The Role of Surgery in Orthodontic Treatment
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In some cases, to achieve full correction, a surgical procedure may be considered in combination with orthodontic treatment. Examples include:
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Jaw surgery, also called ‘orthognathic’ (or jaw straightening) surgery.
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Oral surgeries, such as surgical exposure or removal of teeth that are otherwise trapped under the gums.
These treatments require a number of specialists working together. Dr Fine works closely with Oral & Maxillofacial Surgeons and Periodontists depending upon the type of surgery needed.
This guide is intended to provide some introductory information regarding orthodontic treatment combined with oral-facial or jaw surgery.
Corrective Jaw Surgery: A Guide to Orthodontic Jaw Surgery
In some situations, full orthodontic correction cannot be achieved conservatively (i.e. without surgery). In cases where the jaws are incorrectly aligned, jaw surgery (orthognathic surgery) may be discussed as an option in order to align the jaw bones.
This may be the case in patients with significant underbites, overbites and open bites. In these cases orthognathic surgery may be used to change the shape and/or position of the jaw bones to correct jaw alignment and the bite.
Why is Orthognathic Jaw Surgery Performed?
Jaw surgery treatment involving combined orthodontic / orthognathic surgery is usually only undertaken in cases involving adults or older teens.
Parents of younger patients may be interested to learn that early orthodontic intervention can reduce the likelihood of jaw surgery being indicated at a later stage.
Some situations where orthognathic surgery may be an option include:
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Where there is a recessive lower jaw and/or weak chin
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To address a lower jaw that is excessively prominent
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Where the upper jaw is too large or too far forward (protruding upper jaw)
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Where the lower jaw is too small, or recessive
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To assist with jaw and chin alignment issues and asymmetries
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To help correct significant bite issues
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To address unbalanced facial appearance
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To help provide improved soft tissue support
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To assist with management of sleep apnea
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To reduce the appearance of a ‘gummy smile’ and improve lip function (which may present with a ‘long face’).
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To correct a severe, traumatic deep bite, or to improve incisal display on smile (which may be present with a ‘short face’)
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As part of an overall management plan in cleft lip and palate cases
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To correct some of the effects of jaw joint disease
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As part of restorative treatment following severe facial trauma
These surgical treatments are usually carried out in conjunction with braces or clear aligners. The orthognathic surgery corrects the larger discrepancy, while the braces or aligners fine-tune the teeth and the smile to function well in the context of the new jaw position/s.
What is Involved in Corrective Jaw Surgery?
Orthognathic Jaw Surgery Initial Consultation
Your first step in your othodontic / orthognathic jaw surgery journey will usually involve a consultation with a specialist orthodontist, who will undertake a detailed examination, and discuss potential orthodontic treatment options. Your options will vary depending on your unique needs, as well as your preferences and treatment goals.
If applicable in your case, the option of orthognathic surgery may be discussed for aesthetic and/or functional reasons. It is important to note that all types of surgery have potential risks, even when carried out by an appropriately qualified surgeon.
Should you wish to explore a surgical option, the next step will usually include an introduction to an appropriately qualified and experienced Oral and Maxillofacial surgeon. At Fine Orthodontics, Dr Fine has extensive experience working closely with some of Sydney's top specialist jaw surgeons. We will connect you to a surgeon who has experience with cases similar to yours, and we will work closely with them to plan the required orthodontic / orthognathic surgery movements needed to achieve your treatment goals.
After discussing your options with us at Fine Orthodontics, if you are keen to consider orthognathic surgery as an option, you will attend a separate consultation with the surgeon, who will undertake their own examination and assessment, and is the best person to provide you with specific advice regarding the procedure.
The surgeon will be able to provide you with information regarding:
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the procedure and associated risks,
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anaesthesia and pain relief,
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your expected length of hospital stay,
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advice regarding arranging for time off work or school,
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financial information,
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other general information regarding what to expect before, during, and after the surgery and recovery period.
Your surgical consultation is a great opportunity to learn and ask questions, and can help you to decide if jaw surgery is the best option in your case, with regard to your individual circumstances.
Orthodontic Surgery Treatment Planning
Should you decide to go ahead with a combined orthodontic / orthognathic surgery plan, the treatment planning for orthognathic surgery is usually carried out using a multi-disciplinary approach involving your Orthodontist, your Oral and Maxillofacial Surgeon, and possibly other dental or medical professionals depending on your needs.
Your combined orthodontic / orthognathic surgery treatment will be informed by your preferences and concerns, as well as your clinical diagnosis. Your specialists will take a variety of records, including clinical examinations, photographs, 3D X-rays and scans to assist with this planning. 3D models are also used to assist with precise treatment planning in preparation for surgery.
