Orthodontic treatment can be a great treatment option used to straighten teeth.  However sometimes crooked smiles may involve more than just the teeth.  The teeth can appear/become crooked because of an underlying skeletal discrepancy.

What is a skeletal discrepancy?

Skeletal jaw discrepancies are when the upper and lower jaws do not meet in the “ideal” relationship.

The jaws are made up of teeth and bone.  The teeth are placed in sockets in the upper and lower jaw bones.  The teeth are held in place by ligaments and are independent to the jaw bone. This is why when you have orthodontic treatment that involves forces on your teeth (such as braces) that you get movement of the teeth, however do not get movement of the jaw bones.

Camouflage orthodontics

Sometimes orthodontic treatment will be used to camouflage the underlying skeletal jaw discrepancy.  The outcome may be a more “socially acceptable” aesthetic smile but will not correct the underlying issue of the skeletal jaw discrepancy and its effect on your health.  Camouflage orthodontics often involves extraction of teeth which usually results in a negative long term impact on the airway.

Jaw Surgery

Traditionally jaw surgery was/is viewed in a very negative light by many orthodontic providers.  This is based on outdated misinformation.  Orthodontists do not provide jaw surgery therefore many are unaware of the extraordinary advances made in the last few years.  Gone are the days of needing blood transfusions and weeks in hospital with jaws wired shut.

Most procedures are day or overnight stays.  New custom plating systems have eliminated the requirement of jaws being wired for weeks on end.  Elastics or wire are only required in rare cases.  Many procedures can now be done with minimal time in orthodontic appliances and often the orthodontics can be delayed until after the jaw surgery.

If you have a skeletal discrepancy, jaw surgery should always be discussed as part of your informed treatment consent.  An orthodontic provider can say it is an option but they have no training in jaw surgery, therefore you should always seek an opinion from a specialist oral and maxillofacial surgeon (or several)  who can discuss your specific surgical options, show you similar cases they have treated, and answer your personal questions.

Jaw surgery should not be left as a “last resort”.  It should always be considered as the “ultimate treatment option”.  Jaw surgery (combined with orthodontic treatment) is the only way to definitively treat a skeletal jaw discrepancy.  Jaw surgery will not be the chosen treatment option for everyone, however everyone with a skeletal discrepancy should be given the option to investigate the only treatment that will successfully treat the skeletal jaw discrepancy.  

Jaw surgery can be provided if you are not happy with your orthodontic outcome, however Jaw surgery chosen as a “last resort” often results in a compromised result, especially if teeth have been extracted during the initial orthodontic treatment.  The treatment usually calls for further orthodontic intervention and often dental implants to replace the teeth extracted during the initial orthodontic treatment.  The overall treatment time therefore is usually also longer for these cases.

‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’