Orthognathic Surgery

What Is Orthognathic Surgery?

Orthognathic surgery is an advanced surgical treatment performed to correct positional discrepancies of the jaw bones. It is applied in cases where not only the teeth but also the jaw bones are misaligned. Orthodontic treatment alone can move teeth but cannot change the position of the jaw bones. For this reason, surgery is necessary in patients with severe skeletal discrepancies. The treatment is a comprehensive process planned jointly by an orthodontist and a maxillofacial surgeon, often lasting 18-24 months.

Conditions requiring orthognathic surgery include severe mandibular retrognathia, cases where the lower jaw protrudes forward relative to the upper jaw, upper jaw narrowness and retrusion, asymmetric jaw structures, severe open bite, and underbite. These patients have both significant aesthetic and functional complaints. Chewing difficulty, speech impairment, jaw pain, TMJ disorders, snoring, and sleep apnea are findings that support the need for surgery.

The treatment process consists of three phases. The first phase is pre-surgical orthodontic treatment. Here, braces are used to position the teeth correctly within the jaw bones. This phase can take 8-12 months, and the teeth may sometimes appear temporarily worse before surgery. The second phase is the surgical intervention. It is performed under general anesthesia by a maxillofacial surgeon. The jaw bone is cut in a controlled manner, moved to the planned new position, and secured with titanium plates. Hospital stay is typically 1-2 days.

The third phase is post-surgical orthodontic treatment. In this phase, fine adjustments are made to align the teeth with the new jaw position. The duration ranges from 6-12 months. When treatment is completed, both facial aesthetics improve significantly and functional complaints are largely resolved. After orthognathic surgery, some patients may experience joint sensitivity. In such cases, using a TMJ splint can be beneficial. After treatment, to maintain the new position of the teeth, the retention phase begins with retainer wire or Vivera retainers.

Types of Orthognathic Surgery

How Is the Surgical Type Determined?

• Clinical examination: Your jaw structure, bite relationship, and facial proportions are examined in detail by our orthodontist Uzm. Dt. Merve Özkan Akagündüz.
• Radiological evaluation: The structure of the jaw bones, their relationship with anatomical structures, and measurements necessary for surgical planning are performed using panoramic X-ray, cephalometric analysis, and three-dimensional cone beam computed tomography (CBCT).
• Digital surgical planning: Three-dimensional digital planning software is used in modern orthognathic surgery. Pre-surgical outcome simulation is performed, and custom cutting guides to be used in surgery can be produced.
• Multidisciplinary planning: The orthodontist and oral surgeon coordinate to determine the surgical type, cutting lines, and fixation method.
• Shared decision with patient: All information is clearly explained to the patient. Expected outcomes, risks, and alternatives are shared. The decision is made together with the patient.

Problems Treated

You May Have Multiple Problems at Once

Alternative Treatments

Dental Camouflage (Orthodontic Treatment Only)

• No surgery required, no risk of general anesthesia.
• No recovery period needed.
• Significantly more cost-effective compared to orthognathic surgery.
• Single-phase orthodontic treatment process, no multi-stage surgical process.
• With proper indication in suitable cases, yields very successful functional results.

• Only tooth positions change; the actual position of the jaw bones remains the same.
• Changes in facial profile are limited; insufficient for severe skeletal anomalies.
• In severe cases, forced compensation may affect the long-term health of teeth.
• In cases with high aesthetic expectations, patient expectations must be managed realistically.

Functional Appliances During Childhood and Adolescence

• The actual position of jaw bones can be guided during the growth period.
• Can prevent the need for orthognathic surgery later.
• No surgery involved, no anesthesia risk.
• Early intervention provides long-term results.

• Can only be applied during the growth period (typically ages 8-13).
• Not effective after growth is completed.
• Treatment success directly depends on the child's compliance with appliance use.
• May not be sufficient alone in severe skeletal cases.

