When you are referred to see an orthodontist, the first things that comes to mind are usually braces, rubber bands, expanders, and maybe even extractions (pulling teeth). Some patients who come to see me for pre-treatment evaluations are shocked when I mention that their treatment may also require jaw surgery. What is orthognathic surgery and who needs it?

Need for surgery determined by severity of problems
Some patients have crooked teeth but their jaws are in good position. Other patients have teeth that are pretty straight, but their jaws are not properly aligned. Then there are those with both crooked teeth and jaws that are out of alignment. If patients have jaws that are close to normal size and position, conventional orthodontic treatment using braces, elastics, expanders, and extractions is usually able to correct the problem. In cases of mild to moderate jaw-size discrepancies, teeth can be positioned to compensate for or “camouflage” the underlying discrepancy. In cases of moderate overbites for example, elastics, springs, or removing two upper teeth facilitates moving the top teeth backwards, the bottom teeth forwards, or a combination of the two. In cases of mild underbite, a patient may wear elastics or have two lower bicuspids removed to compensate for the mismatch. This camouflage approach is acceptable in over 95% of all orthodontic patients.

Jaw surgery is performed by an oral surgeon working with an orthodontist
Jaw surgery, officially known as orthognathic surgery (from “ortho” meaning straight and “gnathic” meaning jaw), is performed by another dental specialist called an oral surgeon. During the surgery, the oral surgeon carefully sections and repositions the bones of the face and jaw. This may be done for esthetic or functional reasons. Although patients commonly describe orthognathic surgery as having their jaws “broken,” the actual procedures are performed with a great deal of expertise and precision.

Two conditions require jaw surgery with orthodontics
In my opinion, there are two times when jaw surgery must be considered. The first is when a patient has such a severe skeletal discrepancy that braces alone (even with extractions) cannot produce an acceptable outcome. This happens in cases of severe “overbite,” moderate to severe underbites, and anterior open bites. There are other conditions that require surgery too, and they all have one thing in common. The skeletal problems are so severe that braces alone can’t produce an acceptable result. While these patients may choose not to have the necessary surgery, they know from the start that their final result will be compromised.

Suregery may be necessary to give your desired result
The other condition where I require surgery is when the patient’s chief concern cannot be addressed in any other way. For example, if a patient explains in the initial consultation that the main reason they are there is that their chin is too small, braces alone cannot give them a bigger chin. I might be able to reduce the size of their overbite with braces alone, but my brackets and wires will not change their profile no matter how gifted my clinical skills. Extremely prognathic (long) lower jaws, long facial types, or visible skeletal asymmetries are other examples of conditions that cannot be corrected with orthodontic treatment only.

What it comes down to is this. Braces move teeth but cannot move jaws. If a patient’s teeth are crooked but their jaws are close to normal, braces alone will typically do the job. If a patient has skeletal problems however, surgery may be needed to correct the discrepancy.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 30,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.