What This Guide Covers and Who It Is For
This guide explains the full timeline for braces combined with orthognathic (jaw) surgery from first consultation to final results.
Orthognathic surgery is a procedure that repositions the upper jaw, lower jaw, or both to correct skeletal misalignment. The word "orthognathic" comes from Greek roots meaning "straight jaw." This surgery is not purely cosmetic. It addresses functional problems like difficulty chewing, breathing issues, chronic jaw pain, and severe bite problems that braces alone cannot fix. [1]
This guide is for adults and older teens who have been told they may need jaw surgery along with orthodontic treatment. It is also useful for parents researching the process on behalf of a teenager. If you are unsure whether your bite problem requires surgery or standard braces, a consultation with a specialist on the orthodontics page can help clarify your options.
Each section below covers a specific phase of the process. You can read straight through for the complete picture or skip to the phase you are currently in.
Core Facts About Orthognathic Surgery with Braces
Orthognathic surgery corrects jaw misalignments that are too severe for braces or aligners to fix on their own.
Why Braces Alone Are Not Always Enough
Braces move teeth through bone, but they cannot move the jawbones themselves. When the upper and lower jaws are significantly different in size or position, teeth cannot be aligned into a stable, functional bite without surgically repositioning the jaws first. [1]
Common skeletal problems that typically require surgery include a severely receding lower jaw (retrognathia), a lower jaw that protrudes too far forward (prognathism), an open bite where the front teeth do not touch when the mouth is closed, and significant facial asymmetry where one side of the jaw is longer than the other. [3]
An orthodontist evaluates these problems using X-rays, 3D imaging, dental models, and clinical examination. When the discrepancy between the jaws exceeds what tooth movement can compensate for, the orthodontist will refer you to an oral and maxillofacial surgeon to plan a combined treatment approach. [2]
Types of Jaw Surgery
There are three main categories of orthognathic surgery, and the type you need depends on which jaw is causing the problem. [3]
A Le Fort I osteotomy repositions the upper jaw (maxilla). The surgeon makes cuts in the bone above the teeth, then moves the upper jaw up, down, forward, or backward as needed. A bilateral sagittal split osteotomy (BSSO) repositions the lower jaw (mandible). The surgeon splits the jawbone on each side near the back molars and moves the front segment into the correct position. A genioplasty reshapes the chin bone and is sometimes performed alongside one of the other procedures. [3]
In some cases, both jaws need surgery at the same time. This is called bimaxillary (two-jaw) surgery. Your surgeon and orthodontist will determine which approach fits your specific skeletal pattern.
The Treatment Team
Orthognathic treatment requires close coordination between at least two specialists. The orthodontist handles all tooth movement before and after surgery. The oral and maxillofacial surgeon performs the surgical procedure itself. [1]
In some cases, other providers are involved. A periodontist (gum specialist) may be consulted if there are concerns about gum health or bone support. A sleep medicine physician may be part of the team if obstructive sleep apnea is one of the reasons for surgery. Your general dentist continues to monitor your overall dental health throughout the process.
Risks and Potential Complications
Like any surgical procedure, orthognathic surgery carries risks. Understanding these risks helps you make an informed decision and prepare for your recovery.
The most commonly reported complication is altered sensation (numbness or tingling) in the lower lip, chin, or cheeks. This happens because the inferior alveolar nerve, which runs through the lower jaw and provides sensation to the lip and chin, is stretched or bruised during the procedure. A 2021 systematic review of 25 studies published in the International Journal of Oral and Maxillofacial Surgery found that inferior alveolar nerve neurosensory disturbance occurred in approximately 85% of patients one week after bilateral sagittal split osteotomy. By one year after surgery, that number dropped to about 36%. [7] In many patients, sensation continues to improve over the months following surgery, but some patients experience long-term or permanent partial numbness.
The lingual nerve, which provides sensation to the tongue, can also be affected during lower jaw surgery, though this is less common. A 1998 retrospective analysis of lingual nerve changes after BSSO found that some patients experienced altered tongue sensation, with most cases resolving over time. [4]
Other potential risks include infection at the surgical site, unfavorable jaw healing requiring additional surgery, relapse (the jaw shifting back toward its original position over time), temporary or prolonged difficulty with jaw opening, damage to tooth roots near the bone cuts, and the need for revision surgery. Blood loss during the procedure is also possible, though transfusions are uncommon. [3]
Serious complications are rare when the procedure is performed by an experienced oral and maxillofacial surgeon in an appropriate hospital setting. Discuss your specific risk factors with your surgeon before consenting to surgery.
Practical Details: Age, Timing, and Preparation
Timing matters because jaw surgery is typically performed after jaw growth is complete.
