Chewing: People with jaw and bite problems often avoid certain foods that they are unable to bite into or completely chew their foods. As a result, many patients receive poor nutrition over time. By correcting these problems, orthognathic surgery patients can enjoy a healthier diet and eat a wider variety of foods.
Digestion: The digestive process begins in the mouth, where food is incised and crushed so that it can be properly digested once swallowed. A poor bite that doesn’t efficiently process food in the mouth may lead to problems with digestion. Treatment that improves chewing function may improve digestion.
Jaw and Jaw Joint Pain: People with certain jaw and bite problems, particularly a small lower jaw, may experience discomfort in their jaws or jaw joints. Often it is because they have developed a habit of protruding their jaw forward to form a better bite, or to hide the appearance of a weak chin. As a result, patients may experience tension in the jaw muscles and joints, eventually leading to jaw discomfort and headaches. Although it cannot be guaranteed, correction of these jaw and bite problems often reduces or eliminates jaw and jaw joint pain.
Tooth wear: Teeth that do not meet properly may eventually lead to excessive tooth wear. This is especially a concern for anterior open bite problems, where only the back teeth make contact. Correction of the dental malocclusion will help to protect the teeth from excessive wear.
Mouth breathing: Certain jaw problems that lead to difficulty bringing the lips together result in mouth breathing. While the jaw problem may not be the cause of mouth breathing (theories assert that mouth breathing from chronic nasal obstruction is the main cause of the jaw problem), the effect is often dry mouth and inflammation of the gum tissues. Corrective jaw surgery that allows the lips to come together without straining helps to reduce the inflammation caused by a chronically dry mouth.
OSA (obstructive sleep apnea): OSA is a problem of upper airway collapse during sleep. Not only does this condition impair good restful sleep leading to daytime sleepiness, but it also has other serious health consequences, including high blood pressure, heart disease, and depression. While corrective jaw surgery is not a first-line treatment for OSA, it may be an alternative when other treatments have failed or not well-tolerated by the patient. While this is particularly the case for individuals with recessed jaws, it may also be an option for those with OSA who have healthy jaw development.
In most cases, we do not proceed with orthognathic surgery on patients who have not completed skeletal growth, especially those with an underbite. Proceeding with surgery too early, before the jaw and surrounding structures have fully formed, may result in the need for additional treatment. Patients are more prone to growing out of the correction, and further surgery would be necessary realign the bit. There is no upper age limit for completing the treatment, as long as the patient is in good health.
Opinions differ regarding impacted wisdom teeth. It is our routine to have impacted lower wisdom teeth removed in young adult patients at least six months before orthognathic surgery involving the lower jaw, but longer is preferred. At this age, wisdom tooth removal usually presents the fewest complications, and the most common orthognathic surgery procedure on the lower jaw is easier without the presence of wisdom teeth. In older adults, wisdom tooth removal can be more complicated. In these instances, we may recommend removing the wisdom teeth during the same surgical procedure as the jaw realignment.
Orthodontic treatment is almost always needed. When the jaws are misaligned, the teeth naturally compensate somewhat for the skeletal problem. The teeth will crowd or tilt in a way that lessens the true extent of the skeletal misalignment. Before surgery, the orthodontist needs to move teeth into a position that allows for a correct bite when the jaws are surgically aligned. After surgery, the orthodontist must usually fine-tune the bite to create the best possible dental occlusion.
In some cases, it is possible to do orthognathic surgery on patients who desire or require concealed braces. This treatment may necessitate a temporary, fixed set of braces just for surgery and for a short time afterward. Alternatively, we may place temporary anchor devices (TADs) above and between the teeth for the necessary handles for the jaws. Your surgeon would need to confer with your orthodontist to determine if this treatment is possible.
The length of your treatment depends on how much preparation your orthodontist must do to prepare you for surgery. This process may take as little as a few months if the teeth are not overly crowded or misaligned, or it may take up to a year, especially if the plan calls for the removal of certain teeth and orthodontic closure of the resulting spaces.
Yes, your braces provide the necessary handles for the jaws during the procedure. Although it is seldom necessary to wire the jaws together after surgery, the jaws must be fixed together during certain parts of the operation. The braces facilitate this process.
Screws and plates are inserted to fix the jaws in their corrected alignment. We do not routinely remove these fixtures, even though a healed jaw does not require this hardware for strength. The screws and plates have the same titanium composition as dental implants, a biomaterial that has been studied extensively and has no ill effect on the body. Due to the small size of the hardware, most patients have no awareness that it is present. In the infrequent occasion that we must remove when a plate or screw, it can often complete the procedure in the office.
The length of surgery depends on upon the complexity of the case. Routine surgery on one jaw typically takes one to two hours. Surgery that involves multiple procedures may take as long as three to five hours.
While pain is an expected side effect of most surgery, many corrective jaw surgery patients tell us that their post-surgical discomfort was much less than they anticipated. We, of course, prescribe the pain medications you may need to transition through the recovery process with the least amount of pain as possible.
Swelling and bruising varies and may not be relative to the extent or complexity of the surgery. In general, younger patients tend to swell more and bruise less, while older adult patients tend to bruise more and swell less. Much of the swelling and bruising resolves within the first few weeks, but it may take up to a year for the swelling to completely resolve. Ice packs, elevation of the head while sleeping, and use of the facial muscles will help the swelling to resolve more quickly.
As with any surgery, patients should weigh the treatment risks against the treatment benefits before proceeding with corrective jaw surgery. These risks include but are not limited to pain, infection, decreased sensation or numbness, bleeding that could be potentially serious, jaw joint problems, and damage to normal structures such as the teeth, gums, and bone. There could be healing issues that may require more surgery, and there are certain risks associated with the general anesthesia that is necessary for corrective jaw surgery. We will discuss these risks in detail at your first visit.
Problems with the bite often go hand in hand with an imbalance in facial proportions, such as a weak or strong chin, or a gummy smile. Depending on the severity of the condition, appearance changes may range from subtle to significant. Swelling may mask these changes at first, but in time, the result will become apparent. We always plan the surgery for a result that appears natural and nonsurgical. The case studies illustrate some aesthetic changes that occur as a result of treatment.
Patients having uncomplicated surgery on one jaw often go home on the day of surgery. Patients who undergo a more extensive surgery should expect to remain in the hospital or aftercare facility overnight. If desired, a family member can usually stay with the patient overnight.
Most corrective jaw surgery patients will resume regular activity within a few weeks, but it will take a few months before you are ready to engage in contact sports and strenuous physical activities.
We begin to determine the answer to this question at your very first office visit. We do not contract with any insurance companies so, if your insurance plan only provides benefits for treatment by in-network doctors, then with few exceptions the surgery would not be covered. If your plan permits you to see any doctor, then all or part of your surgery may be covered. We are familiar with the terms of coverage for most of the major insurance plans, and we will assist you throughout the insurance process by submitting the necessary preauthorization and claim paperwork. If your insurance company denies benefits (corrective jaw surgery excluded from coverage or no benefits for out-of-network providers), we can discuss potentially affordable options.
To request a consultation and learn more about our services, please request an appointment now. We look forward to helping you improve your oral health and smile!