What is surgical orthodontics?

Just as orthodontics repositions teeth, there are some cases where the upper and lower jaw have not developed in a harmonious relationship making it impossible to fit the teeth together with orthodontic treatment alone. In these cases, surgical orthodontics (also known as orthognathic surgery) corrects jaw irregularities to improve the patient’s ability to chew, speak, and breathe and for improved facial appearances.  Moving the jaws also moves the teeth, so braces are always performed in conjunction with jaw correction. This helps make sure teeth are in their proper positions after surgery. About 1% of orthodontic patients would benefit from surgical orthodontic treatment.

Who needs surgical orthodontics?

Non-growing (ie. skeletally mature) patients with improper bites and those with facial aesthetic concerns. These patients are typically those where we are unable to correct the bite discrepancy with orthodontic treatment alone, though early interceptive treatment can eliminate the need for jaw surgery in many cases.  All growth must be completed before jaw surgery can be performed so that there are no changes to the bite once the surgery has been done. Because it can take 1-2 years to prepare the teeth for jaw surgery, we often will begin treatment 1-2 years before skeletal maturity (ie. ages 14 for girls and 16 for boys).

How does it work?

Surgery is performed in the hospital with an oral surgeon, and can take several hours, depending on the amount and type of surgery needed. In lower jaw surgery, the jawbone behind the teeth is separated and the tooth-bearing portion is moved forward or backward, as needed. In upper jaw surgery, the jaw can be repositioned forward or backward, or the jaw can be raised or lowered. Certain movements may require the jaws to be separated, with bone added/removed to achieve the proper alignment and stability. Other facial bones that contribute to alignment may also be repositioned or augmented.

When you have completed surgery, you should be able to return to school or work within two weeks. After the necessary healing time (about 4–8 weeks), we will “fine-tune” your bite just like in cases who receive no jaw surgery. In most cases, braces are removed within 6–12 months following surgery.

Sample scenarios of jaw surgery (note the changes in the positions of the lips and chin) can be seen below. While these are just a few scenarios, no two people are alike and the upper/lower jaws are precisely repositioned in three planes of space to properly fit together and provide the most ideal esthetic and functional result. The entire surgery is performed about 1 week prior on a set of plaster models then duplicated on the patient – it is important to get the jaw movements accurate to less than 1 mm.

• Deficient lower jaw
• Overgrown lower jaw
• Deficient upper jaw
• Combination upper & lower jaw
• Open bite
• Gummy smile

Patient Testimonials

After much deliberation, I decide that the surgical option would be the best choice from all the alternatives available to me. Dr. Shapiro took great care in explaining the details and goals of my treatment plan and addressing my concerns regarding the risks involved. Ultimately, the results of the surgery and orthodontic work far exceeded my expectations, greatly improving the feel, look, and function of my mouth. Also, I should mention that Dr. Shapiro and all his staff were always courteous and professional. They genuinely cared about my well-being and celebrated the excellent results of my treatment. – Robert G.

Surgery may seem daunting at first; however in my experience it was nothing to be afraid of. Hospital recovery was quick and painless. The biggest change for me was the liquid-only diet for the first two weeks. Still, it was a small price to pay for a great outcome. The surgery and outstanding orthodontic treatment provided by Dr. Shapiro and his team improved both the aesthetics of the smile and my self-confidence. I find that I am more open and smiling post-surgery. In addition, surgical orthodontics improved my bite, making it easier to chew and reducing my chances of developing joint deterioration in future. Overall the surgery was definitely worth going through and I would highly recommend it to those who would benefit from it. – Vasily G.

At first I was unsure and nervous about getting the surgery done, but Dr. shapiro did a great job at explaining me the entire process and what to expect. He made me feel a lot better about getting the surgery done and now that it is finished with I am very pleased with my results and I can’t believe the difference it has made in my appearance. I would recommend to anyone who is considering the surgery to get it done you will be amazed with the results. – Adam C.

For a long time I lived with a combination overbite and cross-bite that lowered my self-confidence, and made me uncomfortable eating around other people. I knew that, in my case, to fix the problems with my bite it wasn’t simply a matter of braces, but a process that involved several surgeries, an appliance, and braces. I was petrified. In fact, I had postponed my decision to proceed with treatment twice before I met with Dr. Shapiro and his team. Knowing they would provide the best treatment possible, I decided to move forward. The process was definitely challenging, and needless to say, I’m glad that it’s now complete. However, I’m also glad that I did proceed with treatment. I’ve regained confidence in my appearance, and much greater functionality with my bite. Many thanks to Dr. Shapiro and his team for their encouragement and support along the way! – Angela B.