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Orthodontic treatment with orthognathic surgery

We tell you how to correct your bite with maxillofacial surgery and show you the results of treatment
Extensive experience in solving complex cases
Treatment periods — from 2 years

Many patients with bite abnormalities give up when they learn that orthodontic systems alone will not be able to cope with their case. Not everyone knows that pronounced defects can be successfully treated by joint efforts of orthodontist and oral surgeon.

Orthognathic surgery — is the correction of pronounced skeletal bite abnormalities that orthodontic systems (braces, eliners) cannot cope with by surgery. If the orthodontist cannot camouflage bite pathologies by moving teeth within the jaws, they must be dealt with at the skeletal level, i.e. by moving the patient's jaws directly.

What are the dangers of bite abnormalities?

Abnormal jaw positioning can lead to a risk of improper distribution of the load on the teeth, which leads to premature wear of the teeth, as well as impaired function of the temporomandibular joint. Even the gastrointestinal tract can suffer, as food is not properly pulverized and leads to longer digestion, resulting in impaired GI function. Moreover, a misaligned bite can cause a change in posture, leading to back pain and even a change in gait.

Indications for orthodontic treatment with orthognathic surgery

Surgery is not resorted to in all cases of malocclusion, but only when it is skeletal. That is, the anomaly is not at the level of improperly standing teeth, but at the level of improper size and position of the jaws. Improper jaw alignment takes several forms:

  • Mesial bite — the lower jaw protrudes forward in relation to the upper jaw. In skeletal form, it is usually caused by either underdevelopment of the upper jaw or macrognathia (abnormal enlargement) of the lower jaw. A mesial bite is quite often an indication for orthognathic surgery.
  • Distal bite — the upper jaw is strongly forward in relation to the lower jaw, there is a large distance between the upper and lower front teeth, which is called “sagittal gap”. Severe forms of distal bite are also corrected by osteotomy surgery.
  • Deep bite — the upper teeth overlap the lower teeth by more than ⅔. This shape can be combined with a distal overbite.
  • Open bite — the lack of interlocking of a group of teeth at the front or sides. Often formed due to bad habits of putting the tongue or objects between the teeth or improper swallowing. Leads to inability to close the lips, facial asymmetry, and TMJ problems. Can be corrected by surgery if braces alone cannot cope. Distal bite — the upper jaw is strongly forward in relation to the lower jaw, there is a large distance between the upper and lower front teeth, which is called “sagittal gap”. The pronounced forms of distal bite are also corrected by osteotomy surgery. Deep bite — the upper teeth overlap the lower teeth by more than ⅔. This form can be combined with a distal bite. Open bite — lack of interlocking of a group of teeth in the anterior or lateral regions. Often formed due to bad habits of putting the tongue or objects between the teeth or improper swallowing. Leads to inability to close the lips, facial asymmetry, and TMJ problems. Can be corrected by surgery if braces alone cannot cope.
Correction of mesial open bite
Correction of distal bite

Types of orthognathic operations:

By the scope of the intervention:

  • Single-jaw operations
  • Double-jaw surgery

By area of intervention:

  • Osteotomy — correction of the lower or upper jaw in width and inclination
  • Genioplasty — correction of the chin to create a more harmonious profile and face shape.
  • A palatal suture osteotomy or SARPE – a technique used to widen the upper jaw. The treatment involves a one-stage tear of the palatal suture and its subsequent retention.
Method SARPE

Age restrictions for maxillofacial surgery

Maxillofacial surgery is most often performed in adulthood. Due to the fact that children and adolescents are at the stage of intensive jaw growth, it is possible to perform effective orthodontic treatment with braces or eliners and stop the development of skeletal pathology.

Stages of treatment with orthognathic surgery:

As a rule, orthodontic treatment with surgery necessarily involves an orthodontist and an oral surgeon, because for an effective and stable result, it is not enough to correct the position and size of the jaws — it is also necessary to put the teeth in the correct position with braces to ensure a correct bite and straight teeth after surgery.

