Patient Frequently Asked Questions:

Am I your patient? How do I know, whether I need orthognathic surgery?

Orthognathic surgery enables us to solve problem by eliminating the cause, rather than masking it and hence provides aesthetical and functional results at maximum. It is a complex treatment method which improves teeth alignment as well as jaw and facial defects along with restored proper functions. Nevertheless, one should remember that such results call for longer treatment period, professional of high competence and at the same time, your time, determination and effort. A consultation is the way to test whether orthognathic surgery is the treatment method required in your case. Meanwhile, the theses provided below may help you to decide whether the consultation would be adequate.

Orthognathic surgery might be purposeful as…
Please evaluate ten statements provided below:

  1. My dentist says he/she is not able to properly restore my teeth because of malocclusion.
    2. I don’t like my face: the lower jaw seems to be too large or too small, or asymmetrical.
    3. Lower front teeth bite into the palate or are lower front teeth are more prominent than the upper front teeth.
    4. Upper teeth overlap the lower teeth (overbite or deep bite) or even do not fit together with lower teeth (open bite).
    5. My teeth wear too fast, fillings and dentures crack.
    6. I feel discomfort in the lower jaw area, constant crackle, pain or grinding.
    7. I would like orthodontist to align my teeth, however, I dislike not only my misaligned teeth, but the shape of the face as well.
    8. My teeth are not visible when I smile or talk (they are hidden under the lip), or my front teeth are visible too much, when I smile gums can be seen as well.
    9. I suffer from constant daytime sleepiness; I sleep long at night, but still experience lack of sleep.
    10. I can commit to a long term treatment and complex surgery to attain maximum functional and aesthetic result.

Orthognathic surgery is most likely not suitable for me, because…
A series of statements which, unlike the previous, will help to decide that this treatment is not for you, and that a simpler isolated orthodontic treatment would be a better solution in your case:

  1. I do not want surgery as even 1% risk of complications risk scares me.
    2. I know that my face is abnormal, but I do not want to change anything, I just want to align the teeth.
    3. I want to just align several teeth, even though doctors say that my bite is abnormal; at this stage of life I want the simplest possible treatment.


Tooth removal

My dentist recommends removing multiple healthy teeth and I do not feel good about it. Is it really necessary?

There always are at least several ways to solve the problem. While one method is simple and effective, another one is complex and takes a long time, however, is more conservative as well. When is teeth removal required?

  1. Lower teeth of wisdom

These teeth must be removed 6 to 9 months before the orthognathic surgery. This is a must since the jaw cuts are performed very close to these teeth. Sometimes the improper position of the teeth of wisdom forces the surgeon to modify the cut lines and run into the risk of improper jaw split. In order to avoid such a risk and minimise the complications the teeth are removed prior to the surgery. Quite often the lower teeth of wisdom are not fully grown or not erupted at all. Their removal is a surgical procedure as well and may also cause serious complications. For this reason, it is recommended to choose an oral surgeon or a dentist who is competent in performing such a procedure.

Most often these teeth are removed at the beginning of the treatment. In special cases where these teeth could serve as a supplementary support for orthodontic treatment, they might be preserved for half a year or one year period. It is important not to forget and remove them as if right before the surgery it appears that the teeth of wisdom remain the surgery would be postponed or larger risk should be accepted in jaw surgery. In very rare cases the teeth of wisdom may be preserved by means of orthodontic treatment allowing sprouting up and replacing the missing teeth. This approach takes more than 1.5 years and most often a defective tooth of wisdom mechanically does not replace the missing molar tooth. For this reason our team suggests removing the tooth of wisdom and replacing it with a tooth implant. The teeth of wisdom can nevertheless be advantageous in cases of children and teenagers if the “golden months” are not missed. During this period of time the tooth of wisdom has already formed out of its bud as much as necessary and the tooth bud can be successfully transplanted for replacing the missing tooth and later on avoiding the implantation procedure once maturity is reached.

  1. Upper teeth of wisdom

These teeth likewise the lower teeth of wisdom often do not erupt. Upper teeth of wisdom cause no problems during the surgery and therefore can be preserved, yet it is usually recommended to remove them at the beginning of treatment for another reason: they complicate the orthodontic treatment. It is important to know, however, that these teeth buds also can be transplanted in cases of children.