Age Recommendations and Jaw Growth
Most orthodontists and surgeons recommend waiting until the jaws have stopped growing. For females, this is typically around age 16 to 17. For males, growth often continues until age 18 to 21. [1]
Your orthodontist may track growth using a series of X-rays taken several months apart. If the X-rays show the jaw is still changing, surgery will be postponed. Operating on a jaw that is still growing risks an unstable result because the bones may continue to shift after the procedure.
There is no strict upper age limit for orthognathic surgery. Adults in their 30s, 40s, and beyond can be good candidates as long as they are in reasonable overall health and have adequate bone density. The healing process may be somewhat slower in older adults, but outcomes are generally similar. [3]
Initial Consultations and Planning
The planning phase begins with consultations with both the orthodontist and the oral surgeon. Expect these appointments to include a clinical exam, photographs of your face and teeth, dental impressions or digital scans, a panoramic X-ray, a cephalometric X-ray (a side-view image of the skull), and often a cone-beam CT scan (a 3D X-ray of the jaws). [2]
Using these records, the orthodontist and surgeon create a detailed treatment plan. They determine exactly how many millimeters each jaw needs to move and in which direction. Modern planning often uses computer software to simulate the surgical outcome and predict how the face will look after surgery. Virtual surgical planning (VSP) has become increasingly common and can improve accuracy in complex cases. [5]
This planning phase can take several weeks to a few months as records are gathered and shared between specialists.
How to Prepare Ahead of Time
Practical preparation makes the recovery period much easier. Stock your kitchen with soft foods before surgery: soups, smoothies, yogurt, mashed potatoes, scrambled eggs, and protein shakes. You will be on a liquid or very soft diet for several weeks after the procedure.
Arrange for time off from work or school. Most patients need 2 to 4 weeks away, depending on the type of surgery and their job requirements. If your work involves physical labor, you may need more time.
Your surgeon will give you specific pre-operative instructions. These typically include stopping certain medications (like blood thinners or aspirin) at least a week before surgery, not eating or drinking after midnight the night before, and arranging for someone to drive you home from the hospital. If you smoke, your surgeon will likely advise you to stop smoking well before the procedure, as smoking can significantly impair bone healing and increase the risk of complications. [3]
Step by Step: What Happens During Each Phase
The process moves through three distinct phases: pre-surgical braces, the surgery itself, and post-surgical braces.
Phase 1: Pre-Surgical Braces (12 to 18 Months)
Pre-surgical braces align the teeth within each jaw so the upper and lower arches will fit together properly once the jaws are repositioned. This phase typically lasts 12 to 18 months. [1]
Here is an important point that surprises many patients: your bite may actually look and feel worse during this phase. That is expected. The orthodontist is positioning the teeth based on where the jaws will be after surgery, not where they are now. For example, if your lower jaw currently sits too far back, the orthodontist may align your lower teeth forward within the jawbone, which temporarily makes the underbite appear more pronounced. This process is sometimes called "decompensation" because the orthodontist is removing the natural dental compensations your teeth have made for the jaw discrepancy. [6]
During this phase, you will visit the orthodontist approximately every 4 to 8 weeks for adjustments. The surgeon may also see you periodically to monitor progress. Toward the end of this phase, the orthodontist and surgeon will confirm that the teeth are in the correct pre-surgical positions using updated X-rays and models.
Surgical hooks, which are small metal attachments on the braces, are placed near the end of this phase. The surgeon uses these hooks to attach wires or rubber bands that help stabilize the jaws during and after surgery.
Phase 2: The Surgery
The surgery is performed under general anesthesia in a hospital or surgical center. Most procedures take 2 to 4 hours, though bimaxillary surgery may take longer. [3]
Nearly all orthognathic surgery is performed through incisions inside the mouth, which means there are typically no visible scars on the face. The surgeon cuts the bone in precise, planned locations, moves the jaw segments into their new positions, and secures them with small titanium plates and screws. These plates are usually left in permanently, though they can be removed later if they cause any issues. [3]
After surgery, you will spend time in a recovery room before being moved to a hospital room. Most patients stay in the hospital for 1 to 3 nights. During this time, the medical team monitors swelling, manages pain with medication, and ensures you can take fluids safely.
Your jaws will not be wired shut in most modern cases. Surgeons today typically use the titanium plates for rigid fixation, which allows limited jaw movement soon after surgery. However, you will likely have rubber bands (elastics) connecting the upper and lower braces to guide your bite into the correct position during healing. [3]
Recovery After Surgery
The first two weeks are the most challenging. Swelling peaks around day 3 to 4 and gradually improves over the following weeks. Bruising around the cheeks, chin, and sometimes the neck is common and typically fades within 2 to 3 weeks.
