Facial asymmetry, where one side of the face does not perfectly mirror the other, is a common human trait. When the asymmetry becomes noticeable or affects function, individuals often seek orthodontic treatment, such as braces, to address the imbalance. The efficacy of braces in correcting an asymmetrical face hinges entirely on the underlying cause of the unevenness. Braces are a powerful tool for aligning teeth and influencing jaw position, but their ability to improve facial balance is limited by the location and severity of the discrepancy.
Understanding Facial Asymmetry: Dental Versus Skeletal Causes
Facial asymmetry is broadly categorized into two types: dental and skeletal, which determines the appropriate treatment path. Dental asymmetry arises from issues strictly involving the teeth and their alignment within the jawbones. This type often includes a functional shift, where the lower jaw moves sideways to accommodate a misaligned bite, such as a crossbite, resulting in a temporarily uneven facial appearance.
Skeletal asymmetry involves a physical difference in the size, shape, or positioning of the underlying jawbones themselves (maxilla or mandible). This structural imbalance can be caused by uneven growth, developmental conditions, or trauma. Skeletal issues represent a true difference in the bony framework that cannot be altered by moving teeth alone.
How Braces Correct Asymmetry Originating in Dental Alignment
Braces are highly effective when the facial unevenness is primarily due to dental asymmetry or a functional jaw shift. They work by applying continuous pressure to gradually move the teeth into their ideal positions. Correcting a malocclusion, such as a crossbite, removes the physical impediment that forces the jaw to shift to one side when closing.
The orthodontic process focuses on achieving a proper bite, which stabilizes the jaw joint and encourages the mandible to rest in a centered, more symmetrical position. Braces also correct midline deviations. By bringing the teeth into a harmonious relationship, the overall appearance of the lower face, including the alignment of the lips and chin, can be significantly improved.
Addressing Major Skeletal Discrepancies
The ability of braces to correct facial asymmetry is constrained when the imbalance is skeletal in nature. Braces function by moving teeth through the surrounding alveolar bone. They cannot change the fundamental size, shape, or position of the jawbones themselves.
In cases of severe skeletal discrepancy, such as laterognathism (where the entire lower jaw deviates significantly to one side), braces alone are insufficient. Even if the teeth are perfectly aligned, the underlying bony imbalance remains, meaning the chin and other facial features will still appear uneven. For these structural issues, the role of braces shifts from a corrective tool to a preparatory one, aligning the teeth to fit the eventual surgical plan.
Combining Orthodontics and Surgery
For individuals with significant skeletal asymmetry, a combined treatment approach involving orthodontics and orthognathic surgery is necessary to achieve a balanced result. Orthognathic surgery, often referred to as jaw surgery, is performed by an oral and maxillofacial surgeon to physically reposition the jawbones. This procedure is the only method that can correct the size, shape, and three-dimensional position of the maxilla and mandible.
The integrated treatment typically follows a three-phase sequence: pre-surgical orthodontics, the surgery itself, and post-surgical orthodontics. During the initial orthodontic phase, braces align the teeth within their respective jaws (dental decompensation), ensuring they will fit together correctly once the bones are moved. The surgeon then repositions the jawbones to align with the facial midline. Final, post-surgical orthodontics refine the bite to achieve long-term stability and optimal function.