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Facial growth and jaw development set the foundation for how your teeth come together and how your face looks. When the upper and lower jaws do not develop in harmony, the result can be an off-centered bite, reduced facial symmetry, or visible imbalance between the midface and lower jaw. These differences are not purely cosmetic — they often affect how the teeth function together and how the muscles and joints of the face operate day to day.
Misaligned jaws can make chewing less efficient, interfere with clear speech, and in some cases contribute to airway problems that affect breathing. For some patients, the temporomandibular joint (TMJ) may be placed under abnormal stress, increasing the likelihood of discomfort, clicking, or limited movement. Recognizing these signs early allows clinicians to evaluate whether orthodontic care alone will be sufficient or if surgical correction should be considered.
Because jaw development varies from person to person, assessment is individualized. Providers look at skeletal proportions, dental alignment, facial aesthetics, airway status, and functional complaints. The goal of that evaluation is to determine which elements are dental, which are skeletal, and how each contributes to the patient’s concerns so an appropriate plan can be chosen.
Braces and clear aligners are powerful tools for moving teeth, but they have limits when the underlying jaw bones are out of proportion. Orthodontic mechanics can align teeth within the existing skeletal framework, but they cannot reliably move the jaws themselves. When the relationship between the upper and lower jaws is the primary driver of a bite problem — for example, a significant underbite, open bite, or facial asymmetry caused by jaw position — surgical orthodontics (orthognathic surgery) may be required to correct the skeletal foundation.
Choosing surgery is about addressing root causes, not just surface symptoms. If only the teeth are repositioned to mask a skeletal discrepancy, the result can be unstable or functionally compromised. A combined approach—orthodontics to align the teeth and surgery to reposition the jaws—aims to produce a stable bite, improved facial proportions, and better long-term oral health.
Decisions about whether to incorporate surgery take into account growth patterns, age, overall health, and patient goals. Adolescents may be evaluated for timing of intervention relative to growth, while adults are assessed for medical readiness and realistic expectations. In all cases, the choice rests on achieving the best balance of function, comfort, and appearance for the patient.
Successful surgical orthodontics depends on collaboration between specialists. The orthodontist first aligns the teeth so they will fit together properly once the jaws are repositioned. A skilled oral and maxillofacial surgeon then performs the corrective jaw procedure to reposition the skeletal bases. This teamwork extends through preoperative planning, surgery, and post-surgical orthodontic refinement to ensure each phase builds toward the intended result.
Planning often uses modern imaging and model techniques to visualize outcomes and anticipate how bone movement will affect the bite and facial appearance. The orthodontist and surgeon map out a timeline: pre-surgical orthodontics to align the arches, the surgical procedure itself to correct skeletal relationships, and post-surgical orthodontics to fine-tune tooth positions and settle the bite. Communication among team members keeps treatment efficient and predictable.
At every step, patient education and informed consent are central. The care team discusses expected benefits, the general course of recovery, and any clinical considerations unique to the individual. Because multiple disciplines are involved, patients benefit from a coordinated plan that balances the technical demands of surgery with the orthodontic stages needed for a lasting and functional outcome.
The pathway to corrective jaw surgery typically begins with a comprehensive evaluation: dental records, facial and dental photographs, dental models, and specialized radiographs. During the pre-surgical phase, orthodontic appliances are used to position the teeth so they will interlock correctly after the jaws are moved. This phase can last several months and is essential for achieving the surgical objectives.
On the day of surgery, procedures are performed by an oral and maxillofacial surgeon in a controlled surgical setting. Surgical techniques vary depending on the correction needed — the upper jaw, lower jaw, or both may be repositioned. In most cases the surgeon works through intraoral incisions, so external scarring is minimized. Hospital stays and immediate postoperative protocols depend on the case complexity and the surgeon’s standard practices.
Recovery includes both the surgical healing period and a post-surgical orthodontic phase. Initial healing focuses on swelling control, pain management, and gradual return to normal function. As the jaws heal and the bite stabilizes, the orthodontist resumes adjustments to refine tooth positions and ensure the occlusion settles as planned. Follow-up visits remain important for monitoring healing, occlusal stability, and overall progress.
When performed for the right reasons and planned carefully, surgical orthodontics can improve chewing efficiency, speech clarity, and facial balance. It can also address functional problems such as severe malocclusion and certain airway concerns that are related to jaw position. Many patients find that correcting the skeletal foundation of the face produces both functional improvement and a more harmonious facial appearance.