Pre-Surgical Orthodontic Treatment
Most orthodontic surgery cases commence with some initial orthodontic treatment in preparation for the new jaw positions. This usually involves lining up the teeth (addressing dental alignment) and often also includes ‘de-compensating’ teeth which are in incorrect positions due to underlying skeletal issues.
Your orthodontist will let both you and your surgeon know once all the pre-surgical movements are nearing completion, and advise that it is time to go ahead with making a date for the jaw surgery.
Your orthodontist and surgeon will communicate closely leading up to your surgery, and as the date of surgery approaches, you'll see the surgeon again for pre-surgical visits to ensure that all planned surgical movements are compatible with the new, improved alignment of your teeth.
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Any questions? Read our FAQs - Fine Orthodontics specialists cover all the most important topics.
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Do I need a referral to see an orthodontist? Read our blog post.
Types of Corrective Jaw Surgery
The specific type of corrective jaw surgery performed depends on the orthodontic and other anatomical issues present, as well as your desired results.
Some common types of jaw surgery performed in combination with orthodontic treatment are as follows:
Upper Jaw Surgery
May be considered in circumstances such as when the upper jaw is too far forward or back, to treat a skeletal asymmetry, or there are 'vertical' issues, e.g., a 'gummy smile'.
Upper jaw surgery can also improve support for soft tissue, further enhancing facial aesthetics (e.g., in some cases, upper jaw surgery can provide better support under lips). Examples of upper jaw surgery include:
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Maxillary Osteotomy - The upper jawbone (maxilla) may be moved forwards, backwards, downwards, or rotated.
If upper jaw expansion is indicated, the following procedure may be done instead (or in addition):
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Surgically Assisted Maxillary Expansion - This may be performed to facilitate expansion of the upper jaw.
Lower Jaw Surgery
May be an option in cases such as where the lower jaw is too far back or forward, or where there is an asymmetry. This type of jaw surgery can also provide improved support and aesthetics for soft tissue (e.g., can correct or reduce a 'double-chin' in some cases). Lower jaw surgery is also known as:
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Mandibular Osteotomy - The lower jawbone (mandible) can be lengthened, shortened or rotated.
Upper Jaw Surgery and Lower Jaw Surgery (together)
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Bimaxillary Osteotomy - Both the upper and lower jaws are treated in coordination to maximise functional and aesthetic results.
Chin Surgery
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Genioplasty - The chin can be moved forwards, backwards, vertically or rotated sideways to improve aesthetics and/or lip function. This procedure may be done in conjunction with upper or lower jaw surgery, or as a separate procedure.
A genioplasty is a little different to the other options listed above, as it won't change the way your teeth bite together. This means that it can sometimes be considered as an option independently of orthodontic treatment (so, possibly no need to do at the same time as your braces or aligner treatment).
For this reason, depending on their needs and preferences, some people consider having a genioplasty after, or even instead of having orthodontic treatment. It is sometimes done at the time of wisdom tooth removal.
Post-Surgical Orthodontic Treatment
Following your orthognathic surgery, additional months of post-surgical orthodontic treatment are usually required to fine-tune the bite and alignment. As with most other orthodontic treatments, retainer wear will be required once the active treatment has been completed.
Free* Orthodontic Assessment
At Fine Orthodontics, we are here ready to discuss your goals and needs. From your first visit, to the unveiling of your healthier, more radiant smile, we’ll be there to guide the way.
Get in touch with us with any questions regarding orthodontic treatment and orthognathic surgery, or schedule a visit with us to begin your journey:
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Orthodontic Surgery - Oral Surgery
Orthognathic surgery (jaw surgery) is not the only type of surgery which is sometimes carried out as part of an overall orthodontic treatment plan. In some cases, surgery is an option to assist with managing situations such as significantly off-course teeth which need to be uncovered or even extracted.
If a surgical procedure is indicated, your orthodontist will generally refer you to a qualified surgeon for a consultation.
The surgeon will be able to provide advice regarding the specific details of the recommended procedure, including an overview of possible risks and likely benefits as they relate to your specific case. It is important to remember that all surgeries involve risk, even when carried out by an appropriately qualified, experienced professional.
Orthodontic Surgery Before and After - Impacted Canine Tooth
At Fine Orthodontics, our 3d imaging technology plays an important role in preventing, diagnosing and managing orthodontic issues. In some cases, early detection means that relatively simple actions (such as removing a baby tooth) can avoid the need for more invasive procedures being indicated later in order to re-direct adult teeth which have drifted significantly off-course.
Off-course adult teeth have the potential to result in one or more of the following problems:
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They can becoming stuck under the gums, often jammed up against other teeth.
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They can cause damage to the roots of other adult teeth.
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They can come through in an undesirable position, such as in the place of another tooth, in front of the teeth (looking like a 'fang'), or behind the other teeth, sometimes even in the palate.
