For distinct misalignments of the jaws, e.g. an extremely deep overbite of the lower jaw with a retruded chin and insufficient lip closure, a regular orthodontic treatment is not feasible. In these cases, the orthodontic treatment is supplemented with orthognathic surgery during which one or two jaws are cut and repositioned by a specially trained maxillofacial surgeon. These procedures were developed decades ago and have constantly been improved. Orthodontists who mainly take care of children with removable plastic appliances are overchallenged by these demanding combination treatments. In our office, we routinely handle orthognathic surgery cases which require particularly profound information and treatment planning. We are permanently providing at least ten adult patients with treatment before or after these surgeries. The cooperation with three of our preferred centers (Dr. Barth in Mannheim, University Hospital Heidelberg and the Marienhospital Stuttgart) runs smoothly and we are a renowned partner to all of them. Unfortunately, this does not work out all the time and everywhere and bad cooperation between orthodontist and oral surgeon has got disadvantages for the treatment process and result. We give our best to provide optimal conditions for a successful interdisciplinary treatment.
An important step in the treatment planning is the simulation of the results beforehand. In order to do so, the x-ray findings and the lateral portrait photographs are superimposed on screen. The lateral portraits can be changed within seconds, simulating different treatment options. In doing so, you can easily compare whether a surgery on one or the two jaws would yield the better result, or, whether it was better to move a jaw more or less either to the top or the front. Since it is all about aesthetics, it is crucial to involve the patient: it is you who has to live with the altered face after-wards and you should be pleased with the aspired result. As well, we recommend taking along partners or close relatives to consultation since they can support you in making a decision. The world’s leading software Quick Ceph, which was developed by a U.S.-based German orthodontist, allows us the treatment simulation.
Just like all other surgical procedures, orthognathic surgery has got risks like bleeding, inflammation, and the risks from general anesthesia. Apart from these general risks, the repositioning of the upper jaw does not bear any apprehensive special risks. In contrast, repositioning the lower jaw does: surgical adjustments of the lower jaw are associated with damage to the lower jaw nerve which provides the teeth, lower lip and parts of the chin with sensation, and on the other hand with damage to the jaw joints. In both cases, the percentage of major damages that influence life quality resides in the lower, single-digit range. Neither the orthodontist nor the oral surgeon carries the risks, but only the – hopefully – well informed patient. We never put pressure on the patient concerning these extensive treatments, instead we rather see ourselves as mediators. Only if you are really sure you want such a treatment, you should get it.
No other treatment exhibits changes as strong and positive as orthodontics in combination with orthognathic surgery. The aesthetic gain, often as well as functional aspects, can be overwhelming in some cases, in particular if breathing, sleep quality and mouth closure are remarkably improved. After treatment has been finished we pose the question which is of vital importance: Would you do it again? Most of our patients answer: absolutely yes.