  1. Upper and/or lower fourth and fifth teeth

Patients are often concerned why their healthy premolars need to be removed. The rationale behind that is that during the life span, due to jaw misalignment and improper fitting between upper and lower teeth, the front teeth are often influenced by the forces of tongue and lower lip without opposing, and therefore, shifts forward or backwards. Teeth shifting backwards do not cause a big problem since the dental braces may help to correct the positioning of teeth and shift them forward. If the front teeth shift forward and lengthen, restoring the initial position is very difficult as the teeth which are situated behind move forward as well, leaving almost no room for shifting backwards. In latter case two alternatives can be considered: either fourth and fifth teeth are removed and the gaps can be employed for the necessary front teeth shifting an inward inclination as well as moving molars forward; or the teeth are preserved and the whole dental arch is moved forward. The second alternative requires several screws to be inserted into the jaw or several titanium plates to be placed on the jaw surface in order to attain a strong support base and move the whole dental arch with the use of elastics. The placement of orthodontic implants is a regular procedure that can be performed in a dental chair without any following supplementary maintenance.

  1. Removal of defective teeth

If the tooth cannot be treated, it is best to remove it and after several months fill its space or another estimated area with a dental implant. A dental implant with temporary crown is a very strong support and may serve in orthodontic treatment as well as minimise the duration of it.


Tooth transplantation

How to avoid implantation when your child turns 18?

Congenital pathology, when one or more tooth buds are missing, is not a rare phenomenon. If a bud is missing, the tooth is missing, too. While given the advances of modern implantology this is not a big problem for adults and the missing tooth can be replaced with a dental implant within several months. Yet the concern remains in cases of children since it is forbidden to place the implants while the jaws are growing until the age of 18. Does a child have to live without a tooth until he turns 18 and qualifies for implantation? Such an amount of time due to absence of load often results in bone resorption in the area of a missing tooth – nature tends to destroy what it is not used. Hence if measures are undertaken only in full age, bone restoration procedure, implantation and a denture would be required. While it may sound constructive, these procedures are often costly in financial terms.

Are there any alternatives that would enable the child to take an advantage of new tooth until full age is reached?

Dental transplantation is such an alternative. In essence, it concerns transplantation of tooth bud into the area of a missing tooth. The transplanted tooth bud then forms and grows as a new tooth.

Missing teeth

I would like to undergo orthognathic surgery, however, multiple teeth are missing. Can this surgery be applied in my case?

The more teeth there are during the orthognathic treatment, the easier it is to treat, as all the orthodontics is based on the principle of force and resistance. If there is a non sufficient amount of molar teeth, it gives no space for support and hence, no way for front teeth alignment. For this reason, it is anticipated that before or during the orthodontic treatment all teeth would be restored at maximum.

The same conditions apply for the orthognathic surgery: the more teeth there are, the easier it is to fix the bite and the more reliable results are achieved. Nevertheless, not all patients have the time and possibilities for restoring the teeth before the surgery. What shall one do about it?
Implantation and dental prosthetics before the orthognathic surgery are recommended when:

  1. The patient is young or only several teeth are missing.
    2.    Implantation is possible without greater bone transplantation procedures.
    3.    Implantation is possible by transplanting the bone from chin and saving the lower jaw branches before the surgery.
    4.    The patient is seeking the result at maximum and is not limited in terms of time.

It is recommended to postpone Implantation and dental prosthetics and perform them after the surgery, when:

  1. The patient seeks to solve the abnormal bite issue as soon as possible and restore the teeth at a later life stage.
    2. The patient of older age undergoes the treatment: if the preparation for the surgery takes more than 2 years, the possibility of related illnesses becomes greater and those diseases might have impact and raise the risk of a long surgery (heart and blood-vessel, lung diseases).
    3. The majority or all teeth are missing: in order to restore the teeth in these cases, additional reconstruction procedures are required: sinus lifting, implantation, bone transplantation. It is better to perform bone reconstruction of greater scope during the orthognathic surgery, as it might require a donor bone from other areas of the organism. If the bone transplantation is performed by means of other lower jaw areas, the further orthognathic surgery becomes complicated. Therefore, if orthognathic surgery is planned, it is better to postpone the implantation and bone transplantation procedure that is performed by means of lower jaw branches and perform them after the orthognathic surgery.

