imaging. The position of the upper and lower jaw relative to the skull base is measured on these records.

If the deviation exceeds certain limits, surgery may be recommended. Treatment may involve only the lower jaw, only the upper jaw or both. Software can show the possible effect of the planned movement on the facial profile in advance. This is an estimate and does not mean a definite result.

Orthodontics before and after surgery

When the jaws do not match, the teeth gradually tilt to compensate. Orthodontic treatment before surgery corrects this tilt and places the teeth correctly over their own bone, so that the teeth fit together once the jaws are moved.

Orthodontic treatment continues for a while after surgery to fine-tune the bite. It can be done with braces or, in suitable cases, with clear aligners. Some centres use a surgery-first approach. The right sequence is decided by the orthodontist and the surgeon together.

Surgery and recovery

Orthognathic surgery is done in hospital under general anaesthesia. The bone cuts are mostly made inside the mouth. Some lower jaw techniques may need a small skin incision on the cheek. Marked swelling lasts for several days. Liquid and soft food are needed in the first weeks.

Altered sensation of the lip or chin can occur. It usually improves over months and is rarely permanent. More detail is in the orthognathic surgery section.

Frequently asked

If I am not happy after orthodontics, can I have surgery afterwards?

Camouflage and preparation for surgery move the teeth in different directions. The route should therefore be decided at the start by the orthodontist and the surgeon together.

Will there be a scar?

The cuts are mostly made inside the mouth and are not visible. Some lower jaw techniques may need a small skin incision on the cheek; this is discussed beforehand.

Can preparation for surgery be done with clear aligners?

In suitable cases, yes. The orthodontist chooses braces or aligners according to the tooth movements needed.

Related section and videos

• Section on the expertise page: Orthognathic and jaw surgery
• What is a dental implant and what are the stages of treatment?
• Who are dental implants suitable for?
• Care after implant treatment
• How are dental implant types classified?

This information is for general guidance and does not replace an examination. Rapidly spreading facial swelling or difficulty swallowing or breathing is an emergency. Go to a hospital emergency department.