What is Orthognathic Surgery?
The term Orthognathic originates from the greek word ”Osthos” (right) and ”Ghathos” (jaw), therefore the Orthognathic surgery is used to move the teeth and bones to a position that is more adequate, more Cosmetic, more functional and of course, healthier; this is achieved through a combination of two doctor- odontologist areas or specialities: the orthodontist moves the teeth and the Maxillofacial surgeon moves the bones.
Dentofacial deformities are very frequent, between 8 and 12 percent of the world population present some type of unbalance related to the teeth and the face, such as disharmony, alterations which affect as much the teeth as the face.
This makes them frequent problems which require Maxillofacial Surgeons with a grade of maximum speciliaty in this field. Apart from great technical capacity, it requires a profound knowledge in the growth of the deformities for a correct surgical planning.
The planning is carried out together with the orthodontist odontologist who moves the teeth into the desired position so that the surgeon can reposition the jaw bones.
During the Orthognathic surgery the maxillofacial surgeon repositions the facial bones returning an adequate smile and facial aesthetics. It is therefore a Cosmetic and Pathological Surgery.
Many patients with dentofacial deformities present, as a consequence of this alteration in the skeletal growth, alterations in the function and the aesthetics of the nose and other facial areas, which are corrected in the same surgical procedure.
Solutions to deformities
Alternatives to Surgery
The dentofacial deformities can only be adequately corrected with a combined surgical-odontological treatment.
If the patient decides not to operate, the deformity and the chewing problems will continue but if they visit their dentist regularly and maintain a good oral hygiene there is no reason why they should prematurely lose their teeth unless they have a severe problem of malocclusion, bruxism (dental wear) or any pathology such as sleep apnea. There could also be appearance of pain or pathology in the Temporomandibular joint.
Phases of the combined surgical-odontological treatment
Within the treatment, there intervenes a team made up of at least two specialists: one orthodontist and one maxillofacial surgeon. The treatment usually lasts a little more than two years and is divided into three phases:
1. Pre-surgical orthodontics for the duration of approximately a year and a half. During this phase it could be necessary to extract the third molars (wisdom teeth) and some times other dental pieces (premolars…) during this phase the orthodontist straightens and aligns the teeth of each dental arch, separately preparing them for the surgery.
2. Surgery. The surgeon establishes a good relationship between the upper jaw and the lower jaw taking into account the occlusion, the airways and the facial harmony. The surgery lasts a few hours and the patient can go home within a few days with a recuperation period of approximately 5 weeks.
3. Post-surgical Orthodontics. During this phase (approximately 6 months) the orthodontist adjusts the final details of the dentary occlusion.
More common problems
1. Small or set back jaw: the lower teeth are set back with respect to the upper ones, just like the chin. There are usually problems with the jaw joint and there could be difficulty to breath during sleep (apnea).
2. Set back upper jaw: the cheeks are flat (Maxillary hypoplasia), the upper teeth are set back and hard to see when smiling.
3. Extended upper jaw: the gum can be seen in excess when smiling. The face is extended, the chin is usually set back and it is hard work to close the lips.
4. Large or set forward jaw: the lower teeth are set forward when compared to the upper ones, the chin is set forward and the molars get damaged more than normal due to the malocclusion.
5. Open biting: the upper and lower teeth to not make contact when the mouth is closed, they leave a space. The lips have to be forced shut and it is difficult to eat. In extreme cases it can affect speach and cause problems to pronounce some letters. The molars that make contact have excess work, meaning that they also become damaged before time and there is usually pain in the jaw joint.
6. Jaw assimetry: the chin and the teeth redirect to one side. Without realising it, the patient tends to tilt their head to hide the defect, sometimes creating pain in the neck. There can also be problems on the joints and of malocclusion.
Orthognathic Surgery: the intervention
When the dentofacial deformity is severe and cannot be corrected with orthodontic treatment it is necesary to perform a surgical intervention to improve the dental occlusion and the appearance of the face.
