Do your upper and lower teeth meet perfectly when you close your mouth?

If they do, it’s thanks to the correct alignment of your jaws.

However, there are those whose jaws are naturally misaligned. This can result not only in difficulties in eating and speaking, but also negatively affect their looks.

Fortunately, this jaw malalignment can be treated with a combination of braces and jaw surgery, or in medical lingo, orthognathic surgery.

Orthognathic surgery or corrective jaw surgery is a method of treatment that may be advised for patients who have severe jaw size problems, including asymmetry.

This discrepancy of the jaw bones often results in severe malocclusion (wrong bite) and treatment with normal braces alone will not be adequate to achieve a good functional bite with pleasing dental and facial aesthetics.

Cases of maxillary prognatism (upper jaw being big or too far forward), mandibular prognatism (lower jaw being big or too far forward), asymmetry (jaw off to one side) and anterior open bite (vertical discrepancy, whereby the upper and lower front teeth do not meet during biting) are among the conditions that are suitable to be treated with jaw surgery.

This treatment may help in improving the bite, achieving a more balanced facial appearance, and improving function, such as chewing, swallowing and speech.

It may also correct birth defects that affect the facial bones.

Multidisciplinary team

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An anterior open bite, where the upper and lower teeth don’t meet vertically when the mouth is closed.

In this multidisciplinary treatment, the orthodontic (braces) treatment is supplemented with jaw surgery to move the jaws into a more normal position, and helps to improve the patient’s facial appearance and achieve a better bite.

The entire treatment is usually carefully planned at a joint or combined clinic involving an orthodontist (braces specialist) and a maxillofacial surgeon (dental and facial bones surgeon).

A clinical psychologist will also perform an assessment as it is important to evaluate and determine the patients’ suitability and preparedness for the surgery.

A speech therapist will also be asked to assess certain patients who also have speech problems.

Orthognathic surgery can be accomplished in two ways. In the surgery first approach, the surgery is done first prior to the braces treatment, and in the conventional approach, the braces are placed first, prior to the surgery.

The approach for each patient is decided according to what best suits the patient.

Conventional approach

In the conventional approach, the treatment involves putting on braces for almost a year or two prior to the surgery.

Adjustment of the braces will be made once every six weeks to get the teeth into the position planned for the surgical movements.

Once the alignment and bite are in the position suitable for surgery, detailed surgical planning will first be done on a dental model of the patient (model surgery).

This is when the exact surgical movements will be meticulously planned to achieve the best bite possible suitable for the patient’s facial appearance.

Just before the surgery, there will be more frequent follow-up appointments to ensure that all the patient’s details are accurate.

A baseline health check by the medical team will be arranged to ensure that the patient is fit to undergo surgery.

During the surgery, the patient will be under general anaesthesia, meaning that he will be unconscious throughout the surgery.

The duration of the surgery depends on the complexity of the jaw cuts and whether it involves single jaw or double jaw surgery.

The cuts will be made from inside the mouth, thus avoiding any visible scars on the skin.

Metal plates and screws will be used to re-connect the jaws after their movements have been performed.

After the surgery, some discomfort, facial swelling and pain are to be expected, and a liquid diet is recommended for the first few days.

The patient can expect to stay a few days in hospital to be monitored closely, especially the bite and the surgical sites, and to recover properly.

Once discharged from the hospital, appointments will be given at a close interval to further adjust the braces until the ideal bite is achieved.

Once an ideal result is achieved, the braces will be removed and the patient will be given a set of retainers to help keep the teeth in their finished positions.

Post-surgical healing of the jaw bones can take up to eight weeks. The total treatment duration, on average, can be up to two to three years.

Risks and costs

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Maxillary prognatism or an overbite, where the upper jaw is too big or too far forward.

The risks involved are those of wearing braces and having surgery respectively.

The risks of wearing braces include pain, discomfort, mouth ulceration, tooth cavities and brown spots (if brushing is not good), root resorption (roots of the teeth becoming shorter), and relapse, where the teeth become crooked again due to insufficient retainer wear.

The risks of surgery include bleeding, infection, facial swelling, limited mouth opening, numbness or loss of sensation of the lips, and an improper bite.

The relevant specialists would be able to explain the risks in more detail, tailored to the characteristics of each patient, during the consultation.

Meanwhile, the cost depends very much on the procedures involved and varies between cases.

In essence, it can be divided into the costs for the braces and the costs for the surgery. The costs can be estimated once a proper examination and plan is done.

Assistant Professor Dr Noraini Abu Bakar is the head of the orthognathic team at the International Islamic University Malaysia’s Kuantan campus. Those seeking orthognathic treatment can ask for a referral from the university’s Faculty of Dentistry outpatient clinic by calling the Dental Assistant in charge Nor Azma Che Deraman at 09-570 5537. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.