Some bite problems are so severe that orthodontics alone cannot correct them. These cases require orthognathic (jaw) surgery combined with orthodontics to surgically reposition the jaws into proper relationships. While more involved than orthodontics, jaw surgery can resolve severe functional problems and dramatically improve facial appearance.
When Jaw Surgery is Necessary
Jaw surgery becomes necessary when:
- Severe underbite: The lower jaw is excessively forward relative to the upper jaw
- Severe overbite: The upper jaw is excessively forward relative to the lower jaw
- Severe open bite: A gap exists between upper and lower teeth even when closing
- Facial asymmetry: Severe asymmetry where one side of the face differs from the other
- Functional problems: Severe difficulty chewing, swallowing, or breathing
- TMJ dysfunction: Significant jaw joint problems secondary to bite problems
- Esthetic concerns: Severe facial appearance problems affecting quality of life
Orthodontics cannot fix these skeletal jaw problems—only surgical repositioning works.
Pre-Surgical Orthodontics
Treatment begins with braces to align teeth within each jaw arch, though correcting the actual bite remains impossible without surgery. This pre-surgical phase typically lasts 18-24 months.
During this phase, your orthodontist works closely with the oral surgeon, planning the exact jaw movements needed.
Surgical Procedures
Common surgical procedures include:
Bilateral sagittal split osteotomy (BSSO): The lower jaw is surgically cut on both sides, allowing it to be repositioned forward or backward as needed.
Le Fort osteotomy: The upper jaw is surgically separated from the skull, allowing upward, downward, forward, or backward repositioning.
Bimaxillary surgery: Both upper and lower jaws are surgically repositioned to establish proper relationships.
The specific procedure depends on your bite problem and facial characteristics.
Surgery Timing
Surgery typically occurs after pre-surgical orthodontics is complete, usually when permanent teeth are developed but growth has stabilized. For adolescents, this is typically age 17-18 or older. Adults can have jaw surgery at any age.
Hospitalization and Recovery
Most jaw surgeries require 1-2 days hospitalization. Recovery is more involved than standard surgery:
- Initial healing: 2-4 weeks
- Diet restrictions: Liquid diet initially, progressing to soft foods
- Activity restrictions: 4-6 weeks
- Complete recovery: 2-3 months
Swelling is significant after jaw surgery, peaking around day 3-5. Bruising is common. Pain is managed with prescribed medications.
Post-Operative Bite Correction
After surgery, braces remain to fine-tune the bite and ensure proper alignment. This post-surgical orthodontic phase typically lasts 6-12 months.
During this phase, small adjustments are made as tissues heal and settle into their new positions.
Risks and Complications
Jaw surgery carries risks:
- Numbness: Temporary or permanent nerve damage affects sensation in the lower lip, chin, or upper lip depending on surgery type
- Bleeding: More extensive than routine surgery; usually controlled without complications
- Infection: Rare but possible; treated with antibiotics
- Non-union: Rarely, surgically cut bone fails to heal properly
- Relapse: Rarely, the jaw shifts back toward original position
Experienced surgeons minimize these risks significantly.
Functional Improvements
After jaw surgery and subsequent orthodontics, patients often experience:
- Dramatically improved chewing and eating
- Improved breathing and sleep apnea resolution (sometimes)
- Reduced jaw pain and TMJ dysfunction
- Improved speech
- Elimination of difficulty swallowing
These functional improvements often matter as much as appearance improvements.
Facial Appearance Changes
Jaw surgery creates dramatic facial appearance changes:
- Underbite correction can transform a recessed upper face into balanced proportions
- Overbite correction can change facial profile dramatically
- Correcting open bite closes the mouth comfortably, improving appearance
- Correcting asymmetry creates facial balance
These changes affect self-confidence profoundly for many patients.
Cost Considerations
Jaw surgery costs $15,000-$30,000+, including surgeon fees, anesthesia, hospitalization, and facility costs. Combined with pre- and post-surgical orthodontics, total treatment cost often exceeds $30,000-$40,000.
Insurance sometimes covers jaw surgery when deemed medically necessary for functional improvement. Coverage varies widely; clarify your benefits before committing to treatment.
Timing and Lifestyle Impact
The complete treatment process—pre-surgical orthodontics, surgery, and post-surgical orthodontics—typically takes 3-4 years. This is substantial time, but most patients feel the investment is worthwhile given the functional and appearance improvements achieved.
Psychological Impact
Jaw surgery patients report significant psychological benefits from improved appearance and function. However, the significant time investment and expense should be considered carefully before committing.
Is Jaw Surgery Right for You?
Discuss with your orthodontist and surgeon:
- Is your case severe enough to warrant surgery?
- What improvement would you expect?
- What are the specific risks for your case?
- What is realistic timing?
- What are costs and insurance coverage?
- Are you willing to commit to the extended treatment process?
Jaw surgery is a significant undertaking with potentially life-changing results when indicated. Thorough discussions with your treatment team help ensure this decision is appropriate.