Surgery

Some problems can not be fixed by braces alone. Usually, these problems involve incorrect balance between the upper and lower jaws. Correcting the bite is like building a house. The roof (upper jaw) and the foundation (lower jaw) must be in the same position if we want to have straight, stable walls (teeth). If the roof and the foundation do not line up properly, then we need to tilt the walls to compensate for this misalignment, and the more we tilt the walls, the less stable the house is. In reality, we can only move teeth a certain distance, and large discrepancies often require surgery to re-position the jaws into their ideal relationship. Sometimes, surgery will be recommended if the treatment with braces alone, while effective at straightening the teeth, may worsen the facial appearance.

The combined orthodontic/surgical treatment usually takes 18-24 months to complete. The treatment is arbitrarily divided into 3 phases:

Pre-surgical orthodontic phase where the braces on upper and lower teeth are used to correct any crowding, rotations or spacing, and to undo some of the natural compensations in tooth position due to the jaw discrepancy. This stage usually takes 12-18 months to complete, and it is at this stage that some extractions may be necessary to remove the wisdom teeth or to correct the crowding.
Surgery - the surgery is performed under a general anesthetic in a private hospital. The oral and maxillofacial surgeon gains access to the upper or lower jaw through the mouth, and then the upper or the lower jaw (or both) are repositioned into their ideal position. The jaw segments are usually held together by titanium screws or plates, to allow the bone to heal. These screws or plates are usually left in place as they are well tolerated by the body and in fact integrate with the bone. Usually, the patients undergoing jaw surgery stay in the hospital for 1 to 3 nights, and require 2-3 weeks off work. They are able to open the mouth immediately after the operation and quickly go from vitamized food to normal diet in approximately 4-6 weeks. The braces stay on for the operation.
Post-surgical orthodontics - 2 weeks after the operation, the orthodontic treatment resumes, and it takes approximately 6 months to idealize the bite and complete the treatment.

Commonly asked questions:

Will it be sore?

Remarkably, there is little pain after jaw surgery. This is because of the swelling that takes place around the surgical area. The swelling compresses the nerves that transmit pain sensation to the brain, and in effect temporarily block that transmission. The result is that by the time the transmission resumes (2-6 weeks), most of the healing has taken place. Most of our patients do not require any pain killers after the operation.

Do I need health cover?

Private hospital cover is necessary at least 12 months prior to surgery. Without this cover, the operation in a Private Hospital will cost many thousands of dollars.

Will it change my facial appearance?

In most cases the change to facial appearance is desired and expected. This change, however, can range from mild to extreme. In our practice, we use computer imaging techniques to demonstrate the potential changes and to ensure that the potential changes are within your expectations.

Are there any risks?

As with all surgical procedures there are potential risks and complications. We explain all the risks during the treatment planning session, and make sure that they are understood by you. We also try to give you alternative treatment options and discuss advantages and disadvantages of these options. In the end, the decision to have the surgery is yours and yours alone, but we make sure that it is based on accurate information.

When is the best age to have the surgery?

In this instance, we prefer to treat patients who have achieved skeletal maturity. Most patients requiring a combined orthodontic/surgical approach are young adults, aged between 16 to 40 years of age. There is no upper age limit to this treatment, provided that the teeth and gums are healthy.