There have been so many improvements in orthodontic technology and materials that more and more patients are able to get excellent outcomes without needing corrective jaw surgery, technically called orthognathic surgery, even in severe cases. While there are rare instances when an adult patient has such a significant bite imbalance that surgery is needed, most of the time it can be avoided. If you’ve been told you need corrective jaw surgery, the good news is, there may be alternatives.
What is Malocclusion?
Before we dive into avoiding underbite surgery, overbite surgery and everything in between, first, it’s important to discuss what malocclusion is. As a general dentist practicing orthodontics only, Dr. James Scramstad diagnoses and treats malocclusion. Malocclusions are issues with the size, positioning and alignment of the teeth and jaws that cause an improper bite.
With normal occlusion, the upper and lower teeth meet in an ideal way. This not only influences the appearance of your smile, but also encourages healthy jaws, temporomandibular joints (TMJ), teeth and gums, and allows you to chew and speak properly. Malocclusion, or a bad bite, on the other hand, can lead to a host of issues, including jaw pain, uneven wear of the teeth, an increased risk of tooth decay and gum disease, and make protruding or overjet teeth more susceptible to injury.
When patients have what we call class 1 malocclusion, the top teeth overlap the bottom teeth but the bite is normal. Class 1 malocclusion doesn’t warrant jaw surgery and if patients with class 1 malocclusion have a problem like crowding, spacing, slightly overjet teeth or crooked teeth, it can be treated with braces or Invisalign that would focus on tooth alignment and your bite after treatment would remain pretty much the same.
What are the More Serious Types of Malocclusion and How Can They be Treated Without Jaw Surgery?
So, class 1 malocclusion doesn’t require surgery but what about the other types? All other types of malocclusion can be treated without surgery as well in the vast majority of cases. Here are some of the bite problems that would have warranted corrective jaw surgery in the past and a few options for treating them without surgery:
You’re said to have an overbite, or class 2 malocclusion, if the upper teeth sit significantly in front of the lower teeth when you bite down. With class 2 malocclusion, the space between the two arches is much larger than it is in class 1 malocclusion, and, sometimes, in extreme cases, the lower teeth can even hit the soft tissues behind the upper teeth when you bite down. You can often avoid overbite surgery for class 2 malocclusion, even if it’s skeletal in nature (as opposed to related to tooth position like you see with flared or overjet teeth).
In cases of a severe overbite, with early evaluation and intervention with appliances during childhood, Dr. Scramstad can guide the lower jaw forward and ensure the jaws grow at a similar rate to close the space between the upper and lower teeth and eliminate the overbite. Even if you are done growing, auxiliary appliances can often be used with your braces or Invisalign to create more leverage and either move the upper teeth back or the lower teeth forward. This ensures your bite after braces or Invisalign is healthy and comfortable and allows you to get great results without overbite surgery.
An underbite, also known as class 3 malocclusion, is when the lower teeth and jaw are positioned in front of the upper teeth. The lower jaw will be more prominent than the upper jaw. If a significant underbite isn’t addressed when a patient is still young, jaw surgery could be needed. If you look at underbite jaw surgery before and after photos, you’ll see that the procedure is used to create an ideal bite and make the upper and lower jaw appear harmonious and balanced.
An underbite may be caused more by tooth position instead of jaw position. If that’s the case, Invisalign or braces can be used to fix the issue. For an underbite that’s caused by the lower jaw being too far forward or larger than the upper jaw, early intervention is key to avoiding jaw surgery. If Dr. Scramstad detects an emerging underbite in a growing patient, he can guide jaw growth with appliances in Phase 1 orthodontic treatment and then finetune the smile with braces or Invisalign Teen in Phase 2 treatment during the teenage years.
For teenage or adult patients who are no longer growing, avoiding surgery may still be possible in mild or moderate cases. Dr. Scramstad might be able to combine braces or Invisalign with rubber bands or other extra appliances.
In an open bite, the upper and lower teeth don’t meet at all. If a patient has a posterior open bite, the front teeth come together when the jaw is closed but the upper and lower back teeth don’t touch. An anterior open bite is when the back teeth meet but the upper and lower front teeth don’t come together.
Most cases of an open bite can be treated with braces. Or, if you want to fix an open bite without braces, Invisalign and Invisalign Teen can also be super effective. It’s extremely rare that an adult patient’s open bite is so severe that surgery is necessary.
A crossbite is when some of the bottom teeth sit in front of the top teeth when you bite down. If the back teeth are affected, it’s known as a posterior crossbite, or back crossbite. If it involves the front teeth, it’s called an anterior crossbite, or front crossbite.
Again, the majority of crossbites can be fixed without corrective jaw surgery using braces or Invisalign. Dr. Scramstad might also use extras like elastics for crossbite treatment. In these cases, crossbite elastics or appliances such as an expander help achieve skeletal alignment while your braces or aligners shift teeth into place.
For certain types of crossbites, early intervention can go a long way in preventing the need for surgery and will allow Dr. Scramstad to guide jaw growth in childhood. Rarely, surgery is needed to fix a crossbite.
When is Corrective Jaw Surgery Necessary?
Corrective jaw surgery is only reserved for adult patients who are done growing. An oral surgeon performs the jaw surgery, typically in a hospital. You have to have orthodontic treatment when you have corrective jaw surgery because moving the jaws also moves the teeth. If you have, for example, an underbite, you’d get Invisalign or braces before and after underbite jaw surgery. This ensures that post-surgery, your bite after braces or clear aligners comes together properly. The process takes several years and recovery can be challenging, which is why it’s only considered as a last resort for adults whose bite imbalance and facial esthetic concerns are severe and affect their health and/or quality of life.
Avoiding Corrective Jaw Surgery: The Key Takeaways
The reason it’s recommended that kids have their first orthodontic evaluation at age 7 is because, at this point, we can see how their permanent teeth and bite are developing. If Dr. Scramstad spots certain red flags, he can step in and manipulate a child’s jaw growth and intercept problems before they become serious. This is really the best way to avoid needing procedures such as underbite or overbite surgery.
However, this doesn’t mean that every teen or adult patient with a significant bite imbalance will require surgery. With digital treatment planning, Dr. Scramstad can plan your treatment from every angle and visualize different outcomes for better results even in complex cases. Additionally, braces and Invisalign have come a long way and are able to treat a wider range of patients than ever before. If you’ve been told you need corrective jaw surgery, it’s always a good idea to get a second opinion.
If you have bite concerns and are unhappy with the appearance of your smile, schedule an in-person or virtual consultation at Align Ortho in Kelowna to learn more about your options for aligning your teeth and jaws without corrective jaw surgery. In many cases, Dr. Scramstad can create a personalized treatment plan that brings out the best in your smile and ensures your bite after braces or Invisalign is healthy and functional. Book your visit today!