Realistic expectations are essential. While surgery can produce substantial improvements, outcomes depend on individual anatomy, compliance with the treatment plan, and post-surgical healing. The team will review potential risks and the typical recovery timeline so patients understand what to expect and can participate actively in the process.
Long-term success also depends on retention and routine dental care. Once teeth and jaws are positioned for optimal function, the focus turns to maintaining those results with appropriate retainers, periodic evaluations, and attention to dental health. With careful planning and follow-through, surgical orthodontics offers a durable solution for complex bite and skeletal issues.
At Longo Dietz Orthodontics our goal is to offer thoughtfully planned, evidence-based care that aligns aesthetics with function. If you have concerns about jaw alignment, bite problems, or breathing issues related to jaw position, please contact us to learn more about whether surgical orthodontics may be appropriate for you. Our team can guide you through the evaluation process and explain the steps involved in a combined orthodontic and surgical approach.
Surgical orthodontics, also known as orthognathic surgery, combines orthodontic tooth movement with corrective jaw surgery to address skeletal discrepancies that braces or aligners alone cannot correct. Traditional orthodontics moves teeth within the existing jaw structure, while surgical orthodontics repositions the jaw bones to establish a stable skeletal foundation for the teeth. This combined approach targets both function and facial balance rather than treating tooth position in isolation.
The goal of surgical orthodontics is to create a functional bite, improve chewing and speech, and enhance facial proportions when skeletal issues are the primary cause of a malocclusion. Treatment is planned jointly by an orthodontist and an oral and maxillofacial surgeon to align the dental arches before surgery and refine the bite afterward. At Longo Dietz Orthodontics we emphasize careful evaluation and coordinated planning when a surgical solution is indicated.
Candidates for surgical orthodontics are patients whose bite problems are driven primarily by jaw position rather than by tooth alignment alone, such as significant underbite, open bite, severe overbite, or notable facial asymmetry. Individuals who experience functional issues like difficulty chewing, chronic TMJ symptoms, or airway concerns related to jaw position may also be considered. A comprehensive clinical and radiographic evaluation helps determine whether skeletal correction is necessary.
Age, growth status, overall health, and patient goals factor into candidacy decisions; many adults who have completed growth are appropriate candidates, and some adolescents may be timed for surgery after growth is complete or managed in staged care. The evaluation process distinguishes dental versus skeletal contributors to the problem so that the treatment plan addresses root causes rather than temporary cosmetic solutions.
Coordination begins with a joint diagnostic phase where the orthodontist and surgeon review records, radiographs, and models to create a unified treatment plan that sequences pre-surgical orthodontics, the surgical procedure, and post-surgical refinement. The orthodontist prepares the teeth so they will fit together properly after the jaws are repositioned, and the surgeon defines the precise skeletal movements needed to achieve functional and aesthetic goals. Regular interdisciplinary communication and shared planning meetings keep timelines and objectives aligned throughout care.
Modern planning often uses three-dimensional imaging and virtual surgical simulation to visualize outcomes and anticipate how bone movement will affect the bite and facial contours. This shared planning reduces surprises and helps set realistic expectations for recovery and final results. Clear communication with the patient about each phase ensures informed consent and a coordinated experience from evaluation through retention.
A thorough diagnostic workup includes a clinical examination, dental and facial photographs, dental impressions or digital scans, and specialized radiographs such as panoramic and cephalometric images; three-dimensional CBCT imaging may be used when airway or complex asymmetry is a concern. The orthodontist assesses tooth position and occlusion, while the surgeon evaluates skeletal relationships and joint health to determine the extent of skeletal discrepancies. Assessment also considers airway function, temporomandibular joint symptoms, and facial aesthetics as part of a holistic evaluation.
The diagnostic phase clarifies which aspects of the problem are dental versus skeletal and informs timing and sequencing of treatment. Simulation tools and model setups help the team predict postoperative occlusion and facial changes, which aids in patient counseling and consent. Comprehensive records are essential for accurate planning and for documenting progress through pre-surgical and post-surgical phases.
Common orthognathic procedures include Le Fort osteotomies for repositioning the upper jaw (maxilla), bilateral sagittal split osteotomies for adjusting the lower jaw (mandible), and genioplasty to modify the chin for improved facial balance. The specific procedure or combination of procedures depends on the skeletal discrepancy being corrected and the desired functional and aesthetic outcomes. Most corrective jaw surgeries are performed through intraoral incisions, which minimizes visible scarring.
