When Jaw Alignment Problems Need Surgical Orthodontics
When Jaw Alignment Problems Need Surgical Orthodontics
Most bite problems respond well to orthodontic treatment. Braces, clear aligners, and related appliances can reposition teeth effectively and produce significant improvements in both function and appearance. But there's a category of jaw problems where orthodontics alone has clear limits because cases where the bones themselves, not just the teeth, are the source of the misalignment.
When that line is crossed, surgical orthodontics becomes part of the conversation. Understanding when jaw alignment problems cross from the orthodontic into the surgical realm is important for patients who have been told their case is "complex" or who have noticed that their bite problems go beyond just crooked teeth. This article explains the key signs, conditions, and processes involved.
The Difference Between Dental and Skeletal Alignment Problems
Not all bite problems are created equal. Some arise primarily because teeth have grown in at incorrect angles or are overcrowded. These are dental alignment issues, and they respond well to braces or clear aligners.
Others stem from the underlying jaw bones being disproportionate in size, position, or shape. An upper jaw that is too far forward, a lower jaw that didn't develop fully, or jaws that don't match symmetrically are skeletal issues. Braces can improve how teeth meet within a misaligned jaw, but they cannot physically move bone into a new location. That requires surgery.
Common Jaw Alignment Problems That May Require Surgery
Severe Underbite
An underbite occurs when the lower jaw protrudes beyond the upper jaw, thereby causing the lower front teeth to sit in front of the upper front teeth. Mild underbites can sometimes be addressed with orthodontic treatment, especially if caught early during growth. Severe underbites where the lower jaw is significantly forward due to skeletal overgrowth typically require orthognathic surgery to reposition the lower jaw.
Significant Overbite with Skeletal Component
A deep overbite, where the upper front teeth overlap the lower teeth excessively, can sometimes involve a skeletal component. If the upper jaw is too far forward or the lower jaw is underdeveloped, surgery may be needed alongside orthodontic treatment to bring the jaws into proper relationship.
Open Bite
An open bite means the upper and lower front teeth don't touch when the back teeth are closed together. Open bites can result from habits like thumb sucking, but they can also have a skeletal origin. Surgically assisted open bite correction may be recommended for adult patients when the problem is rooted in jaw morphology.
Facial Asymmetry from Jaw Discrepancy
When one side of the jaw grows differently from the other, facial asymmetry becomes visible. This can affect not only appearance but also how the teeth meet and how the jaw functions. In moderate to severe cases, correcting this asymmetry requires surgical repositioning of one or both jaws.
Signs That Your Bite Problem May Be Skeletal
| Sign | What It May Indicate |
|---|---|
| Lower jaw visibly protrudes beyond upper jaw. | Skeletal underbite or prognathism. |
| Upper teeth cover most or all of lower teeth. | Deep overbite with possible skeletal component. |
| Front teeth don't touch when mouth is closed. | Open bite which is possibly skeletal in origin. |
| Face appears noticeably asymmetrical. | Jaw asymmetry or unilateral growth discrepancy. |
| Difficulty chewing or biting into foods. | Functional jaw misalignment. |
| Previous orthodontic treatment didn't hold results. | Skeletal relapse after dental correction. |
| Mouth breathing, snoring, or sleep apnea. | Possible airway related jaw positioning issue. |
How Surgical Orthodontics Works
Surgical orthodontics, also referred to as orthognathic surgery, is a carefully planned multi-phase treatment process involving close coordination between an orthodontist and an oral and maxillofacial surgeon. The goal is to correct skeletal jaw discrepancies that cannot be resolved with braces or aligners alone while improving bite function, facial balance, and long-term oral health.
The treatment process usually includes several important stages:
- Pre surgical orthodontics to align the teeth before surgery.
- Detailed digital planning and imaging for accurate jaw positioning.
- Jaw surgery under general anesthesia in a hospital or surgical center.
- Placement of titanium plates and screws to stabilize the repositioned jaws.
- Post surgical orthodontics to fine tune the final bite alignment.
Treatment typically begins with a pre-surgical orthodontic phase. During this stage, braces are used to move the teeth into positions that will properly fit together after the jaws are surgically corrected. Interestingly, this phase can temporarily make the bite appear worse because the teeth are being prepared for the future jaw position rather than the current one.
Who Is a Candidate for Surgical Orthodontics
Surgical orthodontics is generally recommended for patients who have completed jaw growth and have significant skeletal alignment issues that cannot be corrected through orthodontic treatment alone. Candidates often experience both cosmetic and functional concerns related to jaw positioning.
Common signs that a patient may qualify for surgical orthodontics include:
- Severe underbite or overbite caused by jaw structure.
- An open bite where front teeth do not touch properly.
- Noticeable facial asymmetry from uneven jaw growth.
- Difficulty chewing or speaking comfortably.
- Chronic jaw discomfort or bite instability.
- Sleep related breathing concerns linked to jaw position.
- Previous orthodontic treatment with unstable long-term results.
Most candidates are evaluated after jaw growth is complete, which usually occurs around age 16 to 17 for females and age 18 to 19 for males. Performing surgery too early may allow the jaws to continue growing afterward, potentially affecting treatment stability.
The Role of Your Orthodontist in Surgical Cases
Your orthodontist plays a central role in surgical orthodontics from start to finish. They conduct the initial evaluation to determine whether surgery is needed, develop the pre-surgical orthodontic treatment plan, communicate closely with the oral surgeon throughout the process, and manage post surgical orthodontic refinements.
This collaborative model ensures that the surgical outcome and the orthodontic outcome are coordinated and that the final bite is both stable and functional. For patients navigating this process, having clear communication with their treatment team and asking questions at each phase makes a meaningful difference.
Conclusion
Jaw alignment problems that have a significant skeletal component often cannot be fully corrected through orthodontic treatment alone. Surgical orthodontics offers a comprehensive path for patients whose jaw proportions, positions, or symmetry require more than braces can provide. The process is longer and more involved than conventional orthodontic treatment, but it addresses the structural root of the problem rather than working around it.
Contact your dentist today in Danville, Dr. Hoss Abar, at Danville Orthodontics, to learn more about Common Signs You May Need Surgical Orthodontic Treatment.
This article is for informational purposes only and is not a substitute for professional dental or medical advice. Consult a licensed orthodontist or oral surgeon for evaluation and treatment recommendations specific to your case.