Orthognathic surgery corrects significant misalignments between the upper and lower jaws. These skeletal discrepancies often result in difficulties with chewing, speaking, or breathing, and cannot be fully addressed by moving the teeth alone. Successful treatment requires a coordinated effort, combining the work of an oral and maxillofacial surgeon with an orthodontist. Orthodontic appliances, such as braces or clear aligners, are almost always required both before and after the surgical procedure. The surgery repositions the jawbones to their correct alignment, but the orthodontics ensures the teeth fit together perfectly within the new jaw structure.
Preparing the Jaws Before Surgery
This initial phase focuses on moving the teeth into specific positions necessary for the surgeon to correctly fit the jawbones together during the operation. This process is termed “decompensation,” reversing the natural way teeth may have shifted over time to hide the severity of the underlying jaw problem. For instance, the orthodontist uses braces to move tipped teeth upright into the position they would occupy over a correctly aligned jawbone. As the teeth move into these new, decompensated positions, the patient’s bite may temporarily appear to worsen, highlighting the true skeletal issue. This pre-surgical phase typically lasts between 6 and 18 months, ensuring the teeth are positioned precisely to meet one another after the jawbones are surgically moved.
The Critical Final Alignment Phase
After the surgeon successfully repositions the jawbones using small plates and screws, the braces remain in place for the final, detailed stage of treatment. While the surgery corrects the major skeletal framework, the postsurgical orthodontics, often called the finishing phase, achieves a perfect functional bite. This stage begins a few weeks after the operation, once the initial swelling has subsided.
The primary goal of this phase is “occlusal finishing,” which is the precise alignment of every tooth contact. This involves achieving perfect “interdigitation,” where the cusps of the upper teeth lock neatly into the grooves of the lower teeth, maximizing the surface area contact. The orthodontist meticulously adjusts the wires to fine-tune the positions, ensuring that every tooth contributes to a stable and efficient bite.
To guide the teeth and the surrounding muscles into the new relationship, small orthodontic elastics, or rubber bands, are introduced. These elastics apply light, continuous force in specific vectors to settle the bite. They are instrumental in retraining the masticatory muscles, which have a memory of the old jaw position and naturally try to pull the jaw back into its former alignment. The patient wears these elastics nearly full-time to reinforce the new, correct jaw position.
Another detailed objective is “root paralleling,” where the roots of the teeth are aligned vertically and parallel to one another within the bone. While the crowns of the teeth may look straight, misaligned roots can compromise the long-term health and stability of the teeth. The braces allow the orthodontist to make subtle adjustments to the root position, ensuring that the teeth are securely supported within the newly positioned jawbone. This phase of active orthodontic adjustment typically lasts for an additional 6 to 12 months after the surgery.
Managing the Post-Braces Period
The second phase of active orthodontic treatment concludes when the perfect bite has been achieved and the teeth are stable in their final positions. At this point, the braces are removed, marking the transition to the retention phase. The duration of post-surgical orthodontics is relatively short compared to the pre-surgical phase, often ranging from six months to a year.
The retention phase is necessary because the bones and soft tissues around the newly positioned jaws and teeth need time to solidify and adapt. Post-surgical bone remodeling, the process where the body strengthens the bone around the surgical sites, can take a full 9 to 12 months to complete. Furthermore, the muscles, ligaments, and gingival fibers have a “memory” of the old misalignment and can exert forces that attempt to shift the teeth and jaw back, a phenomenon known as relapse.
To counteract these forces, retainers are prescribed, and adherence to the retention protocol is a lifetime commitment. Retainers come in two main forms: fixed and removable. Fixed retainers are thin wires bonded to the back of the front teeth, providing permanent, passive stabilization. Removable retainers, such as clear vacuum-formed appliances or Hawley retainers, are worn full-time initially and then transitioned to nighttime wear indefinitely. Consistent use of these appliances is the most important factor in maintaining the functional and aesthetic results.