Patient Selection
Do You Need Orthognathic Surgery?
Orthodontic treatment — whether with braces or aligners — moves teeth within the alveolar bone. It cannot alter the underlying skeletal relationship between the maxilla and mandible. When the discrepancy between the upper and lower jaws is skeletal in origin rather than purely dental, attempting to compensate with tooth movement alone produces a compromised result: teeth tilted to their mechanical limits, an unstable occlusion, and often an unaesthetic facial profile.
Orthognathic surgery addresses the skeletal foundation directly. By repositioning the jaws into their ideal three-dimensional relationship — correcting anteroposterior, vertical, and transverse discrepancies simultaneously — surgery enables the orthodontist to align the teeth into a stable, functional, and aesthetic final occlusion that braces alone could never achieve.
Candidacy is determined through comprehensive cephalometric analysis, study models, CBCT imaging, and facial aesthetic evaluation. Digital surgical simulation (VSP — virtual surgical planning) allows the orthodontist and surgeon to visualize and plan jaw movements precisely before a single incision is made.
Common presentations that indicate surgical candidacy include significant Class II or Class III skeletal relationships, severe vertical dysplasia (open bite or deep bite of skeletal origin), facial asymmetry, and cases where dental compensation would compromise periodontal health or root integrity.
Clinical Indications
Conditions That May Require Surgical Correction
These presentations share a common characteristic: the underlying problem lies in the jaw skeleton, not in the teeth themselves. Orthodontic treatment alone cannot fully resolve them.
Skeletal Class III (Prognathism)
Mandibular overgrowth or maxillary deficiency resulting in a significant underbite. Dental compensation has clear limits — severe cases require mandibular setback, maxillary advancement, or both (bimaxillary surgery).
Skeletal Class II (Retrognathia)
Mandibular deficiency producing an excessive overjet with a recessed lower jaw. Mandibular advancement surgery — often combined with maxillary repositioning — corrects both the functional occlusion and facial profile.
Skeletal Open Bite
Vertical jaw discrepancy with no anterior tooth contact. When dentoalveolar compensation and aligner intrusion mechanics are insufficient, maxillary impaction surgery provides a stable, predictable correction with far lower relapse rates than orthodontic-only approaches.
Facial Asymmetry
Transverse or vertical jaw asymmetry producing a canted occlusal plane, midline discrepancy, or asymmetric facial appearance. Surgical leveling of the occlusal plane is the definitive treatment — orthodontics cannot address structural asymmetry.
Severe Vertical Excess (Long Face)
Excessive vertical maxillary growth producing an elongated lower facial third, lip incompetence, and often a gummy smile. Maxillary impaction surgery simultaneously addresses all three — reshaping the skeletal, dental, and soft tissue components together.
Failed Dental Compensation
Cases where prior orthodontic treatment attempted to camouflage a skeletal discrepancy through tooth movement, resulting in unstable occlusion, periodontal compromise, or relapse. Surgical decompensation followed by orthognathic surgery corrects the underlying problem definitively.
Collaborative Care
A Coordinated Team Approach
Orthognathic surgery requires seamless coordination between your orthodontist and an oral and maxillofacial surgeon. Both specialists are essential — neither can achieve the outcome alone.
Your Orthodontist's Role
Plans and executes pre- and post-surgical tooth movement. Coordinates arch forms so that when the surgeon moves the jaws, the teeth interdigitate correctly. Provides surgical splints to guide jaw positioning during the procedure, and manages final occlusal settling and retention after surgery.
The Oral & Maxillofacial Surgeon's Role
Performs the osteotomies — bone cuts — that free the jaw segments and allow repositioning. Common procedures include Le Fort I osteotomy (maxilla), bilateral sagittal split osteotomy (mandible), and genioplasty (chin). Uses rigid fixation — titanium plates and screws — to secure the repositioned segments in their new positions.
Virtual Surgical Planning (VSP)
Modern orthognathic treatment utilizes 3D CBCT data and digital surgical simulation to plan jaw movements with sub-millimeter precision before surgery. This technology allows the team to optimize outcomes, anticipate anatomical challenges, and produce custom surgical splints — significantly improving predictability and reducing operative time.
Ongoing Communication Throughout Treatment
Successful outcomes depend on continuous interdisciplinary communication. Your orthodontist and surgeon will coordinate at each critical transition — confirming surgical readiness before the procedure and monitoring stability throughout post-surgical treatment.
What to Expect
Surgery, Recovery & Results
Orthognathic surgery is a major procedure with a defined recovery arc. Understanding what lies ahead at each stage reduces anxiety and supports better outcomes.
PHASE 03A
The Surgery
Orthognathic procedures are performed under general anesthesia in a hospital or accredited surgical center. Incisions are made intraorally — inside the mouth — leaving no visible facial scarring. The jaw bones are carefully cut, repositioned to the pre-planned coordinates, and secured with small titanium plates and screws that remain permanently in place. Procedures may involve the upper jaw, lower jaw, or both simultaneously (bimaxillary surgery), with operative times ranging from 1.5 to 5 hours depending on complexity.
Performed under general anesthesia — inpatient procedure
Incisions placed entirely inside the mouth — no external scars
Titanium fixation hardware: permanent, MRI-compatible, undetectable
Hospital stay typically 1–2 nights post-procedure
PHASE 03B
Recovery
The initial recovery period requires planning and preparation. Swelling peaks at 48–72 hours post-surgery and gradually resolves over 4–8 weeks — though subtle residual swelling may persist for several months as tissues fully settle. Dietary restrictions (soft/liquid diet) are standard for the first 4–6 weeks to protect the healing bone and fixation hardware. Most patients return to school or desk work within 1–2 weeks; physically demanding activity is restricted for 6–8 weeks.
1–2 weeks off school or work recommended for initial recovery
Soft/liquid diet for 4–6 weeks post-surgery
Swelling peaks at 48–72 hrs; resolves over 4–8 weeks
All post-operative protocols provided by your surgeon
Orthodontic appointments resume 4–8 weeks after surgery
PHASE 04
Final Results
Post-surgical orthodontics typically continues for 6–12 months, guiding the teeth into their final occlusal positions within the newly corrected jaw relationship. The full aesthetic and functional result emerges progressively as swelling resolves and bone consolidates — often described by patients as a transformation that extends well beyond the teeth alone. Improvements in chewing efficiency, speech, airway, sleep quality, and facial profile are commonly reported outcomes. Retention follows the same protocol as all orthodontic treatment.
Post-surgical orthodontics: 6–12 months to final occlusion
Full aesthetic result visible as swelling resolves over months
Functional improvements: chewing, speech, airway, TMJ loading
Standard orthodontic retention protocol follows active treatment
