Orthognathic surgery is a procedure designed to correct significant misalignments of the jawbones that affect bite, speech, and breathing. Because moving the jawbones inherently moves the teeth, orthodontics is an integral part of this comprehensive treatment plan. The answer to whether you need braces after jaw surgery is almost always yes, as the full process requires them both before and after the operation. Jaw surgery corrects the skeletal structure, while braces are necessary to precisely position the individual teeth on the newly aligned jawbones. This combined approach ensures the teeth meet correctly and the results are stable.
Preparing the Foundation: Pre-Surgical Orthodontics
Before the surgeon can move the jaws into their correct skeletal positions, the teeth must be prepared through an initial phase of orthodontic work. This preparation is counterintuitive because the teeth are moved into positions that temporarily make the bite look worse. This process is known as decompensation, which involves undoing the natural tipping of teeth that occurred over time as the body attempted to mask the underlying jaw discrepancy.
In a patient with a severe overbite, for example, the upper front teeth may have naturally tipped backward and the lower front teeth tipped forward to allow them to touch, partially hiding the skeletal problem. The pre-surgical braces move these teeth back to their correct, upright positions over their supporting bone, which is necessary so they can interlock perfectly after the jaw movement. While this decompensation is occurring, the gap between the upper and lower teeth often widens, making the misalignment appear more pronounced before the surgery.
The goal of this pre-surgical phase is to achieve proper leveling and alignment of the teeth within each arch, ensuring they are positioned correctly relative to their respective jawbone. Moving the teeth to these specific places dictates the exact movement the surgeon will need to perform on the bone itself. The duration of this preparation varies based on the complexity of the tooth movements required but typically lasts between 6 and 18 months.
Fine-Tuning the Bite: Post-Surgical Stabilization
Once the jawbones have been surgically repositioned and fixed, the second phase of orthodontic treatment begins to finalize the outcome and ensure stability. This phase usually starts four to eight weeks post-surgery, once the initial healing of the soft tissues has progressed. The focus during this stage shifts from major tooth movement to the final detailing of the occlusion, which is how the upper and lower teeth meet.
The orthodontist uses the existing braces to make small, precise adjustments to achieve the tightest possible interdigitation of the teeth. A primary tool during this phase is the use of elastic bands, which the patient wears between the upper and lower braces to gently guide the bite into its final, most stable position. These elastics help coordinate the jaw muscles and maintain the new relationship between the arches as the bone heals.
This postsurgical orthodontic period is shorter than the pre-surgical phase, lasting between 6 and 12 months. The braces are kept on until the bite is considered stable and the teeth are perfectly aligned in the new skeletal structure. The continued presence of the braces after surgery acts as a scaffold for the teeth, allowing for the final necessary movements to lock in the surgical correction.
When Braces May Not Be Required
While the combined surgical and orthodontic approach is the standard for correcting most jaw discrepancies, there are rare exceptions where braces might be avoided. Procedures focused purely on minor chin reshaping, such as a genioplasty, often do not require full orthodontic treatment, as they adjust the chin’s projection without changing the bite. Similarly, some limited surgical movements performed primarily to address severe obstructive sleep apnea may not necessitate a full course of braces if the existing dental alignment is acceptable and the goal is solely airway enhancement.
In some cases of vertical jaw discrepancies, where the bite alignment is already good, a “surgery-first” approach is sometimes considered. Even with this alternative method, post-surgical orthodontic treatment is still necessary to perfect the bite and maintain the results. Attempting to skip braces completely is only feasible when the underlying jaw issue is minor or when the teeth are already perfectly aligned on the bone, which is uncommon in patients needing corrective jaw surgery.
Understanding the Full Treatment Commitment
The decision to undergo orthognathic surgery represents a significant time commitment, as active orthodontic treatment phases bracket the surgery itself. The initial pre-surgical phase requires 12 to 18 months of wearing braces before the operation. Following surgery, the postsurgical orthodontic phase begins, adding another 6 to 12 months of active treatment. The entire process, from brace placement to removal, can span two to three years. Once active treatment is complete, the commitment continues with a retention phase involving wearing a retainer to prevent shifting and ensure the final bite remains stable indefinitely.