In the case below, a combination of orthodontic treatment and oral surgery was used to prevent off-course adult canine teeth from developing into more significant problems.
First Stage
Stage 1: Permanent canine teeth (circled) identified as headed in the wrong direction (correct path indicated by arrow).
Second Stage
Stage 2: Following intervention– Baby teeth have been removed and canine teeth have been guided back ‘on course’.
Third Stage
Stage 3: Review – Canines have grown into the mouth – they are now positioned for straightening with the rest of the teeth.
Areas We Serve in Sydney
Fine Orthodontics is your go-to place in Sydney with our two clinics located in Bondi Junction and Maroubra. Not only do we cater to these areas, but we also extend our quality services to those living in nearby suburbs. Our main goal is to make sure everyone has access to great orthodontic care, no matter where they live.
Bondi Junction
Level 8, 35 Spring Street
Bondi Junction NSW 2022 Sydney
Maroubra
Level 1, 633 Anzac Parade
Maroubra NSW 2035
Sydney
Understanding that it's not always easy for everyone to visit in person, especially if they live far away or have busy schedules, we've added a new feature called Remote Monitoring. This innovative service means that you don't have to visit us often in person. By using a simple phone app, you can take and send us pictures of your teeth. This way, Dr. Fine can see how your treatment is going and give feedback, all without you having to step into the clinic.
For those living or working in Sydney’s Eastern Suburbs, our locations are strategically placed so they're easy to access:
Municipality of Woollahra
Waverley Council
City of Randwick
Bayside Council
City of Sydney
Including the following suburbs of Sydney:
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Bondi Junction
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Queens Park
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Dover Heights
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Bellevue Hill
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Double Bay
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Rose Bay
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Vaucluse
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Bronte
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Bondi North Bondi
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Bondi Beach
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Tamarama
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Clovelly
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Randwick
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Waverley
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Watsons Bay
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Elizabeth Bay
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Potts Point
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Rushcutters Bay
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Darling Point
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Edgecliff
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Woollahra
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Point Piper
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Woolloomooloo
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Centennial Park
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Moore Park
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Paddington
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Sydney CBD
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Darlinghurst
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Surry Hills
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Eastlakes
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Banksmeadow
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Botany
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Kingsford
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Daceyville
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Kensington
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Coogee
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South Coogee
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Maroubra
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Pagewood
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Chifley
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Eastgardens
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Hillsdale
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La Perouse
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Little Bay
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Malabar
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Matraville
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Phillip Bay
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Port Botany
This is great news especially for students and staff from Sydney University and the University of NSW, as our clinics are nearby, making it convenient for check-ups and appointments.
Frequently Asked Questions (FAQs) About Orthodontic Jaw Surgery
Here are the most often asked questions about orthodontic surgery and surgical orthodontics in general.
What is orthodontic jaw surgery?
Orthodontic jaw surgery, also known as orthognathic surgery, is a procedure to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, and more. This surgery reshapes or repositions the jaws and teeth to achieve proper alignment and function.
Why might someone need corrective jaw surgery?
Jaw surgery is recommended for several reasons, including correcting severe overbites or underbites, assisting with the treatment of obstructive sleep apnea, addressing facial asymmetry, improving facial balance with the appearance of the profile, and repositioning misaligned or missing teeth.
Are braces or aligners required in conjunction with surgery?
Yes, in the majority of cases, jaw surgery is usually carried out in conjunction with braces or aligners. While the surgery corrects the major discrepancy, braces or aligners fine-tune the teeth and smile. There are some exceptions to this (e.g., chin surgery may be considered independently of orthodontic treatment).
What are the different types of corrective jaw surgeries?
The specific type depends on the issue at hand. Common types of jaw surgeries include Maxillary Osteotomy (upper jawbone), Mandibular Osteotomy (lower jawbone), Bimaxillary Osteotomy (both jaws).
Are there potential risks associated with jaw surgery?
All surgery involves some risk, even when carried out by a fully-qualified, experienced surgeon. The best way to understand the risks, and how they relate to your specific case, is to speak with a surgeon prior to making a decision to proceed with surgery.
What is the role of 3D imaging in orthodontic jaw surgery?
3D imaging technology is beneficial for diagnosing and managing jaw and tooth issues, ensuring precise surgical planning and maximising results..
How does jaw surgery impact facial appearance?
Jaw surgery can improve facial aesthetics by correcting imbalances, achieving symmetry, and optimising alignment, resulting in a more balanced and proportional appearance.
Where can I see the potential results of the surgery?
Before-and-after photos of actual patients can provide an idea of the transformations possible with orthognathic surgery, showcasing improved balance, symmetry, and alignment.
If you're considering orthodontic jaw surgery, it's crucial to consult with qualified professionals to understand all aspects of the procedure, including potential risks and benefits.