Aesthetic Dental Treatments (Limited Solutions)

• No surgery required, provides quick results.
• Cost-effective compared to orthognathic surgery.
• May be sufficient in mild cases where only aesthetic concerns are primary.

• The skeletal anomaly remains unchanged; only visual correction is provided.
• Functional problems (chewing, TMJ, sleep apnea) are not resolved.
• In cases with bite discrepancies, the lifespan of veneers is shortened.
• Healthy teeth must be reduced; this is an irreversible intervention.

Botox and Fillers for Aesthetic Solutions in Mild Cases

• No surgery required, quick application.
• Provides immediate visual improvement.
• Reversible, creates no permanent change.

• Temporary, requires renewal every 6-12 months.
• Only effective in very mild cases.
• Does not resolve functional problems, only provides visual effects.
• Insufficient for severe skeletal anomalies.

Postponing Treatment and Regular Monitoring

• No unnecessary treatment burden placed on the patient.
• In mild cases, partial improvement with growth may occur.
• Most cost-effective approach.
• Allows for proper treatment planning at the right time.

• In severe cases, the opportunity for early intervention may be missed.
• Functional problems may continue during the monitoring period.
• Requires regular checkups.

Which Treatment Is Right for You?

Risks and Complications

Factors That Increase Risk

How Are These Risks Managed at Doredent?

• Detailed clinical and radiological assessment: Before surgery, panoramic X-rays, cephalometric analysis, and three-dimensional cone-beam computed tomography (CBCT) are used to thoroughly evaluate jaw structure, anatomical relationships (nerves, vessels, teeth), and all measurements needed for surgical planning.
• Digital surgical planning: Modern three-dimensional digital surgical planning software is used to simulate outcomes before surgery. Custom surgical cutting guides can be produced, and cutting paths and movement amounts are planned with millimetric precision.
• Multidisciplinary team approach: The long-standing partnership between orthodontist Uzm. Dt. Merve Özkan Akagündüz and Oral and Maxillofacial Surgery Specialist Uzm. Dt. Tayfun Cıvak ensures a coordinated and seamless treatment process.
• Preanesthesia assessment: A detailed assessment is performed by an anesthesiologist before surgery. Your overall health, existing conditions, and medications are reviewed.
• Surgery in hospital setting: Orthognathic surgery is performed under general anesthesia at a partner hospital. Modern surgical protocols, sterilization standards, and postoperative intensive care facilities are available.
• Preparatory treatments: Before surgery, all active oral health issues, nutritional status, and control of systemic diseases are addressed.
• Patient education: All options, expected outcomes, risks, and limitations are clearly explained. You are empowered to make an informed decision. No decision is imposed.
• Detailed postoperative follow-up: Frequent follow-up appointments in the early postoperative period allow close monitoring of the healing process. Long-term orthodontic finishing and retention are carried out at Doredent.
• Emergency protocol: Patients and families are thoroughly briefed on possible emergency situations in the postoperative period; communication channels remain open.

Who Is Orthognathic Surgery Suitable For?

An Important Prerequisite: Completed Growth

Which Patients Require Additional Evaluation?

What Does Being Ready for the Treatment Process Mean?

• Time commitment: Allocating time to attend regular follow-up appointments, comply with the orthodontic treatment protocol, and go through the post-surgical recovery period.
• Work and social life planning: Since work and social life will be restricted for at least 2-3 weeks after surgery, this period should be planned in advance.
• Family support: Family or close support is important during the initial post-surgical period.
• Psychological preparation: Coping with changes in body image, the long recovery process, and temporary functional difficulties (eating, speaking) requires psychological strength.
• Financial planning: Since the treatment process is long, advance financial planning is recommended.