Surgeons select fixation methods and bone movement techniques based on the individual case and current evidence-based practices, and procedures may be performed on one jaw or both depending on the needs of the patient. The surgical plan is integrated with pre- and post-surgical orthodontics so that tooth positions will match the new jaw relationships. Detailed planning helps ensure predictable occlusion and facial proportion after healing.
On the day of surgery patients are admitted to a surgical facility where anesthesia is administered and final preparations are reviewed; the procedure length varies with complexity but typically takes several hours. Immediate postoperative care focuses on airway protection, pain control, and swelling management, with specific instructions for diet, oral hygiene, and activity restrictions. Hospital stay duration ranges from outpatient recovery to an overnight observation depending on the surgeon’s protocols and the case complexity.
Early recovery commonly involves facial swelling and temporary changes in sensation that gradually improve over weeks to months, and patients receive guidance on wound care, medications, and gradual return to normal activities. Follow-up appointments monitor healing and guide the transition back to regular orthodontic adjustments. Clear expectations about the recovery timeline and milestones help patients plan for support and time away from routine obligations.
As with any surgery, orthognathic procedures carry potential risks including infection, bleeding, adverse reactions to anesthesia, and delayed bone healing; nerve disturbances causing temporary or, less commonly, permanent altered sensation may occur in areas near surgical sites. Temporary difficulty with jaw movement, changes in bite that require orthodontic refinements, and scarring at intraoral incision sites are possible and are discussed during informed consent. The surgical and orthodontic team work to minimize risks through careful planning, sterile technique, and appropriate postoperative care.
Complication rates are generally low when procedures are performed by experienced teams, but patients should understand the specific risks relevant to their case and follow postoperative instructions closely to support healing. Regular follow-up allows the team to detect and manage any issues promptly. Open communication about symptoms during recovery helps the care team intervene early if concerns arise.
Jaw position can influence the size and shape of the upper airway, and in some patients advancing the lower jaw or repositioning the upper jaw can improve airway patency and reduce symptoms related to obstructive sleep-disordered breathing. Evaluation for airway-related concerns is part of the diagnostic process when breathing problems or snoring are reported, and cephalometric or CBCT imaging can help the team assess airway anatomy in relation to skeletal structure. Surgical changes intended to correct airway obstruction are planned carefully to balance functional benefit with overall facial harmony.
Not every patient with sleep-disordered breathing is a candidate for orthognathic surgery, and decisions are made in collaboration with medical sleep specialists when appropriate. When surgery is appropriate and performed as part of a comprehensive plan, patients may experience measurable improvements in airway function and related symptoms. Ongoing monitoring and adjunctive therapies may still be recommended depending on individual needs.
Timing depends largely on skeletal growth status; adolescents are typically evaluated for surgery after significant facial growth is complete to avoid relapse from continued growth, while some growth-modification approaches may be used earlier in developing patients to reduce the severity of later surgical needs. Adults who have reached skeletal maturity and are in good general health are commonly considered stable candidates for orthognathic surgery. The treatment team assesses growth patterns, dental development, and the urgency of functional problems when recommending timing.
Staged treatment plans may be used when patients require orthodontic alignment before surgery or when early orthopedic interventions are appropriate for growing patients. Clear discussion of timing, expected benefits, and impact on daily life helps patients and families make informed decisions. The ultimate objective is to perform definitive corrective procedures when they will produce stable, long-term results.
Long-term success depends on proper retention, routine dental care, and adherence to postoperative instructions provided by the orthodontist and surgeon, including wearing retainers as directed to preserve tooth positions relative to the new jaw relationships. Periodic follow-up visits allow the team to monitor occlusal stability, jaw function, and oral health, and to address any late changes or concerns proactively. Maintaining good oral hygiene and regular dental checkups supports the durability of surgical orthodontic outcomes.
The orthodontic phase after surgery often includes final refinements and a transition to retention that may last for several months to years depending on individual needs, and behavior such as parafunctional habits can affect long-term stability. Patients are encouraged to remain engaged in their care plan and to contact the practice for questions or changes in function. For consultations or to learn more about combined orthodontic and surgical care, the practice can schedule an evaluation to review individualized options with you.
