Jaw surgery, also known as orthognathic surgery, corrects significant misalignments of the jaw and teeth that cannot be fixed with orthodontics alone. Relapse refers to the movement of jawbones or teeth back towards their original, pre-surgical positions after the procedure. While advancements in surgical techniques and post-operative care have reduced its occurrence, relapse remains a concern for patients undergoing jaw surgery.
Understanding Why Relapse Occurs
Biological factors contribute to jaw surgery relapse. Soft tissue memory, where muscles, ligaments, and surrounding tissues revert to their pre-surgical state, exerts pressure on the newly positioned bones. Bone remodeling, a continuous breakdown and rebuilding process, can also lead to subtle shifts over time. In younger patients, continued skeletal growth patterns can influence the long-term stability of the surgical outcome.
Technical considerations during surgery can also contribute to relapse. Inadequate bone cuts or imprecise jaw positioning may lead to an unstable initial correction. Unstable fixation methods, if used to secure jaw segments, may not adequately resist soft tissue and muscle forces, potentially allowing movement. Errors in surgical planning, such as an inaccurate centric bite, can also lead to instability in the final result.
Patient-related factors also contribute to relapse. Non-compliance with post-operative instructions, such as not consistently wearing prescribed orthodontic elastics or retainers, can allow teeth and jaws to drift. An improper diet during healing or habits like teeth grinding (bruxism) can also destabilize the surgical correction. Poor healing capacity or pre-existing temporomandibular joint (TMJ) disorders can also increase the risk of relapse.
Strategies to Prevent Relapse
Preventing jaw surgery relapse involves meticulous planning and consistent post-surgical management. Pre-surgical planning incorporates detailed imaging, such as 3D scans and digital models, and precise cephalometric analysis to accurately visualize the jaw structures and plan the exact movements. Virtual surgical planning further allows the surgical team to simulate the procedure and predict outcomes, helping to minimize errors.
During surgery, stable techniques secure jaw segments in their new positions. Rigid internal fixation, typically involving plates and screws, has significantly reduced relapse rates by providing strong support during healing. Surgeons also work to minimize tension on the soft tissues and muscles, as excessive stretch can contribute to long-term relapse. Bone grafting may be used in specific cases, such as maxillary advancement, to enhance stability and promote healing.
Post-surgical management is important for long-term stability. Consistent and correct use of orthodontic elastics helps guide the jaws into their new bite and retrain chewing muscles. Adherence to dietary restrictions, typically a soft food diet during initial recovery, prevents undue stress on healing jawbones. Long-term retainer wear, including both fixed and removable appliances, is generally recommended to prevent teeth from shifting back towards their original alignment. Regular follow-up appointments with both the orthodontist and oral surgeon allow for continuous monitoring and timely adjustments to maintain the surgical outcome.
Addressing Relapse If It Happens
If jaw surgery relapse occurs, several approaches can manage or correct the changes. For minor dental or skeletal discrepancies, non-surgical options like extended or revised orthodontic treatment may be sufficient. This involves braces or clear aligners to reposition teeth and make small adjustments to the bite. Lifestyle changes, such as avoiding hard foods or managing bruxism with a night guard, can also support the corrected jaw position.
For significant skeletal relapse, re-operation or revision surgery might be necessary. The decision for revision surgery is influenced by the severity of the relapse, the extent of functional impairment, and the patient’s preferences. Revision surgery may be considered if the initial correction is largely reversed or if persistent functional issues, such as difficulty chewing or speaking, arise.
Early detection of relapse signs is important for effective action. Immediate consultation with the oral surgeon and orthodontist allows for a thorough evaluation of jaw and teeth positions. The collaborative assessment helps determine whether non-surgical adjustments or a surgical intervention is the appropriate path to regain the desired outcome.