Not every bite problem requires jaw surgery. Many can be corrected with orthodontic treatment alone, while others are caused by the position of the jaw bones and require a different approach. Understanding whether a bite problem is dental, skeletal, or a combination of both is the first step in determining the most appropriate treatment.
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When Is Orthognathic Surgery Recommended?
Orthognathic surgery (jaw surgery) may be needed when a bite problem comes from the position, size, or alignment of the jaw bones. Orthodontics can move teeth, but it cannot reposition the upper jaw, lower jaw, or chin.
Surgery may be considered when a skeletal jaw problem affects chewing, biting, speech, breathing, facial balance, or long-term oral function. The goal is to align the jaws so the teeth can fit together in a more stable and functional position.
Jaw surgery may be considered for:
- Severe underbite
- Severe overbite or overjet
- Open bite
- Crossbite related to jaw position
- Facial asymmetry
- Receding lower jaw
- Protruding jaw
- Difficulty biting or chewing because of jaw alignment
- Bite problems that cannot be corrected predictably with orthodontics alone
- Airway concerns, including select cases of obstructive sleep apnea
Not every bite problem needs surgery. The need depends on whether the issue is mainly dental, skeletal, or a combination of both.
What Orthodontics Can Correct
Orthodontics focuses on tooth position. Braces or aligners can move teeth into better alignment, close spaces, correct crowding, and improve how the upper and lower teeth meet. Orthodontic treatment may be enough when the jaw bones are reasonably aligned and the bite problem comes mainly from tooth position.
Orthodontics may help correct:
- Crowded teeth
- Spacing between teeth
- Mild to moderate bite issues caused by tooth position
- Rotated or tipped teeth
- Dental midline concerns
- Bite problems that do not involve major jaw imbalance
In these cases, moving the teeth can improve function and appearance without changing the jaw bones. There is also a middle option called camouflage orthodontics. The orthodontist tips the teeth to hide a mild jaw mismatch without surgery. It avoids an operation, but it does not change the facial profile, and pushing teeth too far to compensate can be less stable and harder on the gums.
What Jaw Surgery Can Correct
Jaw surgery changes the position of the upper jaw, lower jaw, or both. Unlike orthodontics, which moves teeth, jaw surgery corrects the underlying skeletal relationship between the jaws to improve bite function, facial balance, and, in some cases, the airway.
Depending on the diagnosis, surgery may reposition the upper jaw, lower jaw, or both to create a more stable bite and improved overall jaw function.
The procedures have specific names. A LeFort I moves the upper jaw. The bone is cut above the tooth roots, moved, and held in its new position with small titanium plates. A BSSO (bilateral sagittal split osteotomy) moves the lower jaw. The bone is split on both sides behind the back teeth, slid forward or back, and plated. A genioplasty moves the chin bone and is often done with one of the other two. Moving both jaws in one operation is two-jaw surgery. Dr. Dhaliwal does all of these at Adara Surgical Institute.
For obstructive sleep apnea, moving both jaws forward (maxillomandibular advancement, or MMA) opens the airway behind the tongue and soft palate. We do a large volume of MMA for patients who cannot tolerate CPAP. More on our sleep apnea treatment page. We also do jaw surgery for cosmetic reasons alone.
How Orthodontics and Jaw Surgery Work Together
Jaw surgery and orthodontics serve different purposes, but they are often used together to correct complex bite problems. Orthodontics focuses on moving the teeth into proper alignment, while jaw surgery corrects the position of the upper jaw, lower jaw, or both.
When both treatments are needed, orthodontic treatment helps prepare the teeth for surgery and fine-tunes the bite afterward. This coordinated approach helps improve how the teeth fit together while addressing the underlying jaw imbalance that orthodontics alone cannot correct.
In most cases, the sequence is braces, surgery, then braces again. Pre-surgical braces run 6 to 24 months and line up the teeth within each jaw. Post-surgical braces run 6 to 12 months to fine-tune the bite, and some patients need as little as 6 weeks.
Insurance is a real question, so ask early. When jaw surgery is covered, it is billed to medical insurance, not dental, and only when it is medically necessary. Some plans exclude it entirely, and pre-authorization is usually required.
