Surgical Orthodontics

surgical orthodontics

Dr. Bruno has worked for over 22 years with oral/maxillofacial surgeons from Seattle to Los Angeles to provide treatment in which orthodontics is combined with oral surgery to correct problems impossible to correct with orthodontics alone. The recommendation of surgical orthodontics often “blind-sides” people who are initially shocked that such a radical-sounding solution is proposed. But in thinking this through, a large proportion of the more severe bite problems and cosmetic compromises of the teeth are the result of an underlying disproportion of the jaws.

The usual reasons for recommending surgical orthodontics are:

  1. A malocclusion (bite problem) that cannot be corrected by orthodontics alone.
  2. A desire to change a facial appearance such as:
    1. Lower jaw set back in relation to a more prominent upper jaw. Often this appears to be protrusion of the upper front teeth when in actuality it is a deficiency of the lower jaw.
    2. Lower jaw appears prominent or upper jaw is deficient. This often results in an underbite, where the lower front teeth close in front of the uppers.

Two general situations with regard to surgical orthodontic recommendations

  • Surgical orthodontics may be the best possible outcome for moderate jaw disproportions, but a reasonable non-surgical compromise may be achievable with conventional orthodontic care. In these instances the bite may be fully corrected although the jaw disharmony remains.   The before/after photo below demonstrates an instance where surgery was recommended as the best treatment, but a non-surgical compromise made a nice improvement in facial appearance using TADs.  There is information about TADs elsewhere on this site.

Surgical Orthodontics

  • In the more severe instances, surgical orthodontics may be the only answer if a full correction is the goal. The following sets of before/after photos are patients that require surgical orthodontics for a complete correction. The first was treated for a deficient lower jaw. The second for a deficient upper jaw. Both achieved satisfying improvements.

Surgical Orthodontics


Surgical Orthodontics


At what age might surgical orthodontics be planned?

Surgical orthodontic care is usually undertaken only after the end of growth of the jaw. This averages age 16 in women and 18 in men, although it may be earlier or later for certain individuals. Either Dr. Bruno or the oral/maxillofacial surgeon involved will perform diagnostic tests to determine if growth has ended.

How does orthognathic surgery work?

Dr. Bruno will prepare your teeth before surgery by using braces to set the teeth so they will meet and function properly once the surgery corrects the jaw position. This may require from a few months up to a year. The braces remain on during and after the surgery. An oral and maxillofacial surgeon will then perform the surgery, usually at a hospital or surgi-center. Orthognathic surgery can take several hours, depending on each individual case.

You will need some time to recover from the surgery and this is quite variable. Your surgeon will advise you about that. After your jaw has healed, your orthodontist will “fine-tune” the corrections. Most patients continue orthodontic care from six to twelve months following surgery. Use of retainers will be important after the braces are removed.

What are the risks associated with orthognathic surgery?

As with any major medical surgery, there may be certain risks of having any surgery. Orthognathic surgery has been performed and improved for many years. Your oral/maxillofacial surgeon will be the primary person to answer most of your concerns, but we are happy to provide you with any additional information we can. Your comfort is important to us.

What are the rewards of having orthognathic surgery?

Orthognathic surgery patients often show remarkable changes in both their smile and their facial appearance. These changes are not possible with facial cosmetic surgery or non-surgical cosmetic procedures that do nothing to address the underlying disproportion. Whether it’s needed to correct a severe bite problem or a jaw abnormality, orthognathic surgery can help restore your confidence and leave you smiling with confidence for many years to come.