Orthodontists Play a Key Role in Orthognathic Surgery Outcomes

Why Braces Are an Important Part of Jaw Surgery

Orthognathic (or-thog-NATH-ik) surgery is the technical term for corrective jaw surgery. The word “orthognathic” comes from the Greek words orqos (meaning “straighten”) and gnaqos (meaning “jaw.”) Almost 5% of the population have conditions that require this type of surgery.

Although the surgery itself is performed by oral and maxillofacial (OMS) surgeons, Dr. Burke and Dr. Redford work closely with the jaw surgeon as part of an interdisciplinary team. Burke & Redford Orthodontics are tasked with performing the orthodontic treatments that guide the surgery and help to ensure a successful outcome.

During surgery, the jaw can be lengthened or shortened, moved up or down, rotated, or shifted in or out. The result is a better bite and improved facial appearance. The surgery itself typically requires a two to four day hospital stay, but the entire treatment process can last several years.

What Conditions Does Orthognathic Surgery Treat?

Orthognathic surgery is used to straighten a misaligned jaw and correct skeletal and dental deformities. The primary purpose of the surgery is to fix severe malocclusions that can cause problems with speaking, chewing, and breathing. Malocclusions are the imperfect positioning of the teeth when the jaws are closed.

Corrective jaw surgery is used to treat:

• Severe jaw size mismatches where the bite cannot be corrected with traditional orthodontics alone. Common jaw size mismatches include:
  • Underbite or a protruding jaw (lower jaw sets ahead of the upper jaw)
  • Overbite or a receding lower jaw and chin (lower jaw sets behind the upper jaw)
  • Crossbite (upper jaw narrow relative to the lower jaw)
  • Open bite (excess downward jaw growth resulting in excess vertical space between upper and lower front teeth when biting down)
• Difficulties associated with chewing, biting, or swallowing food
• Inability of the lips to meet without straining
• Excessive wear of the teeth
• Chronic jaw pain or jaw joint pain and headaches
• Sleep apnea (breathing problems that occur when sleeping, including snoring)
• Chronic mouth breathing
• Unbalanced facial appearance from the front or side
• Excessive gum display on high smile (smile gumminess)
• Birth defects
• Facial injuries
• Tumors or pathologies involving the jaw.

Why Are Braces Needed for Jaw Surgery?

Bite problems that involve only the teeth or those that are a result of mild or moderate jaw size mismatch can usually be corrected by braces. For these cases, early detection and treatment by an orthodontist may prevent the need for jaw surgery. However, if the jaw and teeth are severely out of alignment, surgery may be required.

Patients who need jaw surgery typically wear braces before, during, and after the surgery. Braces play a crucial role in having a successful surgical procedure.

• Before Surgery. Braces are used to move the teeth to where they need to be once the jaw surgery is completed. The braces also help to level and align the teeth for the operation. X-rays, models, and pictures of the teeth are used to guide the movement of teeth with braces so the teeth are correctly aligned with the jaw prior to surgery.

• During Surgery. In the past, patients had to have their jaw wired shut after surgery. This is no longer the case. Nowadays, the jaw surgeon uses the braces to attach small elastic bands that will keep the jaw in place during the healing process.

• After Surgery. Once the jaw is healed, the braces stay on while the orthodontist makes finishing touch adjustments to place the teeth in their final positions. Once the braces are removed, retainers keep the patient’s teeth in place.

Understanding TMJ and Related Disorders

The temporomandibular joint (TMJ) is a sliding hinge joint that connects the lower jaw bone (mandible) to the base of the skull. Everyone has two of these joints, located just in front of the ears on each side of the skull. These joints are what permit the jaw to move up, down, forward, backward, left, and right.

The term “TMJ” refers to the joint itself—not the problems that are associated with the jaw and its related muscles. These problems are known as temporomandibular disorders (TMD). Many people erroneously call these disorders by the joint name instead.

TMD is more common among women than men, particularly women of child-bearing age. TMD can be temporary or last for years. Problems can arise in one or both of the joints. However, in many cases, the pain can be very uncomfortable.

TMD can be caused by:

• Teeth grinding
• Clenching jaw at night
• Stress
• Arthritis in the joint
• Hormonal influences or imbalances
• Dysfunction or Injuries to the jaw, the joint, or neck muscles.

Common symptoms of TMD include:

• Ear and jaw pain
• Jaw pop (popping sounds when moving the jaw)
• Jaw clicking
• Jaw aches
• Tooth and jaw pain
• Jaw bone pain
• Lockjaw (either open or closed)
• Swelling on the side of the face
• Headaches, neck aches, or toothaches.

These symptoms do not always mean a patient has TMD or requires orthognathic surgery. For example, teeth grinding (bruxism) can sometimes be caused by stress and anxiety, but it might also result from an abnormal bite or crooked teeth.

Clicking in the jaw can be a symptom of TMD, but it can also be caused by opening the mouth too wide when eating or yawning. If there is no underlying pain and discomfort, chances are that it is not TMD.

By contrast, ear pain in adults is unlikely to be from an ear infection. The pain could actually be coming from the teeth or the temporomandibular joint, which is located near the ears. This is known as “referred” pain.

To determine if symptoms are related to TMD, patients should be examined by an orthodontist or oral surgeon. These professionals will be able to determine what is causing the problems and what treatment might be needed.

Many of the causes of TMD can be corrected with orthodontic treatments, such as nightguards or braces. However, if the causes are related to a misaligned jaw, then surgery may be necessary.

Burke & Redford Orthodontics: A Critical Part of Your Orthognathic Surgery Team

Dr. Burke and Dr. Redford have over 30 years of experience working with oral surgeons to correct problems with the jaw. They will be able to assess whether surgery is required, discuss available treatment options, and refer you to an experienced oral surgeon.

If surgery is the best treatment option, Dr. Burke and Dr. Redford will work closely with your surgeon to determine and implement an appropriate treatment plan unique to your presentation. Because this type of surgery can be part of a multi-year process, Burke & Redford Orthodontics is committed to being by your side throughout the entire journey.

Contact Burke & Redford Orthodontists in Temecula or Lake Elsinore by calling our main office at (951) 699-8011 or fill out the consultation form on our website anytime.