Risks of Jaw Surgery and Who Should Wait
Jaw surgery has real risks. The most common is numbness of the lower lip and chin after lower jaw surgery, because the nerve that gives those areas feeling runs through the jawbone. Nearly everyone has some at first. Most improve over months, and a minority keep some change in feeling that does not go away. Other risks are bleeding, infection, relapse (the bite drifting partly back toward where it started), and the small plates holding the bone sometimes needing removal later.
Jaw surgery should wait, or may not be the right choice, if you are still growing, have untreated gum disease, or are unwilling to stop smoking around surgery. Surgery is done at the hospital, usually Overlake or Swedish (Dr. Dhaliwal is credentialed at several others as well), under general anesthesia, with a short hospital stay. Afterward the jaws are guided with light elastics between the braces. We almost never wire the jaws shut. Our diet schedule is liquids for the first 4 weeks, soft foods through week 8, light chewing through week 12, then a normal diet.
Other Treatments That May Be Part of Your Treatment Plan
Orthodontic treatment sometimes requires additional surgical procedures, even when jaw surgery itself is not part of the treatment plan. These procedures help orthodontic treatment progress safely, predictably, and efficiently.
One example is temporary anchorage devices (TADs). These small titanium anchors are placed in the jawbone to provide a stable point for orthodontic tooth movement. TADs can help move teeth more predictably and may be used to support complex orthodontic treatment or prepare the bite before jaw surgery. Dr. Dhaliwal places TADs here and also does MARPE (a mini- screw supported palate expander).
Other patients may require procedures such as the removal of impacted teeth, exposure and bonding of impacted canines, or other surgical procedures that allow orthodontic treatment to progress safely and effectively. The specific combination of treatments depends on your diagnosis and overall treatment goals.
Specialized Care for Complex Bite Problems
Complex bite problems require careful diagnosis and treatment planning. At Adara Surgical Institute, we take the time to evaluate how the teeth, jaws, facial structure, and airway work
together before recommending treatment. This comprehensive approach helps determine whether orthodontics alone is appropriate or whether jaw surgery or other procedures may be needed.
As a board-certified oral and maxillofacial surgeon (United States and Canada), Dr. Hardeep Dhaliwal works closely with orthodontists to develop personalized treatment plans based on each patient’s anatomy, functional concerns, and long-term goals. Whether treatment involves orthodontics alone, orthognathic surgery, or additional procedures, every recommendation is made with the goal of achieving a stable, functional, and lasting result.
Oral Surgeon in Issaquah, WA
If you have been told you may need jaw surgery or are unsure whether orthodontics alone can correct your bite, a comprehensive evaluation can help determine the most appropriate treatment approach.
To book a consultation at our oral surgery office in Issaquah, WA, call (425) 428-5888 or visit us at 6505 226th Pl SE, STE #100 Issaquah, WA.
FAQs
Can braces fix jaw misalignment?
Braces can move teeth into better alignment, but they cannot reposition the upper or lower jaw. If the bite problem is primarily dental, orthodontic treatment may be enough. When the underlying problem is the position of the jaw bones, jaw surgery may be recommended to achieve a stable, functional bite.
Is jaw surgery always needed for an underbite?
No. Treatment depends on the cause and severity of the underbite. If the underbite is primarily caused by tooth position, orthodontic treatment may be enough. When it is caused by a significant difference in the position of the upper and lower jaws, orthognathic surgery may be recommended to correct the underlying skeletal problem and create a more stable, functional bite.
Do you need braces before jaw surgery?
Often, yes. In many cases, orthodontic treatment begins before jaw surgery to position the teeth so they will fit together properly after the jaws have been repositioned. Additional orthodontic treatment is usually needed after surgery to refine the bite. The exact sequence depends on your individual treatment plan.
At what age can jaw surgery be done?
Jaw surgery is usually planned after jaw growth is complete. We usually wait until about 18 for
women and 21 for men, with exceptions. Timing varies by patient, but evaluation may begin
earlier if a bite problem, facial imbalance, or airway concern is being monitored.
How much does jaw surgery cost?
Cost depends on your treatment plan and on what your medical plan covers. Coverage, when it
exists, is medical, not dental, and only when medically necessary. We go over the numbers and
the paperwork at the consultation.
Will my jaws be wired shut?
Almost never. We guide the bite with light elastics between the braces instead, and the plates
hold the bone in place.
