Most bite problems are fixed with braces or aligners alone. A smaller group, where the upper and lower jaws sit in genuinely different positions, need the jaw bones themselves repositioned, and that is what orthognathic surgery does. It is a planned, hospital based procedure done with an oral and maxillofacial surgeon and an orthodontist working together, usually alongside a course of braces. It is the only way to change the underlying skeletal structure rather than just the position of the teeth.
Key takeaways
- Orthognathic surgery repositions the upper jaw, lower jaw, or both, when the bite problem is skeletal rather than dental.
- It is usually combined with braces, often worn for 12 to 18 months before surgery and a shorter period afterwards.
- Common reasons include severe underbites, overbites, open bites, facial asymmetry and some cases of sleep apnoea.
- The surgery is done under general anaesthetic, typically with a short hospital stay, and initial recovery takes several weeks.
- It is planned over months, so it suits people whose jaw discrepancy genuinely cannot be corrected by tooth movement alone.
The one question that decides it: teeth or jaws?
The deciding question is whether the problem is the position of the teeth or the position of the jaws. If the teeth are crooked but the jaws meet reasonably, braces or aligners can usually align everything, as our guide to straightening crooked teeth describes. If the jaws themselves are mismatched, so the lower jaw sits well forward or back, or one side is longer than the other, then moving the teeth alone cannot create a healthy bite or a balanced profile. That is the situation orthognathic surgery is designed for. An orthodontist and surgeon assess records, X-rays and scans to tell the two apart.
Common reasons for jaw surgery
- A marked underbite, where the lower jaw and teeth sit in front of the upper
- A severe overbite or a small lower jaw that affects chewing and profile
- An open bite, where the front teeth do not meet when the back teeth are together
- Noticeable facial asymmetry from one jaw growing differently
- Difficulty chewing, biting or speaking that traces to jaw position
- Some cases of obstructive sleep apnoea linked to jaw structure
How braces fit in
Surprising to many, braces usually come first. Before surgery the teeth are aligned within each jaw so that, once the jaws are moved into their new position, the teeth meet correctly. This pre surgical phase often lasts 12 to 18 months and can temporarily make the bite look worse, because the teeth are being set up for where the jaws will be, not where they are now. After surgery, a shorter period of braces fine tunes the bite as the bones heal. Whether the appliances are conventional or less visible options such as lingual braces or clear aligners is part of the planning discussion.
What the surgery and recovery involve
| Stage | What happens | Rough timeframe |
|---|---|---|
| Pre surgical braces | Teeth aligned within each jaw to prepare for the move | 12 to 18 months |
| Surgery | Jaw bones repositioned under general anaesthetic, often a short hospital stay | 1 to 3 hours, then a few days in hospital |
| Early recovery | Swelling settles, soft diet, time off work or study | Several weeks |
| Post surgical braces | Bite refined as the bones finish healing | A few months |
| Final result | Profile and bite settle into their new position | Several months to a year |
Most swelling eases within the first few weeks, and a soft diet is needed early on while the bones knit. The full refined result, in both bite and facial balance, becomes clear over the following months. As with any surgery there are risks to discuss with the surgeon, including temporary numbness of the lip or chin, which usually improves with time.
Is it worth it?
For the right person, orthognathic surgery does what no amount of tooth movement can, correcting a bite that affects chewing, speech or comfort and bringing the jaws into balance. It is a significant commitment of time and recovery, so it suits cases where the jaw discrepancy is real and braces alone would fall short. Where a jaw issue is milder or chiefly cosmetic, less involved options may be discussed first, as our guide to gummy smile treatment shows for one specific concern. A thorough joint assessment is the only way to know which camp you fall into.
Frequently asked questions
Do I have to wear braces if I am having jaw surgery?
Almost always, yes. Braces align the teeth within each jaw before surgery and refine the bite afterwards, and they are central to a good result.
How long is the recovery?
Initial recovery takes several weeks, with swelling easing over the first few. A soft diet is needed early, and the final result settles over several months.
Is jaw surgery only cosmetic?
No. While it improves facial balance, it is primarily done to correct how the jaws and teeth meet, which affects chewing, speech and comfort, and sometimes breathing.
Can sleep apnoea be a reason for jaw surgery?
In some cases. Where the jaw position contributes to airway narrowing, moving the jaws forward can help, and this is assessed individually with the relevant specialists.
Is there an alternative to surgery?
For mild discrepancies, braces or aligners may camouflage the bite. For genuine skeletal mismatches, surgery is the only way to reposition the jaw bones themselves.
The takeaway
Orthognathic surgery is the answer when a bite problem comes from the jaws rather than the teeth, and it works hand in hand with braces over a planned course. It is a substantial undertaking that delivers what tooth movement alone cannot for the right patient. The team at Lumi Dental can carry out an initial assessment and coordinate referral to the relevant specialists. See our current deals page or read about care at our Melrose Park practice. This article is general information and not a substitute for personal orthodontic or surgical advice.