Numbness in the lower lip, chin, or cheeks is very common immediately after surgery because the inferior alveolar nerve is stretched or bruised during the procedure. Research shows that the large majority of patients have some degree of altered sensation in the first week after bilateral sagittal split osteotomy. [7] In many cases, sensation returns gradually over weeks to months. By one year after surgery, most patients see significant improvement, though some may have persistent altered sensation that can be long-term. [7] Your surgeon will discuss nerve-related risks specific to your procedure.
Diet progresses in stages. You will start with liquids only, then advance to pureed foods, then soft foods, and finally return to a regular diet over 6 to 12 weeks. Adequate protein and calorie intake are important for bone healing, so nutritional planning helps.
Most patients return to work or school within 2 to 4 weeks, though energy levels may be lower than normal for several weeks beyond that. Full bone healing takes approximately 9 to 12 months. Contact sports and activities with a risk of facial impact should be avoided for at least 3 to 6 months, or as directed by your surgeon.
Phase 3: Post-Surgical Braces (6 to 12 Months)
After the initial healing period, you will continue seeing your orthodontist regularly for post-surgical braces adjustments. This phase typically lasts 6 to 12 months. [1]
The orthodontist uses this time to fine-tune the bite now that the jaws are in their new positions. Small adjustments close any remaining gaps, correct minor rotations, and ensure the upper and lower teeth mesh together precisely. Rubber bands are often worn during this phase to help settle the bite.
Once the orthodontist is satisfied with the alignment and the bite is stable, the braces are removed. You will then receive retainers, which are essential for maintaining the results. Most orthodontists recommend wearing retainers full-time for several months, then transitioning to nighttime wear indefinitely.
A final set of X-rays and photographs is typically taken after braces are removed to document the completed treatment and confirm that the bones have healed properly.
Cost Factors and Insurance Coverage
The total cost of orthodontic treatment combined with jaw surgery varies widely depending on several factors.
The orthodontic portion (pre-surgical and post-surgical braces) typically ranges from $5,000 to $8,000 or more. The surgical portion, including the surgeon's fee, anesthesia, and hospital stay, can range from $20,000 to $40,000 or higher. Bimaxillary surgery generally costs more than single-jaw surgery. Costs vary significantly by geographic location, provider experience, hospital facility fees, and case complexity. These figures are estimates and may not reflect current pricing in all areas.
Insurance coverage is a critical factor. Because orthognathic surgery corrects functional problems with the jaw, it is often classified as a medical procedure rather than a dental one. This means medical insurance, not dental insurance, may cover the surgical portion when the procedure is documented as medically necessary. [2]
To establish medical necessity, your surgeon typically submits documentation that may include clinical photographs, X-rays, a letter detailing functional impairments (difficulty chewing, breathing problems, jaw pain), and sometimes sleep study results. Insurance companies often require prior authorization before approving coverage. [3]
The orthodontic portion may be partially covered by dental insurance, though many dental plans have a lifetime maximum for orthodontic benefits (commonly $1,000 to $2,500). Check both your medical and dental plans carefully. Ask your orthodontist's office and your surgeon's office about insurance verification, as both teams typically have staff experienced with these claims.
When to See a Specialist
You should consult a specialist if your bite problem involves a mismatch between the size or position of your jaws, not just crooked teeth.
Specific signs that suggest you may need an orthodontic and surgical evaluation include: a significant overbite or underbite that makes chewing difficult, an open bite where your front teeth do not come together when you close your mouth, facial asymmetry where your chin or jaw appears shifted to one side, chronic jaw pain or TMJ (temporomandibular joint) dysfunction that has not responded to other treatments, difficulty breathing through your nose or a diagnosis of obstructive sleep apnea related to jaw position, and difficulty closing your lips comfortably at rest. [3]
Your general dentist may be the first to identify a skeletal jaw discrepancy. If they suggest an orthodontic consultation, that is a good starting point. The orthodontist will determine whether braces alone can address the problem or whether surgery is also needed. If surgery is indicated, the orthodontist will refer you to an oral and maxillofacial surgeon for a joint evaluation.
Getting an evaluation does not commit you to surgery. Many patients benefit from understanding their options even if they decide to proceed with orthodontics alone or to delay treatment.
Find an Orthodontist or Oral Surgeon Near You
If you are considering jaw surgery or have been told you may need it, starting with a qualified orthodontist is a logical first step. An orthodontist can assess whether your bite problem has a skeletal component and coordinate with an oral and maxillofacial surgeon when needed. Use the orthodontics page to search for a specialist in your area who has experience with surgical orthodontic cases.
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