All in all:

  1. If the amount of bone tissue is sufficient and the patient seeks quality results, it is best to perform missing teeth restoration before the orthognathic surgery.
  2. It is best to perform sinus lifting before the orthognathic surgery. After the orthognathic surgery the sinus anatomy and structure of mucosa may change and the titanic micro-plates may become an obstacle.
  3. It is best to perform bone transplantation before the orthognathic surgery when the bone defect is minor, in the area of one or two teeth. In this case, little amount of bone tissue can be taken from the chin while saving the lower jaw branches.
  4. If large-scale bone transplantation is required, it is better to perform it after the orthognathic surgery when the jaw branches have already healed and may serve as donor tissues.
  5. If a total reconstruction of both jaws is required, it is better to perform it before or during the orthognathic surgery.

Orthodontic braces

What types of braces should be chosen for orthognathic treatment?

The answer to this question is quite unambiguous: those braces that your orthodontist will suggest, that is, those whith which he or she believes it is possible to reach the set goals. It does not matter braces of what kind of manufacturer, material or colour will be used. It is important instead that the orthodontist would be confident in them and would know how to manage them. Various means of transport can be chosen for the path from point A to point B. Some of those may be faster, but not very comfortable (e.g. plane), other – slower but more comfortable (e.g. car) while third would be discrete and allow to preserve privacy (e.g. business class flight). The situation with braces is similar:

  1. Metal bracesare chosen most often. Treatment by means of those is the quickest as they have the best mechanical characteristics. Metal braces can be found in largest variety with each system differing in terms of mechanical characteristics being more appropriate for particular clinical cases. It often happens that the system which is very convenient to treat non-surgical cases (self-ligating braces) are not suitable at all for treating patients who are being prepared for orthognathic surgery. Therefore, you should trust your orthodontist and let him choose the system for you.
  2. Ceramic bracesare less visible and are preferred by majority of younger patients and customer service employees. Ceramic braces are usually fixed only on 6th -8th upper front teeth while metal braces are placed on all remaining teeth. Ceramic braces are less noticeable, however, due to inferior mechanical characteristics they come off more often during the treatment process and that may require more time to reach the goals.
  3. Invisible lingual braces. Although these braces are penetrating the market and secure their position in esthetic orthodontics, the preparation with these for orthognathic surgery is extremely difficult, and sometimes impossible. It is expected that this system will develop and become easier to manage. Before the surgery, in most cases, external braces or fasteners are required to be placed for one or two months, as during the surgery and for several months after the surgery, the mouth opening is limited. It would be difficult to manage the new jaw position by means of lingual braces.

Orthognathic treatment approach

Which orthognathic treatment approach is most suitable for me?

Orthognathic treatment approaches: standard and surgery-first

Standard orthognathic treatment involves several steps: orthodontic treatment before the surgery, orthognathic surgery and postoperative orthodontic treatment. The aim of orthodontic treatment before the surgery is to align the forms of upper and lower dental arch, adjust the upper and lower teeth inclination angles so that the post-operative smile and face look flawless. Quite often, jaw size discrepancy becomes more noticeable and facial profile worsens during orthodontic treatment when the dental arch form which has naturally adapted to the position of the jaws is destroyed and the teeth are being tilted at a different angle. This may not be a big problem if not for the fact that this stage of treatment takes about 1.5 years, and the patient wishes to solve the problem immediately. If the orthodontic treatment could be shortened prior to the surgery, the surgery could be performed at the beginning of treatment, and the greatest part of orthodontic treatment would be shifted to the post-operative period. This is the so-called “surgery-first” approach which implies that the operation can be performed at the beginning of treatment, and alignment of dental arches would take place after the surgery. Unfortunately, this is possible only in rare cases where the upper and lower dental arches fit reasonably.

Should I choose the standard approach to treatment?

  1. I seek for ideal functional and aesthetic result.
    2. I am not afraid that my face shape may (but not necessarily) be slightly worse during the orthodontic treatment prior to surgery.
    3. I realise that orthodontic treatment will last for at least 1.5 years and I will be required to visit the orthodontist every 1 to 1.5 months.

Should I choose surgery-first approach?

  1. I do not aim at the ideal result: I would like to at least achieve considerably normal bite.
    2. I understand that I would achieve better chewing function and facial esthetics by choosing the standard approach.
    3. I want to move through the most difficult stage of treatment – surgery – as quick as possible, as I am going to live and work abroad (although I will be coming back for the final orthodontic treatment).
    4. I want the surgery to be performed as soon as possible since we are planning the family (for women).
    5. Due to work related or personal reasons I cannot wear braces for a long time.
    6. The surgeon does not waive my choice for this approach.

Orthodontic implants

When and why orthodontic implants are used?

