When Braces Alone Aren’t Enough: Understanding Surgical Orthodontics
Surgical orthodontics is needed when a person’s bite problem is caused by serious bone alignment problems rather than just misaligned teeth, which braces alone cannot fix. It is necessary to correct adult jaw discrepancies, severe underbites and overbites, facial asymmetry, chronic TMJ pain, and breathing issues. At Weeks Orthodontics, Dr. Travis A. Weeks and Dr. Shadiya Hasan work in close collaboration with board-certified oral and maxillofacial surgeons to coordinate these complex cases from start to finish — ensuring your braces and surgical plan work together smoothly.
What Is Surgical Orthodontics (Orthognathic Surgery)?
Surgical orthodontics — also called orthognathic surgery — is a combined treatment approach where an orthodontist and an oral surgeon work together to correct jaw misalignments that cannot be resolved with braces or aligners alone. Braces move teeth within the bone; surgery moves the bone itself. The American Association of Oral and Maxillofacial Surgeons (AAOMS) estimates that about 5% of the population has jaw discrepancies severe enough to need surgical correction.
Conditions That Require Surgical Orthodontics
Severe Underbite (Skeletal Class III)
When the lower jaw grows a lot longer than the upper, the lower teeth bite far in front of the upper teeth. In adults, the jaw has stopped growing, so braces alone cannot reposition the bone. Surgical correction moves the lower jaw back or the upper jaw forward to achieve a proper bite and balanced facial profile.
Severe Overbite (Skeletal Class II)
When the upper jaw protrudes excessively or the lower jaw is severely underdeveloped, the result is a significant overbite with the lower jaw set far back. Research in the American Journal of Orthodontics and Dentofacial Orthopedics shows that surgical correction of severe Class II cases produces more stable long-term results than orthodontic camouflage alone.
Facial Asymmetry
When one side of the jaw grows more than the other — due to condylar hyperplasia or uneven growth — the result is a visibly asymmetrical face, uneven bite, and often chronic discomfort. Surgery repositions the jaw to restore symmetry to both function and appearance.
Chronic TMJ Pain and Dysfunction
When the jaw joints (TMJ) are under chronic stress due to structural misalignment, conservative treatments may not provide lasting relief. In severe cases, jaw repositioning surgery can alleviate the underlying cause of TMJ dysfunction by correcting the bite relationship that’s creating the problem.
Breathing and Sleep Issues
Jaw position directly affects airway space. A retruded lower jaw or narrow upper jaw can restrict airflow and contribute to obstructive sleep apnea. According to the American Academy of Dental Sleep Medicine, maxillomandibular advancement (MMA) surgery — a form of orthognathic surgery — is one of the most effective surgical treatments for obstructive sleep apnea.
The Surgical Orthodontics Process
Surgical orthodontic treatment usually follows three phases:
Phase 1: Pre-Surgical Orthodontics (12–18 months)
Before surgery, we use braces to align each arch of teeth independently. Counterintuitively, this may make the bite look worse temporarily — but it positions the teeth correctly so the surgeon can move the jaw to its ideal location. Dr. Weeks and Dr. Hasan coordinate closely with the surgical team throughout this phase, using digital records from our iTero® scanner and 3D imaging at both our Winter Springs and Oviedo offices.
Phase 2: The Surgery
Orthognathic surgery is performed in a hospital under general anesthesia. The oral surgeon makes precise cuts in the jawbones and repositions them according to the pre-surgical plan — often using 3D computer modeling and surgical guides for accuracy. Most patients return home within 1–3 days and recover fully within 6–8 weeks.
Phase 3: Post-Surgical Orthodontics (6–12 months)
After surgery and initial healing, we resume orthodontic treatment to fine-tune tooth alignment and perfect the bite. This phase usually takes 6–12 months. Once complete, custom retainers are fabricated to maintain results long-term.
Do You Need Surgical Orthodontics?
Most patients with bite issues are treated with braces or Invisalign® alone. Surgical orthodontics is reserved for cases where the jaw discrepancy is skeletal and significant — usually diagnosed in adulthood when growth is complete. If you’ve been told your bite is “too severe” for braces alone, or if you’ve struggled with jaw pain, breathing issues, or facial asymmetry, a consultation with our team at Winter Springs or Oviedo can clarify your options. We see patients from across Seminole and Orange counties, including Sanford, Longwood, Altamonte Springs, and the University/UCF area.
Schedule a free consultation at Weeks Orthodontics in Winter Springs or Oviedo, FL. Dr. Weeks and Dr. Hasan will review your records and — if surgical treatment is warranted — connect you with trusted oral surgery partners in Central Florida. Call (407) 327-7737.
