The simple answer to whether orthodontists perform surgery is generally no. They are highly specialized dentists who focus on the movement and alignment of teeth and jaws through non-surgical methods. Orthodontics corrects dental and facial irregularities, known as malocclusions, using appliances that guide teeth into proper positions. While they do not operate, orthodontists frequently collaborate with surgical specialists for complex cases involving underlying bone structure, ensuring a comprehensive approach to address both tooth alignment and skeletal discrepancies.
The Non-Surgical Focus of Orthodontics
An orthodontist’s expertise lies in the biomechanics of guiding tooth movement and modifying jaw growth, skills acquired through extensive post-dental school training. After earning a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree, they complete an additional two to three years of specialized residency in orthodontics and dentofacial orthopedics. This focused education prepares them to diagnose and treat complex alignment issues.
The primary tools of an orthodontist are non-invasive appliances that apply gentle, consistent pressure over time to achieve gradual changes. These include traditional metal and clear braces, which use brackets and wires to shift teeth, and clear aligner systems. They also utilize specialized devices like palate expanders to widen the upper jaw and functional appliances to influence the growth direction of the jaws in younger patients.
The practice centers on realigning teeth within the bone structure and improving the bite relationship without needing to cut tissue. The goal is to achieve optimal dental function, including the ability to chew and speak properly, while enhancing the patient’s facial profile. This non-surgical approach is effective for the majority of bite problems, such as crowding, spacing, overbites, and crossbites.
When Orthodontic Treatment Requires Surgery
While most orthodontic issues are resolved non-surgically, some clinical scenarios involve a severe misalignment of the jaw bones themselves. These skeletal discrepancies cannot be corrected by moving teeth alone, regardless of the patient’s age. If the upper and lower jaws are not positioned correctly relative to each other, a functional malocclusion remains.
Conditions that often necessitate surgery include severe Class II malocclusion (a significant overbite caused by a recessed lower jaw) or a pronounced Class III malocclusion (an underbite resulting from a protruding lower jaw). Other indications include significant facial asymmetry, open bites that do not respond to non-surgical treatment, or certain congenital conditions like cleft palate. Since jaw growth is complete in adult patients, skeletal changes can only be achieved by physically repositioning the jaw bones.
The procedure required to correct these underlying skeletal issues is known as orthognathic surgery, or corrective jaw surgery. This procedure involves surgically moving the maxilla (upper jaw), the mandible (lower jaw), or both, into a new, corrected alignment. Orthognathic surgery is necessary when the jaw relationship is so misaligned that moving the teeth to compensate (dental compensation) would compromise the long-term health of the teeth or facial aesthetics.
The Role of the Surgical Specialist
The professional who performs orthognathic surgery is not the orthodontist, but an Oral and Maxillofacial Surgeon (OMS). An OMS is a surgical specialist who completes an extensive hospital-based residency, typically four to six years after dental school. Their training focuses specifically on surgery of the mouth, jaws, and face, preparing them to handle the complex bone and soft tissue procedures involved in corrective jaw surgery.
The treatment process for surgical orthodontics is a highly coordinated, multi-phase team approach involving both the orthodontist and the OMS. The orthodontist manages the initial phase, known as pre-surgical orthodontics, which typically lasts between 6 and 18 months. During this time, the orthodontist uses braces or aligners to position the teeth precisely within each individual jaw, preparing them to fit together perfectly once the jaws are moved.
The OMS then performs the surgery, physically moving the jaw bones to the planned position, often securing them with small plates and screws for stable fixation. After a recovery period, the patient returns to the orthodontist for the final phase, post-surgical orthodontics. This final stage involves fine-tuning the bite with braces for several months to ensure the teeth interlock optimally in the newly aligned jaw structure.