Orthodontic moving of teeth is based on the principle of force and rebound. In order to move a single tooth, others have to be used as stable support. In order to move two teeth the same principle applies. What do you do to move the whole dental arch in the same direction? In this case, additional support mechanisms which are steadily attached to the bone – dental implants or orthodontic implants – are necessary. Dental implants are used in cases of one or more missing teeth. Once the dental implant is placed and fully fixed, a temporary dental crown is mounted.  Braces are affixed to it, and since it has already been included into the dental arch, it is possible to use it for support and move all the teeth. Orthodontic implants are used in cases when not a single tooth is missing. In such cases there is no  space for dental implant and hence smaller structures – orthodontic screws – which are mounted among the existing roots, or titanium plates, which are attached to the bone by several titanium screws.

Orthodontic screws or micro implants are placed atraumatically, it is not a surgical procedure and requires only minimal analgesia. On the other hand, their longevity is limited: micro implants often loosen and their placement among the roots of the teeth limits the movements of adjacent teeth, so the micro implants quite often have to be remounted to other areas during the treatment.

Microplates are much more stable structures which are mounted to the jaw surface above the root with a number of screws. Therefore, they do not limit the adjacent tooth movement and allow the whole dental arch to be moved and pulled with the use of elastic bands. The only drawback is that their attachment, despite being simple, is a surgical procedure. This procedure is performed under local anesthesia. Microplates are also widely used in the childhood: when two plates are attached to the upper jaw and two are placed on the bottom, the jaw growth can be modified by using elastic bands and in some cases, orthognathic surgery may be avoided.

Micro implants in the palate. Teenagers and even young adults of up to 22 years old often encounter cross-bite, when the upper jaw grew insufficiently and remains narrow. In childhood this problem is easily solved by means of rapid palatal expander which enables extension of the jaw through the central upper jaw palate seam. In adulthood this seam has already ossified and the palate expansion is practically ineffective – instead of the expansion of the jaw, the expander inclines the teeth. The rapid palatal expander can be used to solve cross-bite for teenagers, but unlike in cases of children, micro implants placed in the palate rather than teeth have to serve as a support for the expander.

Cases of children

Child encountered an emerging skeletal jaw abnormality, is it possible to avoid orthognathic surgery?

People know that it is possible to perform orthognathic surgery from the age of 18 and often do not contact doctors due to this reason. Today, we can help children as well, and, if the problem is diagnosed timely and conservative treatment is started, the surgery can be avoided.

Child’s lower jaw is too large, what should one do?

If the lower jaw is actually too large (sometimes it just seems so due to an oblique chin), it is important to seek help in time. The “golden years” when it is possible to try to adjust the growth is 10-11 years. It is the time of growth spurt and if tensile force is applied timely, the growth of the upper jaw can be stimulated and the growth of the lower jaw can be slowed. If this period is missed, this method becomes less effective and once the age of 14 is reached – completely inefficient. In order to attain this goal orthodontic palatal implants are also applied to serve as a support for rapid growth expander. The expander, while expanding the jaw, moves the upper jaw seems and accelerates the stretching forward.

Child’s lower jaw is too small, what should one do?

The lower jaw usually does not grow due to joint. In the age of children orthodontic functional devices answer the purpose by holding the lower jaw pushed forward, hence moving the lower jaw joint to a better position and stimulating jaw growth. If a teenager’s jaw growth is severely impaired, it should be made sure that no joint disc dislocation occurs, and if it is identified, the option of disc repositioning may be considered.

Child’s jaw grows crooked, what should one do?

First of all, it should be verified whether it is a child’s habit is to keep the jaw twisted, which led to asymmetric growth, or indeed one side of the jaw grows more than the other.

Functional asymmetry is a mandibular asymmetry caused by abnormal bite and tilting the jaw to one side. This problem is solved by timely orthodontic treatment and centering the jaw and further modifying its growth in a symmetrical position with use of orthodontic appliances.

Morphological asymmetry occurs when the growth of one side is disbalanced or when the other side grows too rapidly. Most often surgical treatment is required:

  • If the growth of one side of the jaw is insufficient, reconstructive joint surgery and later – surgical jaw lengthening may help;
  • If one side of the jaw is elongated, the reasons of growth pathology must be identified and removed surgically.


What are the risks associated with orthognathic surgery?

There is virtually no risk to health caused by orthognathic surgery. There is 1/1500 risk of bleeding during the upper jaw surgery. All patients feel numbness over the lower lip and chin for 2-6 months, and 5% of patients either do not experience numbness at all or the numbness does not fully diminsh.