After Treatment

First 24 Hours: Hospital Period

• Intensive care or ward monitoring: The first few hours after surgery are closely monitored for post-anesthesia awakening, airway safety, and general condition. Single-jaw surgery usually requires only ward monitoring, while bimaxillary surgery may require short-term intensive care monitoring.
• Swelling and bruising: Noticeable facial swelling begins within the first few hours; this is an expected process. Cold compress application and head elevation help reduce swelling.
• Pain management: Pain control is achieved with intravenous analgesics. Once the patient can tolerate pain, oral analgesics are initiated.
• Nutrition: Liquid nutrition begins within the first 24 hours. Water, fresh-squeezed fruit juices, soup, and dairy products are preferred.
• Antibiotic therapy: Prophylactic antibiotic therapy is initiated and continues for a specified period after surgery.
• Oral hygiene: Special hygiene protocols are initiated for cleaning the surgical area. Warm salt water gargles or special mouth rinse solutions recommended by your physician are used.

First Week: Early Healing

• Swelling management: Noticeable facial swelling reaches maximum at 2-3 days, then gradually begins to decrease. Cold compresses are applied for the first 48-72 hours; warm compresses may be preferred afterward. Sleeping with head elevated in bed reduces swelling.
• Nutrition: During the first week, eat liquid and pureed foods. Soup, yogurt, smoothies, mashed foods, eggs, and other soft options are preferred. Avoid hard, chewy, or sharp-edged foods (crackers, nuts, bread crust, etc.) completely.
• Oral hygiene: The surgical area must be cleaned gently. Strict adherence to the special hygiene protocols recommended by your physician minimizes infection risk. A soft toothbrush and chlorhexidine mouth rinse solution are often recommended.
• Medication use: Antibiotics, analgesics, and anti-edema medications prescribed by our contracted jaw surgeon Uzm. Dt. Tayfun Cıvak are taken regularly.
• Smoking and alcohol: Complete avoidance of smoking and alcohol for at least 4-6 weeks after surgery is strongly recommended. Smoking seriously impairs healing and increases infection, bleeding, and malunion risks.
• Activity restriction: Intense physical activity, heavy lifting, and exercise are prohibited during the first week. Light activities like walking are safe and support circulation.
• Speech: Lip and tongue movements may be limited in the first days; speech may be difficult. This condition is temporary.

First Month: Healing Process Progression

• Swelling resolution: Noticeable swelling largely subsides within 2-3 weeks. However, mild swelling may persist for several more months. The final facial contour becomes clear after 4-6 months.
• Dietary transition: From the second week onward, gradually transition from soft foods to normal foods. The speed of transition is determined by Tayfun Hoca. The timing for adding hard and chewy foods varies by case; usually after 6-8 weeks.
• Nerve sensitivity: Temporary nerve sensitivity, numbness, or tingling in the lower lip and chin is normal. In most cases it gradually improves over weeks and months. This process requires patience.
• Return to work and social life: Most patients can return to work and social life within 2-3 weeks. However, strenuous physical work or communication-intensive professions may require slightly longer.
• Regular check-ups: Frequent follow-up appointments are scheduled with Tayfun Hoca during the first month after surgery. Healing progress, suture sites, and general condition are evaluated.
• Suture removal: In most cases, dissolvable sutures are used. If sutures requiring removal are present, they are usually removed within 7-14 days.

2-6 Months: Completion of Surgical Healing

• Bone healing: The jaw bones surgically cut and repositioned completely unite within 4-6 months. During this process the bone structure becomes stable.
• Final facial contour clarification: Mild swelling fully resolves and the final aesthetic result becomes visible. Until this process, patience is important for evaluating the final result.
• Nerve healing: Temporary nerve sensitivity fully resolves in most cases during this period. In rare cases, some sensory changes may persist long-term.
• Return to full diet: During this period, patients can consume all foods normally. Transition to hard foods is gradual.
• Sports and physical activity: Approval from Tayfun Hoca should be awaited before returning to intense sports and physical activity. Usually normal sports activities become safe after 3-4 months.

