Learn about evaluating your need for surgery, the correction of common dentofacial deformities as well as what is involved in these procedures.
When people have crooked or crowded teeth, or when their bite is off, they usually believe that braces will fix their problem. This is frequently true, and the orthodontist can align the teeth and bite without any surgery. There are more difficult cases, though, that cannot be properly corrected with braces alone. When these more difficult cases are treated with braces, only, and no surgery is done, the final bite and appearance is significantly less than ideal, is prone to relapse towards the original appearance, and is at high risk for a variety of dental problems in later years.
In these cases that cannot, or should not, be treated with braces alone, surgical repositioning of the jawbones is necessary. In addition to straightening the teeth and establishing a stable, proper bite, surgical repositioning of the jawbones creates positive changes to the appearance of the face and profile. The common types of bite problems that are treated by this combination of braces and jaw surgery are called, in lay terms, “severe underbite, severe overbite, receded jaw, gummy smile, proud chin, underdeveloped chin, and open bites”. Many of the jaw surgeries that are used to treat these problems are also very effective treatments for Obstructive Sleep Apnea (OSA) related to under-developed upper and lower jaws, poor nasal breathing, and snoring. Our surgeons have extensive expertise in these procedures and often can greatly improve your OSA, remove the need for night-time continuous positive airway pressure nasal masks, or mandibular snore-guards that are poorly tolerated by most patients.
Sometimes the bite problem requires both jaws to be surgically repositioned. Other times the patient only requires surgery in one jaw. When possible, we always try to limit surgery to a single jaw, so as to decrease the potential for complications, decrease the severity of the postoperative recovery, and decrease the financial costs. In any case, the surgeons at Bedford Associates in Oral and Maxillofacial Surgery are experienced in performing jaw realignment surgery and enjoy improving the bites and smiles in these patients.
In addition to the jaw realignment surgeries, there are many more common and less drastic types of surgeries that oral surgeons perform in concert with orthodontic care. The most common of these is removal of wisdom teeth. Frequently, orthodontists need the wisdom teeth removed before placing the braces, so that the wisdom teeth do not hinder the movement of the other teeth. In other cases, the orthodontist desires removal of the wisdom teeth, as soon as possible, after the braces come off. Lastly, there are cases where, after orthodontic tooth movement is begun, the wisdom teeth slowly begin to hinder the orthodontic progress. In these cases, the wisdom teeth are removed while the braces are still on.
Other types of oral surgeries that are performed along with orthodontic treatment are exemplified by impacted “eye teeth”, or canines. These cases are referred to, in lay terms, as “eye teeth being stuck in the roof of the mouth”. Although the teeth that are “stuck” are not always “eye teeth”, and are not always in the “roof of the mouth”, or even in the upper jaw, the lay term does describe the most frequent situation. It is fairly common for teeth that are very important to the bite and smile to be stalled in their progress of coming into the mouth. When this happens, the tooth is termed to be impacted, and it then needs surgical and orthodontic assistance to be brought properly into the bite. The surgery involves opening the gums and affixing a gold chain to the impacted tooth. After a brief period of healing, the orthodontist then applies forces to the chain, so as to drag the tooth into the proper location in the bite and smile.
A newer surgical procedure, that is combined with braces, is offering solutions to orthodontic problems that previously could not be solved. It is possible to place small, metal implants into strategic areas of the jaw bone. After a brief healing period, these implants are used as anchors off of which orthodontic forces are applied. These forces can now move teeth in directions that we previously could not. This is very effective for certain cases that were previously difficult to treat, such as the adult who wants braces to align the front teeth, but in years past had lost all of his molars. With no molars, the orthodontist is missing the strongest, natural anchors available for leverage. In the past, missing molars frequently meant that the other teeth could not be straightened. With these small implants placed in the missing molar locations, the orthodontist regains the major anchors needed to align the front teeth. Additionally, there are a host of other orthodontic tooth movements, that were previously considered very difficult to perform, that are now done relatively easily with these small, orthodontic implants.