How is the intervention carried out?
The intervention is carried out under general anaesthetic. Usually the patient can return home two days after the intervention although some cases require more days under hospital observation.
The surgeon performs on the Maxilla and the jaw through insitions made inside the mouth, meaning that there will be no visible scars.
Once the bone segments are fitted in a harmonious relationship they are fixed with plates and screws of titanium or other reabsorbible materials similar to those used in bone fractures, achieving a better position which improves the appearance of the face and the dentary occlusion.
To perform this last part, the surgeon uses surgical guides (splints) created individually by a laboratory for each case.
There are thousands of succesful Orthognathical surgeries performed in hospitals in Spain.
Every surgical intervention entails risks. When the intervention is performed by an experienced surgeon, the risks are reduced. The patient can reduce the risks by carefully following the instructions of his surgeon before and after the surgery.
After the intervention
After the intervention the patient will feel some discomfort and the doctor will prescribe medication to aleviate it. The patient should spend the first day in bed, with the head raised. It is normal that a large amount of inflammation appears on the face, aswell as echhymosis (bruises) on some parts. Some areas of the mouth and face will remain anaesthesised during the first weeks, the teeth of the maxilla and jaw will remain united with rubber bands which will impede the opening of the mouth and can be fitted for a varied amount of time (up to five weeks depending on the case). While the bones of the face are consolidating, the diet must be in liquid form, pureed and soft, food which is easy to chew. Additionally and in diverse cases, both before and after the intervention it is necesary to receive physiotherapy treatment and in some cases the specialised help of a psychologist.
Although the patient will notice an important improvement two weeks after the operation, it will be necessary for a month to pass before the inflammation of the face dissappears completely. After an intervention of an Orthognathic surgery there are always facial changes. If the disharmony was severe, the changes after the surgery are more obvious. Most patients find these changes favourable for their aspect. Your doctor will speak to you previously regarding the changes you can expect and he will recommend the intervention which will bring the most harmony to your face.
Frequently asked questions about an Orthognathic surgery intervention
Apart from the functionality which I will recuperate, will my face look better?
Of course, with the Orthognathic surgery, when the facial and dental deformity is corrected, your face will have a more harmonious appearance and therefore, more beauty.
Does another alternative to surgery exist?
Each patient will have their treatment based on the diagnosis carried out by the orthodontist and/or the maxillofacial surgery.
Will the intervention remove the pain in my joints?
A correct Orthognathic intervention will correct the defect/malformation of the occlusion and as a consequence improve the function. You will be able to chew normally and the clicking and the pain will cease, although if there are already disorders in the joint, the problems with pain can continue and you will need a specific complementary treatment.
What risks does the surgery have?
As with any surgical intervention, the Orthognathic also entails risk. When the intervention is performed by a professional surgeon appointed by the Society of Oral and Maxillofacial Surgery, the risks are minimal. The patient can reduce the risks carefully following the instructions of the surgeon before and after the intervention.
How much time will pass before I completely recuperate?
The recuperation time varies from one patient to the other. The majority will start to notice two weeks after the operation but the inflammation of the face will dissappear completely when a month has passed since the surgery.
Can any material be used to fix the bones or does it have to be titanium?
These types of surgeries are done once in your life so therefore it is recommended that the material that is used be of prime quality, at both titanim or biogradable level. Titanium is an incompatible and osteoconductive material.
Who is my surgeon?
Dr. José Manuel Battlés Sebastián, after finishing his Speciality in Oral and Maxillofacial Surgery, completed his formation with the Licence of Dentistry with the objective to delve into physiopathology and occlusal aspects of the candidate patients for Orthognathic Surgery. He became a specialist in these disciplines with stays and training in Belgium, Mexico and Barcelona.
He is the surgeon of reference in this discipline of the Kranion Clinic of Alicante and he also practises public activity in the Service of Oral and Maxillofacial Surgery of the Hospital San Juan of Alicante.