Postoperative Orthodontic Completion

• Final orthodontic adjustments: After surgery changes jaw bone position, final orthodontic adjustments are made to bring teeth into their final occlusal position. This process usually takes 3-6 months.
• Appliance checks: Existing braces or Invisalign aligners continue to be used with necessary adjustments after surgery.
• Fine-tuning: Post-surgical occlusion is optimized to the millimeter. This is critical for long-term treatment success.
• Multidisciplinary follow-up: Coordination with Tayfun Hoca continues during this period. If situations requiring surgical evaluation arise, consultation is quickly arranged.

Retention Treatment

• Fixed lingual retainer: A thin wire bonded to the back surface of front teeth continuously maintains tooth position. This method is standard retention practice after orthognathic surgery.
• Night guard: In addition to fixed retainer, night guard use is recommended. Nightly use the first year, then a few nights per week in subsequent years may be sufficient.
• Vivera (optional): Vivera may be preferred as a high-quality clear retainer system. Its three-set package makes it last long.
• Retention duration: Retention after orthognathic surgery is applied long-term and comprehensively. Retainer use may be recommended for years.
• Regular check-ups: During retention, orthodontic check-ups are performed at least once yearly. Retainer condition, tooth position, and general orthodontic status are evaluated.

Long-Term Care and Follow-Up

• Adherence to retention protocol: Strictly follow the night guard and retainer use protocol recommended by your physician. Skipping retention is the main cause of relapse.
• Regular oral hygiene: Brushing twice daily, flossing, and regular oral care are the foundation of long-term oral health.
• Routine dental check-ups every 6 months: Standard 6-month check-ups are sufficient for monitoring both orthodontic status and general oral health.
• Annual orthodontic check-up: During retention, at least one orthodontic check-up yearly is important for retainer condition and tooth position.
• Professional dental scaling: Professional cleaning is performed at regular check-ups when deemed necessary.
• Plate and screw monitoring: Titanium plates and screws placed during surgery usually remain lifelong. Rarely if they cause discomfort or problems, they can be surgically removed; this decision is made by Tayfun Hoca.
• Bruxism management: If you have nighttime teeth grinding habits, regularly use the night guard recommended by your physician. Bruxism can be an important cause of post-treatment relapse.
• Avoid smoking and alcohol: Long-term after treatment, smoking's negative effects on oral and dental health continue.

Expected Improvements After Treatment

• Noticeable improvement in facial profile and symmetry: Jaw-face proportions become harmonious, profile balance is established. This is expressed by many patients as the greatest gain of treatment.
• Correct bite and chewing: Teeth meet in ideal position, chewing function improves. Foods that were difficult before treatment can be consumed comfortably.
• Jaw joint relief: Incorrect loading on the joint decreases, clicking sounds and pain symptoms may improve.
• Speech improvement: Difficulties pronouncing certain sounds decrease.
• Improved sleep quality: Since the airway widens, snoring and sleep apnea symptoms may noticeably decrease. Many patients report waking more rested in the morning.
• Improved confidence and social life: Aesthetic and functional gains positively reflect on the patient's social life and confidence. Behaviors avoiding smiling and taking photos decrease.
• General increase in quality of life: The gains obtained from treatment affect quality of life as a whole, not individually.

Rare Problems and Management

• Permanent nerve sensitivity: In most cases temporary nerve sensitivity fully resolves. Rarely some permanent sensory change may occur; this can be adapted to.
• Plate or screw problems: Very rarely, infection or loosening around a plate or screw may occur. In this case, after healing is complete (usually after 6-12 months), it can be removed with additional surgery.
• Relapse: Over years, teeth or jaw structure may tend to partially return to their original position. Adherence to retention protocol largely minimizes this risk.
• Need for second surgery: Very rarely, the expected result may not be fully achieved; in this case additional surgical correction may be planned.
• Aesthetic expectation mismatch: If the final aesthetic result after surgery differs from patient expectations, additional aesthetic treatments may be considered.

An Important Message to Patients

Frequently Asked Questions