Jaw surgery is an integral component of orthodontic treatment for those patients seeking significant changes to their bite, smile, and facial profile. While the jaw surgery is performed by an oral and maxillofacial surgeon, orthodontics is required in conjunction with the surgery in order for a successful result to take place. Let us walk you through the process below.
Teeth are situated inside the upper and lower jawbones. During development, the jaws grow somewhat independently of one another. If the growth between the two jaws is somewhat harmonious, it is fairly routine for the orthodontist to align the teeth while achieving a good bite. However, if there is too much or not enough jaw growth in any particular direction, the attainment of a healthy bite is much more challenging.
Orthodontic treatment during one’s growth spurt can help mitigate a mild-moderate jaw discrepancy but there are biologic limits to how far teeth can be moved before it becomes unhealthy. Therefore, in cases with significant jaw discrepancies without much growth potential, an orthodontics-only treatment approach is not the appropriate solution to get an ideal result.
When the discrepancy between the upper and lower jaws is very significant we often recommend that our patients have a surgical procedure done in conjunction with their orthodontic treatment. The technical name for the surgery is called orthognathic surgery and it includes several different procedures. The jaw surgery is performed by another dental specialist called an oral and maxillofacial surgeon.
Benefits of Jaw Surgery
1. Faster Treatment Time
Oftentimes fixing the bite in one shot with a 2-hour surgery can result in a faster treatment compared to a non-surgical approach where an appliance is used for years instead.
2. Esthetic Facial Profile
When the jaws are in the right position, the facial profile is usually more balanced and natural-looking.
3. Stable Long Term Result
Because the teeth have not been moved to positions they do not normally occupy or they are moved into a new position where they should have always been, the results tend to be stable in the long term.
4. Healthy Bite
Because the jaws have been moved to their correct position, the teeth are consequently moved to favourable positions which allow for the attainment of a functional bite.
5. Improved Airway
When the jaws are moved forward or made larger, the airway is often improved which allows for better sleep. Some people who have been diagnosed with sleep apnea undergo jaw surgery to help alleviate their symptoms.
Process and Recovery
Learn what is involved in jaw surgery preparation and what to anticipate with recovery.
Traditionally this involves 12 – 15 months of orthodontic treatment prep. Teeth are moved to their natural positions relative to the bones they are in.
During this process, the discrepancy between the jaws actually gets more significant. It is important to emphasize that for this reason, it is very important to commit to the process and follow through with it. If a decision is made to proceed with an orthodontic treatment plan that involves jaw surgery, we cannot stop mid-treatment and decide not to proceed with the surgery because we are moving the teeth in the opposite direction they would go otherwise.
The surgery is done in a hospital. Depending on what needs to be done, the surgery often takes anywhere from 2 – 6 hours to complete and is done under general anesthetic. With advancements in technology, the surgery is usually planned on a computer ahead of time with complete precision. While some surgeries are done on an outpatient basis, most patients spend at least one night in the hospital.
Surgery Types & Risks
There are several types of jaw surgeries, but all include variations of:
- Upper jaw – moved forward, upward, downward, or made wider.
- Lower jaw – moved forward or backward.
- Chin – moved forward, backward, or side to side.
Risks and potential complications are covered in extreme detail by the oral surgeon but the most common ones are bleeding, swelling, infection, and numbness.
Overall, however, the surgeries are very predictable and routine. Studies show over 95% of patients are ultimately happy they proceeded with surgery.
Recovery varies by surgery, but expect to stay at home for 2 – 6 weeks. A lot of our students who undergo jaw surgery often have it done during the summer break from school. During the first few days of recovery it is very normal to experience weakness, inability to eat solid foods for a few days, muscle/jaw soreness, swelling of the face, and intraoral bleeding.
It is not common anymore to be “wired shut” after jaw surgery but mouth opening is quite limited. Most of our patients start on a clear liquid diet, followed by protein shakes, and then soft foods by the end of the first week. Before the surgery we suggest to stock up on meal replacement shakes! After about two weeks, most of the swelling is gone and recovery gets much easier.
After the surgery takes place, orthodontic appliances remain in place since they are required for after the surgery to settle the bite. Most patients are in treatment for 6 – 12 months after the surgery. During this time, there is a lot of elastic wear to help fine tune the position of the teeth and jaws.
An exception to this process is that sometimes surgery is done at the very beginning of the orthodontic process. This is called a “surgery-first” approach and whether or not you are a candidate for this is determined by the oral surgeon.
Have some additional questions? Here are some common questions related to jaw surgery cases.
This is a decision made together by Dr. Walt and your oral surgeon. Traditionally, jaw surgery cases have been done with braces but Invisalign® is becoming more and more popular. It requires a different planning process and ultimately depends on the experience and preference of the oral surgeon and orthodontist. Dr. Walt has done many cases combining jaw surgery with Invisalign® so it may be something that can be done but is evaluated on an individualized basis.
Many oral surgeons request that wisdom teeth, if present, be removed at least 6 months prior to the jaw surgery. The reason for this is that the lower jaw surgery is often done in the area of the wisdom teeth. Nevertheless, some oral surgeons prefer to remove them at the time of surgery. This will be evaluated by your oral surgeon during your initial consultation with them.
If you have OHIP coverage, most of the jaw surgery costs done inside the hospital are covered. There are usually out-of-pocket expenses that your dental insurance may or may not cover, ranging from approximately $5,000 – $8,000 (paid to the oral surgeon).
This is independent of your orthodontics fee and is paid directly to the surgeon. At your initial consultation with your oral surgeon, all of this information will be provided.
No, almost all of the jaw surgery is done inside the mouth so nothing is visible from the outside. Jaw surgery tends to have a very significant and positive change on the facial profile.
The answer to this question is very case specific but it depends on the type of jaw problem. In general, we want growth to be complete or nearly complete. If jaw growth is deficient we tend to be able to do the surgery earlier than if jaw growth is excessive.
Keep in mind that it usually takes about a year of orthodontics before we are ready for the jaw surgery so that is factored into the timeline as well.
Invisalign aligners are a set of custom fabricated, clear plastic trays that fit over your teeth. Every week throughout your treatment, you change to a new tray digitally designed to safely align your teeth. Each tray provides slight tooth movements…View Article