Surgery for a jaw malposition
Correcting a jaw malposition by surgery is a possibility that is usually considered in adults and severe malpositions. Once the growth is complete, fixed braces can only be used to tilt and move the teeth. The remodelling of the bony structures is only possible to a very limited extent.
A so-called hand x-ray can be used to determine the state of growth. Surgery is performed on congenital or acquired malocclusions, an abnormal position of one or both jaws (dysgnathia). However, it must be remembered that an orthodontic pre-treatment is absolutely necessary before such an operation.
The dental arches are aligned as perfectly as possible (usually with fixed braces), and the overall aesthetic appearance at this stage is usually worsened. Only then can the upper and lower jaws be aligned with each other in a so-called repositioning osteotomy and correct interlocking guaranteed. Among other things, a protruding lower jaw (progeny) can be corrected.
If the upper jaw is too far forward, this is called “maxillary prognathism. “A lower jaw that is too far back (mandibular retrognathia) can be corrected in the same way as an upper jaw that is too far back (maxillary retrognathia). This changes the profile image, noses appear optically reduced and the lip position is harmonious.
The basic prerequisite is the diagnosis, the clarification discussion and the planning phase. Various x-rays (almost always a CT), analyses and the creation of models are necessary. Often teeth have to be removed before such a malocclusion surgery, possibly also displaced wisdom teeth.
Oral hygiene has to be optimized, tooth cleaning, a caries-free and healthy periodontal bite is the prerequisite. This is followed by the often lengthy orthodontic pre-treatment in which the teeth are corrected. During the operation, bone parts are usually cut through under anesthesia (osteotomy) and completely removed or relocated as required.
The operation can be performed almost exclusively in the oral cavity (intraoral), scars on the skin in the facial area are avoided. The new jaw position is fixed by means of plates and screws (osteosynthesis procedure, usually titanium). In many cases chin operations are connected to improve the aesthetics.
Nowadays, both jaws are only very rarely wired after a repositioning operation, so it is possible to open the mouth easily, maintain careful oral hygiene and eat soft food. Mostly, however, removable elastic bands are still used. Risks during operations for jaw malalignment are especially nerve injuries, bleeding, fractures and tooth damage. Recurrences are rare, but orthodontic aftercare and physiotherapy are necessary. An inpatient admission, the intake of painkillers and antibiotics are necessary.
