Surgical Orthodontics

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Approximately 5-7% of the population in the U.S. is believed to have facial skeletal deformities that result in incorrect relationships between the jaws. Frequently, orthodontic treatment alone will not provide the stable, ideal jaw and teeth relationship that these patients need. In these cases, orthodontic treatment in conjunction with orthodontic surgery, called orthognathic surgery, is the best solution. Orthognathic means ‘changing jaws’ and describes the interdisciplinary cooperation between orthodontists and oral surgeons.

Because Dr. Ingraham has been involved in treatment of severe orthodontic problems and has experience with cleft palate care, patients with severe malocclusions are frequently referred to us for combined orthodontic and orthognathic care. One of our goals for these patients is to make sure there are no mysteries involved for those who are committing themselves to surgical treatment.

There are several types of malocclusions (‘bad bites’) that may be severe enough to require surgical intervention. These include:

Overbite

  • Class II malocclusion
  • The upper teeth and jaw protrude forward of the lower teeth and jaw
  • Caused by an overgrowth of the upper jaw, a receding lower jaw, or both
  • Appearance – ‘buck tooth’ appearance, or a receding lower jaw (sometimes called a ‘weak chin’)
  • Braces combined with surgery provide the best combination of aesthetics and function.

Underbite

  • Class III malocclusion
  • The lower teeth and jaw protrude forward of the upper teeth and jaw
  • Caused by the under development of the upper jaw, over development of the lower jaw, or a combination of both
  • Appearance – facial profile is often concave, chin is prominent
  • Treatment is to correct the alignment of the teeth with braces and follow with appropriate surgical procedures

Crossbite

  • Transverse discrepancy
  • The upper teeth bite inside of the lower teeth
  • Patients often have a narrow, high palate
  • In a growing patient (child), correction can be achieved with a palatal expansion appliance; for patients whose growth is completed, surgical intervention may be necessary.

Gummy Smile

  • Maxillary vertical excess
  • The upper jaw grows down excessively
  • Appearance – the lips may not close when relaxed, the upper front teeth may appear too full, and an excessive amount of gum tissue is revealed during smiling
  • Often is seen in conjunction with other bite or jaw problems
  • May not be treatable with orthodontic intervention alone; may require jaw surgery

Openbite

  • Apertognathia
  • Teeth don’t meet properly when biting down
  • Results from the downward growth of the upper jaw which may affect muscle balance and further deformities of the upper and lower jaw
  • Possible causes include tongue thrusting, thumb or finger sucking, poor lip musculature, and/or nasal passage pathology
  • Patients frequently experience difficulty chewing and may experience TMJ/TMD problems.

Asymmetry

  • Usually develops from discrepancy between the growth of the left and right sides of the jaws
  • Causes include birth defect, trauma or personal habits
  • Appearance – facial imbalance
  • Requires a complete interdisciplinary analysis with oral surgeon and orthodontist; surgical correction is frequently needed to restore balance, function and appearance.

For conditions that require both orthodontic treatment and oral surgery, treatment normally begins with orthodontia. Dr. Ingraham uses orthodontic appliances to properly align the teeth so that when the jaw is surgically moved, the teeth will fit together properly. After surgery, further orthodontic treatment may be necessary to ‘fine tune’ the positioning of teeth.

Just as every patient is a unique individual, every case is different. However, a common case would involve:

  • 6 months of pre-surgery orthodontic treatment
  • Orthognathic surgical procedure
  • 6-12 months of post-surgical orthodontic treatment

In the last 30 years, since orthognathic surgery was introduced, there has been a continuous improvement in oral surgery techniques, technologies and materials. Orthognathic surgery may be the best way to correct a severe jaw deformity and improve function, appearance and quality of life.