The question of whether braces alone can “fix” the jaw is complex, as the term “fix” can refer to correcting the alignment of the teeth or altering the underlying bone structure. Orthodontic treatment addresses malocclusions, such as overbites, underbites, and crossbites. The success of non-surgical jaw correction depends heavily on the patient’s age and whether the misalignment is primarily dental or skeletal. For many patients, especially those who are still growing, a comprehensive orthodontic plan can achieve significant, non-surgical changes to the jaw relationship.
How Braces Affect Dental Alignment
Traditional fixed braces, consisting of brackets and a tensioned archwire, are primarily tools for moving individual teeth. These appliances work by applying continuous, gentle pressure that triggers bone remodeling. Specialized cells break down bone tissue on the pressure side, while new bone forms on the opposite side, allowing the tooth to shift gradually. This process corrects issues like dental crowding, spacing, and rotations.
Braces can also use elastic bands connected between the upper and lower jaws to apply force to groups of teeth, improving how the top and bottom teeth meet (occlusion). In cases where misalignment is minor, correcting the position and angle of the teeth can effectively mask a slight skeletal issue. This dental camouflage moves the teeth to fit together correctly, even if the underlying bone positions remain largely unchanged, improving function and aesthetics. Fixed braces themselves do not physically move the jawbones.
Non-Surgical Jaw Correction with Orthodontic Appliances
While fixed braces manipulate individual teeth, non-surgical jaw correction focuses on guiding the growth and development of the jawbones, a process known as growth modification. This approach is effective only for children and adolescents whose facial skeletons are still developing and have not yet fused. The goal is to harmonize the growth rate and size of the upper jaw (maxilla) and the lower jaw (mandible).
Specialized appliances are used prior to or in conjunction with braces to achieve skeletal change. Functional appliances like the Herbst or Twin Block correct Class II malocclusions, where the lower jaw is recessed, causing an overbite. These devices hold the lower jaw forward, guiding the growth of the mandible to match the upper jaw. Studies suggest the fixed Herbst appliance may be more efficient at promoting mandibular bone movement than the removable Twin Block.
The palatal expander addresses a narrow upper jaw, which can cause a crossbite. The upper jaw consists of two bones joined at the midline suture, which remains pliable until late adolescence. The expander is fixed to the upper back teeth and uses a central screw mechanism to apply gentle pressure, incrementally widening this suture. This structural widening of the maxilla creates space for teeth and improves the relationship between the upper and lower jaws.
For an underbite, where the lower jaw protrudes, a reverse-pull headgear or facemask may be used in younger patients. This appliance applies forward force to the upper jaw, helping it catch up in growth. Orthodontists use these growth modification techniques around age nine to fourteen, when the patient’s growth potential is highest, often preventing the need for future surgical intervention.
When Orthognathic Surgery Becomes Necessary
Non-surgical methods have limitations once a patient has completed skeletal growth, typically around age fifteen to twenty-one. In a mature patient, the jawbones have fused, meaning growth modification appliances can no longer alter the underlying bone structure. Severe misalignment in these individuals is classified as a skeletal discrepancy, which cannot be corrected by moving teeth alone.
Conditions requiring a permanent structural change include severe overbites, underbites, facial asymmetry, or a bite that significantly impairs function. In these instances, orthognathic surgery (corrective jaw surgery) is performed by an oral and maxillofacial surgeon to physically reposition the upper jaw, lower jaw, or both. This procedure levels a misaligned foundation.
Even when surgery is required, braces are an integral part of the overall treatment plan. The orthodontist uses braces before the operation to align the teeth precisely within their respective jaws, ensuring they will fit together perfectly after the bone repositioning. Following surgery, braces are worn for several more months to fine-tune the bite. Orthognathic surgery is reserved for discrepancies too severe for dentally-focused orthodontics or when non-surgical growth modification is no longer an option.