Orthognathic Surgery

Surgical orthodontics, also known as orthognathic surgery, is a specialized field that combines orthodontic treatment with surgical procedures to correct jaw deformities. 

This approach is particularly beneficial for patients with severe jaw misalignments that cannot be corrected through orthodontic treatment alone.

Types of Jaw Corrections

This procedure can address a range of dental and facial issues. Some types of jaw surgery include: 

Deficient Lower Jaw

For patients with a deficient lower jaw, myofunctional appliances such as the Twin block can be used to improve jaw growth. 

The Twin block appliance consists of two parts – an upper and lower component – that work together to push the lower jaw forward, aligning it with the upper jaw.

Deficient Upper Jaw

In cases of upper jaw deficiency, orthopedic appliances like face masks can be employed to enhance upper jaw growth. A facemask is a removable appliance that guides the upper jaw forward, improving overall jaw alignment. 

It’s important to note that facemask therapy is only effective in young, growing patients.

Surgical Orthodontics: Indications and Procedures

Understand the steps involved in a surgical orthodontics procedure:

1. Skeletal Class III Malocclusions

This condition is characterized by either a small upper jaw (maxillary retrusion) or a large lower jaw (mandibular prognathism), or a combination of both. In severe cases, patients may have:

• A concave facial profile
• Underbite (lower teeth positioned in front of upper teeth)
• Difficulty biting and chewing
• Speech problems

Surgical correction typically involves maxillary advancement, mandibular setback, or both.

2. Skeletal Class II Malocclusions

This condition presents with either a large or normal upper jaw combined with a small lower jaw (mandibular retrognathism). Patients may exhibit:

• A convex facial profile
• Significant overbite
• Receding chin
• Breathing difficulties or sleep apnea

Treatment often involves mandibular advancement surgery, sometimes combined with maxillary procedures.

3. Deep Bite in Non-Growing Patients

A deep bite occurs when the upper front teeth excessively overlap the lower front teeth vertically. In non-growing patients, severe deep bites may require:

• Surgical repositioning of the jaws
• Segmental osteotomies to reposition specific parts of the jaws

This helps achieve proper bite alignment and prevents excessive wear on the teeth.

4. Extreme Vertical Excess or Deficiency

Vertical maxillary excess can cause a “gummy smile” and long face syndrome, while vertical deficiency can lead to a shortened lower face. Both conditions may require:

• LeFort I osteotomy to reposition the maxilla vertically
• Mandibular procedures to harmonize with maxillary changes

5. Skeletal Asymmetry

Facial asymmetry can result from uneven growth of the jaws or other facial bones. Surgical correction may involve:

• Differential jaw repositioning
• Chin surgery (genioplasty)
• Procedures to address specific areas of asymmetry

In each of these scenarios, surgical orthodontics aims to correct the underlying skeletal discrepancies, improving both function and aesthetics. 

The specific surgical procedures are tailored to each patient’s unique needs and are typically combined with orthodontic treatment before and after surgery for optimal results.

At Smiline, various surgical procedures are available to address these issues:

1. Anterior-posterior corrections:
   • Maxillary surgery (upper jaw) for advancement or retraction
   • Mandibular surgery (lower jaw) for advancement or setback
2. Vertical corrections involving both maxillary and mandibular surgery
3. Transverse corrections for both jaws
4. Skeletal open bite correction
5. Genioplasty (chin surgery)

Planning Orthognathic Surgery

The planning process for orthognathic surgery is comprehensive and involves:

1. Clinical examination: Involves a thorough assessment of the patient’s oral health, including teeth alignment, bite relationship, and soft tissue evaluation.
2. Socio-psychological evaluation: Assesses the patient’s motivation for treatment, expectations, and potential psychological impact of orthodontic intervention.
3. X-rays, photographs, and cephalometric evaluation: Includes panoramic x-rays, lateral cephalograms, and intraoral/extraoral photographs to analyze skeletal and dental relationships.
4. Study model analysis: Involves taking impressions to create plaster casts of the teeth, allowing for detailed examination of tooth positions and occlusion.
5. Prediction tracing: Uses cephalometric tracings to predict post-treatment outcomes and plan tooth movements.
6. Model surgery procedure: Simulates potential surgical outcomes on dental models for cases requiring orthognathic surgery in conjunction with orthodontic treatment.

Cost of Jaw Surgery in India

The cost of jaw surgery (orthognathic surgery) in India can vary widely depending on several factors. Here’s a breakdown of the costs:

1. Average Cost Range:
   • The average cost of orthognathic surgery in India ranges from ₹59,943 to ₹1,99,838.
2. Specific Types of Jaw Surgery:
   • Upper Jaw Surgery: ₹20,960 – ₹31,45,840
   • Lower Jaw Surgery: ₹41,920 – ₹62,880
   • Double Jaw Surgery: Approximately ₹32,00,000
   • Genioplasty (chin surgery): ₹83,760 – ₹1,04,720