Approximately 5-7% of the population is believed to have facial skeletal deformities that result in incorrect relationships between the jaws. Frequently, orthodontic treatment alone will not provide the stable, ideal jaw and teeth relationship that these patients need. In these cases, orthodontic treatment in conjunction with orthodontic surgery, called orthognathic surgery, is the best solution. One of our goals for these patients is to make sure there are no mysteries involved for those who are committing themselves to surgical treatment.
There are several types of malocclusions (‘bad bites’) that may be severe enough to require surgical intervention. These include:
Class II malocclusion
The upper teeth and jaw protrude forward of the lower teeth and jaw
Caused by an overgrowth of the upper jaw, a receding lower jaw, or both
Appearance – ‘buck tooth’ appearance, or a receding lower jaw (sometimes called a ‘weak chin’)
Braces combined with surgery provide the best combination of aesthetics and function.
Class III malocclusion
The lower teeth and jaw protrude forward of the upper teeth and jaw
Caused by the under development of the upper jaw, over development of the lower jaw, or a combination of both
Appearance – facial profile is often concave, chin is prominent
Treatment is to correct the alignment of the teeth with braces and follow with appropriate surgical procedures
The upper teeth bite inside of the lower teeth
Patients often have a narrow, high palate
In a growing patient (child), correction can be achieved with a palatal expansion appliance; for patients whose growth is completed, surgical intervention may be necessary.
Maxillary vertical excess
The upper jaw grows down excessively
Appearance – the lips may not close when relaxed, the upper front teeth may appear too full, and an excessive amount of gum tissue is revealed during smiling
Often is seen in conjunction with other bite or jaw problems
May not be treatable with orthodontic intervention alone; may require jaw surgery
Teeth don’t meet properly when biting down
Results from the downward growth of the upper jaw which may affect muscle balance and further deformities of the upper and lower jaw
Possible causes include tongue thrusting, thumb or finger sucking, poor lip musculature, and/or nasal passage pathology
Patients frequently experience difficulty chewing and may experience TMJ/TMD problems.
Usually develops from discrepancy between the growth of the left and right sides of the jaws
Causes include birth defect, trauma or personal habits
Appearance – facial imbalance
Requires a complete interdisciplinary analysis with oral surgeon and orthodontist; surgical correction is frequently needed to restore balance, function and appearance.
For conditions that require both orthodontic treatment and oral surgery, treatment normally begins with orthodontics. Orthodontic appliances are used to properly align the teeth so that when the jaw is surgically moved, the teeth will fit together properly. After surgery, further orthodontic treatment may be necessary to ‘fine tune’ the positioning of teeth.
Just as every patient is a unique individual, every case is different. However, a common case would involve:
6 months of pre-surgery orthodontic treatment
Orthognathic surgical procedure
6-12 months of post-surgical orthodontic treatment
In the last 30 years, since orthognathic surgery was introduced, there has been a continuous improvement in oral surgery techniques, technologies and materials. Orthognathic surgery may be the best way to correct a severe jaw deformity and improve function, appearance and quality of life.
lILLI Pilli Dental practice 487 Port Hacking Road Caringbah South NSW 2229