The question of whether braces can fix an uneven jaw depends entirely on the underlying cause of the misalignment. An uneven jaw, known clinically as a malocclusion, can involve the positioning of the teeth or a structural issue with the jawbones themselves. Braces are highly effective tools, but their primary mechanism is to move teeth, so their ability to correct the jaw depends on the specific diagnosis. A thorough evaluation by an orthodontist, including X-rays and imaging, is necessary to determine the source of the problem and the appropriate treatment plan.
The Difference Between Dental and Skeletal Jaw Misalignment
Orthodontists categorize jaw misalignment into two fundamental types: dental (or dentoalveolar) and skeletal. A dental misalignment means the teeth are incorrectly positioned, but the underlying bone structure of the maxilla (upper jaw) and mandible (lower jaw) is correctly sized and aligned relative to the skull. In these cases, the crookedness or poor bite is strictly a problem of tooth position, which braces are specifically designed to correct.
Skeletal misalignment, however, involves a discrepancy in the size, shape, or position of the jawbones themselves. This can manifest as a severe overbite (Class II malocclusion) where the upper jaw is too far forward, or an underbite (Class III malocclusion) where the lower jaw protrudes excessively. Since braces move teeth within the bone, they cannot significantly change the size or position of the dense jawbone structure. Correcting a skeletal discrepancy requires orthopedic force or surgical intervention to reposition the bone.
Non-Surgical Orthodontic Methods for Jaw Correction
For mild to moderate jaw discrepancies, particularly in growing patients, orthodontists utilize specialized appliances alongside braces to apply orthopedic force. This process, known as growth modification or orthopedics, leverages the body’s natural development to guide the jaws into a more harmonious relationship.
One common tool is the palatal expander, which widens a narrow upper jaw by gently separating the palatine bone at its natural suture. This creates more space for teeth and helps correct a crossbite, where the upper teeth bite inside the lower teeth. Functional appliances, such as the Herbst or MARA devices, are also used to encourage the forward growth of the lower jaw to address certain types of overbites. These appliances connect the upper and lower arches to hold the jaw in a corrected position, promoting growth over time.
Orthodontic elastics, or rubber bands, are used with braces to apply continuous, light force between the upper and lower teeth. These elastics guide the bite into proper alignment by encouraging subtle shifts in the jaw position. While braces move the teeth, these auxiliary appliances apply force to the bone, making them effective for correcting mild to moderate jaw issues before skeletal maturity is reached. These options can often camouflage a slight skeletal issue by shifting the teeth to compensate for the underlying bone difference.
Comprehensive Treatment Requiring Jaw Surgery
For severe skeletal misalignments, especially in adults where jaw growth is complete, braces alone are insufficient to correct the structural problem. In these situations, the definitive treatment is orthognathic surgery, commonly known as corrective jaw surgery. This procedure involves physically cutting and repositioning the upper jaw, lower jaw, or both, to achieve proper alignment and function.
The overall treatment is a comprehensive, three-phase process integrating orthodontics and surgery. The first phase, pre-surgical orthodontics, involves wearing braces for approximately 12 to 18 months to align the teeth properly within each jaw arch. During this phase, the bite may temporarily worsen as the teeth are positioned correctly over the misaligned bone, preparing them to meet perfectly once the jaw is moved.
The second phase is the surgery itself, performed by an oral and maxillofacial surgeon under general anesthesia, usually from inside the mouth to avoid visible scars. The surgeon uses precise bone cuts, called osteotomies, to move the jaw segments into the planned position, securing them with small titanium plates and screws. Finally, the third phase involves several months of post-surgical orthodontics to fine-tune the bite and ensure the teeth settle into their new, corrected position. Braces are therefore a component of this treatment, but they serve to align the teeth, not to perform the major skeletal repositioning.
Why Age is the Determining Factor in Treatment
The patient’s age is the primary factor determining the appropriate treatment for an uneven jaw. This is because the biological potential for growth modification is limited to childhood and adolescence, before skeletal maturity is achieved. For children and teenagers whose facial bones are still developing, an orthodontist can use orthopedic appliances to guide the direction and amount of jaw growth, often preventing the need for future surgery.
Once a person reaches skeletal maturity, typically in their late teens or early twenties, the bones become dense and rigid, making growth modification impossible. At this stage, treatment options for significant skeletal discrepancies narrow considerably. The only way to correct a substantial bone misalignment is through either dental compensation, which involves shifting the teeth to mask the jaw problem, or through orthognathic surgery to physically move the mature bone. Early evaluation, often recommended around age seven, is beneficial as it maximizes the opportunity to use non-surgical methods to guide jaw development.