Orthognathic, or jaw, surgery is a procedure designed to correct significant skeletal discrepancies in the jaw bones. It aims to improve bite function and facial aesthetics. Many associate jaw surgery with wearing braces, often for an extended period. This raises questions about whether orthodontic treatment is always a prerequisite.
Is Jaw Surgery Without Braces Possible?
Jaw surgery without traditional braces is possible in certain circumstances, though it is not the standard approach. The conventional method for orthognathic surgery almost always involves orthodontic treatment before and after surgery. However, advancements have opened alternative pathways for select patients. Whether surgery can be performed without braces depends on the individual’s dental and skeletal conditions and treatment goals.
The Traditional Jaw Surgery Process
The conventional approach to jaw surgery involves an orthodontic phase with braces. Patients usually wear braces for 12 to 18 months before surgery to align teeth within each jaw. This pre-surgical treatment, known as decompensation, positions teeth in a way that might initially appear to worsen the bite. This phase moves teeth into correct positions relative to their jaw bones, regardless of how they meet the opposing jaw.
Aligning teeth before surgery ensures that when jaws are surgically repositioned, they will fit together properly, resulting in a stable, functional bite. Following surgery, braces usually remain on for an additional 6 to 9 months to fine-tune the bite and ensure teeth settle into their final, corrected positions. This process requires close collaboration between an orthodontist and an oral and maxillofacial surgeon.
Scenarios for Jaw Surgery Without Braces
While traditional methods include braces, scenarios allow for jaw surgery with minimal or no pre-surgical orthodontics. One approach is the “surgery-first” technique, where jaw discrepancy correction occurs before extensive orthodontic alignment. This method provides immediate aesthetic improvement and can significantly reduce overall treatment time compared to the conventional approach. However, surgery-first is suitable for patients with well-aligned or mildly crowded front teeth and minimal discrepancies that allow for a stable bite after surgery.
Another scenario is “camouflage orthodontics,” a non-surgical approach that masks a skeletal discrepancy by moving only teeth. This is considered for patients with mild to moderate skeletal issues where the goal is functional correction rather than altering jaw structure. In rare instances, patients may have well-aligned teeth but misaligned jaw structure; in such cases, surgery might proceed without extensive pre-surgical orthodontics. However, surgical correction offers more stable and aesthetically pleasing outcomes for facial asymmetry compared to orthodontic camouflage.
Clear aligners, like Invisalign, offer an alternative to traditional braces for orthodontic preparation. These removable appliances prepare teeth for orthognathic surgery, offering aesthetic advantages and improved oral hygiene. Clear aligners can be digitally mapped to synchronize with planned surgical movements, and studies suggest they are as effective as traditional braces for achieving necessary dental and skeletal changes.
Important Considerations Before Surgery
Before any jaw surgery, especially approaches minimizing or forgoing braces, a comprehensive evaluation is necessary. This assessment involves an oral surgeon and an orthodontist, who use diagnostic imaging (X-rays, 3D CT scans, dental impressions) to develop a precise treatment plan. This examination helps determine suitability for different treatment protocols, including the surgery-first approach.
Not every individual is a candidate for jaw surgery without braces; suitability depends on the severity of jaw misalignment, existing dental alignment, and overall health. Minimizing or skipping braces can impact the long-term stability of surgical results and the functional and aesthetic outcome. A stable temporomandibular joint (TMJ) is also important for jaw surgery’s success and long-term stability. Therefore, a coordinated team approach involving oral surgeons, orthodontists, and other specialists is important. Patients must understand the advantages and disadvantages of each treatment option for their case to make an informed decision.