Orthognatic treatment
In cases where there is a significant discrepancy in the position or size of the jaws, orthodontic treatment alone will not achieve significant aesthetic improvement, and may sometimes even worsen the situation. In such a case, orthodontic treatment must be combined with surgery during which the jaws will be aligned, so that at the end of the treatment we will have alignment between the jaws and also between the teeth.
The discrepancy in the position of the jaws can be congenital or acquired - usually due to an injury the child suffered at a young age that affected the growth of one of the jaws.
Conditions whose occurrence at a high level of severity require orthognatic treatment
1. Malpositioned jaw - one or both of the jaws are positioned too posteriorly, anteriorly or canted.
2. Open bite (anterior or lateral) - a condition in which the upper and lower teeth do not come into contact.
3. Cross bite - a condition in which the teeth close in the opposite direction, meaning that the lower teeth are in a forward position relative to the upper teeth.
4. Excessive exposure of gums when smiling (gummy smile) - This condition is usually caused by excessive growth of the upper jaw in a vertical direction.
5. Sleep apnea of moderate severity or greater resulting from a defect in the position of one or both jaws
The implications of jaws misalignment can be seen on 3 levels
1. Impairment of normal function - Due to the mismatch between the jaws, the quality of chewing may be impaired, and sometimes the quality of speech may be impaired and there may be difficulty pronouncing certain sounds correctly.
2. Aesthetic disturbance - Sometimes the jaw discrepancy, especially if it is large or accompanied by asymmetry (for example - deviation of the lower jaw to one side), will result in significant aesthetic disturbance. This disturbance may cause poor self-confidence and affect the individual's body image, and as a result of this situation, social difficulties may develop.
3. Health implications - in situations of underdevelopment or posterior position of the lower jaw - there may be significant effect to the quality of breathing to the point of sleep apnea. This is a life-threatening condition that requires therapeutic attention. Also at the dental level - a significant mismatch in the position of the jaws may cause increased occlusal load on some of the teeth, TMJ pain and an increased tendency to dental and gum diseases.
How is the examination and diagnosis conducted in cases requiring orthognathic treatment?
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Initial Orthodontic Examination
During this examination, the condition and need for orthognathic treatment are assessed. Not every case justifies orthognathic intervention. In some situations, despite intermaxillary misalignment, precise orthodontic treatment can significantly improve aesthetics and function, providing a satisfactory solution while avoiding surgery. -
Initial Surgical Consultation
If the orthodontic evaluation determines that orthognathic treatment is necessary, the next step is to consult with an oral and maxillofacial surgery specialist. This specialist will confirm the initial assessment and collaborate to outline the treatment plan. -
Referral for Additional Tests
To complete the orthodontic and surgical case documentation, additional diagnostic tools such as X-rays, photographic imaging, and simulations will be utilized as needed. -
Developing a Combined Orthodontic and Surgical Treatment Plan
At this stage, the orthodontist and maxillofacial surgeon will provide an overview of the proposed orthodontic and surgical treatments, discussing expected outcomes, common side effects, and potential risks. They will also determine which of the following two approaches will be used for the orthognathic procedure (following text).
Main Types of Orthognathic Treatment
A. Standard Orthognathic Treatment
In this approach, teeth alignment is performed before surgery. This includes three stages:
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Orthodontic Treatment
This stage focuses on aligning the teeth and positioning them correctly within their respective jaws. The average duration is 1–2 years. Completion of this stage signals readiness for surgery. -
Surgery
The surgery aims to achieve harmony and alignment between the jaws and their relation to the face and skull. This may involve one or both jaws, with various surgical options available for each. -
Post-Surgical Orthodontic Treatment
This phase involves final adjustments to optimize aesthetics and achieve a proper bite. In some cases, the results of the first two stages are excellent, eliminating the need for additional orthodontic work.
B. "Surgery First" Approach
In this method, the surgery is performed before orthodontic alignment. This includes two stages:
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Surgery
The surgery is performed to align and harmonize the jaws with each other and the face. -
Orthodontic Treatment
After the surgery, orthodontic treatment is used to align the teeth and correct the bite.
This approach is suitable for cases where surgery is essential, and the teeth are relatively straight, making the required orthodontic treatment less complex and ensuring that initial tooth positioning does not interfere with surgical outcomes.
How is the surgery performed?
The surgery is conducted under general anesthesia in a hospital operating room by a team of surgeons. It typically lasts several hours, depending on the complexity. Following surgery, patients are hospitalized for a few days, followed by a recovery period at home with detailed aftercare instructions.
The procedure does not result in visible scars, as all surgical access is performed through the oral cavity.