  1. Consultation with an orthodontist. The first step in such a large and complex treatment — is to find a doctor you can trust and with whom you will be psychologically comfortable. At the consultation, you get to know the doctor, fill out a detailed questionnaire.

  2. Orthodontic diagnosis. The doctor's task at this stage — to assess the possibility of correcting the bite without surgery based on the results of diagnostics and calculations. For calculations necessarily need a 3D-scan — volumetric image of the entire head, which will assess: the position of the teeth, roots, jaws, the volume of bone tissue, etc. In addition, the doctor takes impressions in order to make models and calculate the position of the jaws in relation to each other and in the skull.

  3. Sending the data to the maxillofacial surgeon. After all the tests and calculations have been performed, the orthodontist discusses the treatment plan with the patient, referring them to the maxillofacial surgeon with the diagnostic models already in place.

  4. Personal consultation with the maxillofacial surgeon. At the first meeting, the doctor gets to know the patient and presents a plan for the further course of treatment. The patient's task at this stage – to agree on the surgical intervention and familiarize himself with the procedure of preparation for surgery, and subsequently and rehabilitation after it.

  5. Placement of braces to align the teeth before surgery. After coordinating treatment with the surgeon, the orthodontist places braces on the patient to form the correct teeth for the success of the surgery. The duration of pre-surgical orthodontic treatment is determined by the orthodontist, averaging six months to a year.

  6. Surgery. The nature of surgery depends on the clinical situation, but all are performed with the brace system in place.

  7. Rehabilitation. During rehabilitation, the brace system performs the function of splinting – to fix and properly heal the bones of the jaw.

  8. Detailed orthodontic treatment. After rehabilitation, the orthodontist will lock the patient's teeth into the correct position, detailing the position of the teeth to form a beautiful smile.

  9. Removal. When proper positioning and alignment of the teeth has been achieved, the orthodontist removes the braces and places the retainers. We also recommend professional oral hygiene to completely remove any residual retainer material and thoroughly polish the teeth after braces.

The clinic «Konfidencia» has a long experience of working with a freelance oral and maxillofacial surgeon with whom a large number of clinical cases have been successfully completed during the joint collaboration.

Profile change after orthognathic surgery

How maxillofacial surgery goes: from preparation to rehabilitation

The maxillofacial surgeon develops his own treatment plan and performs the necessary calculations in cooperation with the orthodontist who referred the patient. After all the data for the operation is known, the patient returns to the orthodontist to prepare for surgery — treatment on the bracket system. After the task of aligning the teeth and placing them in the correct tilt is completed, the moment of maxillofacial surgery comes. The patient undergoes surgery without removing the braces.

Maxillofacial surgery is performed under general anesthesia. The surgeon provides operative intraoral access, which allows not to leave scars on the patient's face.

  • In lower osteotomy, bone incisions are made in the area behind the chewing teeth.
  • At the top — above the upper teeth under the eye sockets.
  • In a genioplasty, a portion of the chin bone is either cut away and placed in the correct position or augmented additionally if there is a deficiency.

After the incision is made and the parts of the bone are placed in the correct position, they are cemented together with titanium plates or screws until the bones are naturally fused.

After surgery, the patient's jaws must be splinted for the duration of the hospital stay (an average of one week). After discharge, there is a home rehabilitation phase, which lasts about two weeks. During this period, any chewing movements should be avoided.

Results of treatment with orthognathic surgery:

Bicuspid osteotomy
Bicuspid osteotomy
Thanks to maxillofacial surgery, even the most complex jaw pathologies, which used to be a verdict for the patient, can be solved today.
Diagnostic consultation with a leading orthodontist
  • A detailed treatment plan in 1.5 hours
  • Planning according to the concept of accelerated treatment
  • Personal curator's help
4 900 rub
10 000 rub

Cost of complex orthodontic treatment

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08.10.2022
Updated 31.12.2023