SURGICAL ORTHODONTICS
This field of dentistry diagnoses oral and maxillofacial disorders using radiological and clinical examinations.
About Surgical orthodontics
Surgical orthodontics, also known as orthognathic surgery, is a procedure that can dramatically enhance your appearance and address functional issues. It is often necessary when developmental disturbances, growth issues, or injuries affect facial symmetry.
This type of surgery is typically done in conjunction with orthodontic treatment. Procedures can range from minor, like tooth extraction, to major surgeries such as orthognathic surgeries of the upper (maxilla) and/or lower (mandible) jaw.
Patients with significant skeletal discrepancies and dentofacial deformities may require surgical correction for optimal results. This is especially true for adults whose skeletal malocclusion cannot be addressed through growth modification procedures alone. Children with congenital malformations, like cleft lip and palate, often need surgical procedures in addition to orthodontic treatment.
Recent advancements in surgical orthodontics include the “Surgery First” approach, which reduces treatment time, as well as techniques like implant placement for anchorage and distraction osteogenesis for jaw advancement.
Approximately 5% of the Indian population has dentofacial deformities that require orthognathic surgery. This surgery can correct gross jaw discrepancies (antero-posterior, vertical, or transverse), facial skeletal discrepancies associated with airway defects, and those associated with temporomandibular joint problems.
About PLANNING
Planning for orthognathic surgery typically involves a multidisciplinary team, including oral and maxillofacial surgeons, orthodontists, and sometimes a speech and language therapist. Given the surgery’s potential impact on a patient’s facial appearance, a psychological assessment may also be necessary to evaluate the patient’s readiness and expected psychological response to the procedure.
Radiographs and photographs play a crucial role in the planning process. At FMS hospitals, we use software like Onyx Ceph to predict the post-surgery facial appearance, aiding both in planning and in communicating the surgical plan to the patient and their family.
The primary objectives of orthognathic surgery are to achieve proper alignment of the bite, improve facial aesthetics, and enhance the airway.
Surgery for jaw discrepancies is indicated for patients with severe upper or lower jaw alignment issues.
Upper Jaw (Maxillary Osteotomy):
- Corrects significantly receded or protruded upper jaw
- Resolves crossbite, open bite, or improper teeth showing
- Procedure involves cutting the bone above the teeth from inside the mouth, allowing the upper jaw and teeth to move forward as one unit. Screws and plates hold the bone in place.
Lower Jaw (Mandibular Osteotomy):
- Corrects significantly receded or protruded lower jaw
- Procedure involves cuts behind the molars and lengthwise down the jawbone, allowing the front of the jaw to move as one unit. Screws hold the jaw in its new position.
Chin Surgery (Genioplasty):
- Corrects a deficient chin accompanying a severely receded or protruded lower jaw
- Involves cutting and repositioning the chin bone
Procedure:
- Surgery can involve one or both jaws
- Done under general anesthesia
- Often done through the inside of the mouth without cutting the skin
- Hospital stay of one to two days
- Full recovery at home in three to six weeks
Orthodontic Preparation:
- Braces are typically placed on the teeth before surgery
- Braces are on for nine to eighteen months to align teeth
- After jaw heals, braces are used for final alignment, usually removed after six weeks
- Entire orthodontic process, including surgery, may last 18 to 24 months.