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Surgical Orthodontics

Did you know that about 3-5% of population have facial and dental disproportions severe enough to be handicapping in function and /or social acceptability? With these patients, jaw function is often compromised. Extra effort is needed for successful chewing. Speech difficulty may also be present. Dental and facial appearance often leads to discrimination in social interaction.

If a discrepancy in the size or position of the jaws contributes to the malocclusion and is reflected in improper facial proportions, braces alone will not be able to provide good facial esthetics, proper function, and long term stable results.

So what makes a problem too severe for orthodontic treatment or braces alone? When is surgery indicated?

1. In a growing child - If the problem in a growing child can not be corrected by dentofacial orthdopedics (growth modification) and camouflage (improve teeth alignment without correcting the jaws problems) to the point that both interdigitation of teeth and facial proportions are acceptable.

2. In an adult -  If the jaw problem is too severe to obtain good facial esthetics and bite relationship by camouflage alone.  Taking some taking some teeth out to allow teeth movement to improve facial appearance alone in this case is not enough. 

3. If correcting the bite relationship is not an adequate description of successful treatment,  facial esthetics in these situations must be taken into account. In these unique cases, patient's facial esthetics will benefit tremendously.

What are some examples of problems may require surgery?

1. Extreme openbite is highly associated with a long face deformity. This is when there is at 6-7 mm of gap between  upper and lower front teeth when patients bite down 

2. Extreme overjet or horizontal overlap -  this is when the lower front teeth are too far behind the upper front teeth either because the upper jaw is too large or the lower jaw is too small. 

3. Extreme reverse overjet or underbite - this happens when the lower jaw is too large for the upper jaw or the upper jaw is too small. If the lower front teeth are at least 5-6 mm in front of the upper front teeth, surgically repositioning the jaw may be indicated. 

4. Extreme deepbite or vertical overlap - if the upper front teeth completely cover the lower front teeth because the lower jaw is too small, surgically repositioning the lower jaws will benefit facial appearance tremendously.