What is Orthognathic Surgery Treatment?
Healthy, aesthetic and permanent solutions can be produced with orthodontic treatment for teeth alignment and jaw closing problems in cases that only concern teeth or when they start at a young age. However, in adult patients, orthognathic surgery is used when orthodontic treatment alone is not sufficient, especially in cases of skeletal (bone structure) disorders such as closing problems, asymmetries or open bite that concern the maxillofacial region.
Orthognathic surgery is a multidisciplinary treatment approach in which both orthodontic treatment and jaw surgery are carried out together. The orthodontist first takes various film and model analyzes and photographs of the inside and outside of the mouth of the patient applying for treatment, and makes a treatment plan as a result of all these analyzes and examinations. During this planning, it becomes more or less clear which jaw or jaws the surgery will be performed by the plastic surgeon and what kind of surgery should be planned. Then, the orthodontist clarifies the treatment plan by referring the patient to the plastic surgeon with the analyzes he has prepared and the physician who will perform the surgery approves the plan or makes recommendations. In other words, all treatment stages have been determined from the very beginning of the treatment and progress is made by adhering to this plan.
First, it starts with orthodontic treatment. If the patient has upper or lower jaw stenosis, the necessary expansion appliances are first applied to eliminate these stenosis. This process alone can take between 3-6 months, or the expansion phase and the fixed treatment phase can be carried out simultaneously. After the expansion phase, fixed brackets are attached to the lower and upper jaw teeth, and the arch wires of various thicknesses are changed every month and the leveling phase is completed. The aim at this stage is to ensure the proper alignment of the teeth in each jaw bone, to open them if there are crooked teeth, to close the spaced teeth, to prepare a place for the prostheses planned in the future, and to arrange them if there are teeth in a position that will prevent this closure when the lower and upper jaw teeth are brought to closure during the surgery.
Decompensation:
Compensation means balancing, compensating. This term, which is frequently used in medicine, means making the existing problem tolerable and balanced by nature. This state of balance actually makes the underlying problem seem less or masks it. In terms of orthodontics, in cases of skeletal malocclusion, naturally compensated teeth may try to get closer to each other, making the closure acceptable or at least chewing possible, causing them to bend at much more exaggerated angles than they should. For example, a person whose lower jaw is forward than normal tries to bring these teeth closer together and close the difference by bending the lower teeth backwards and the upper teeth forward. When planning orthognathic treatment, it is necessary to first reverse this compensation, that is, perform decompensation. Because the teeth that are forced to compensate have reached angles and inclinations that are more deviated than they should be within the jaw bones, and this situation is not healthy for the surrounding gum and bone structures and the teeth themselves. First of all, it must be ensured that the teeth are aligned in the jaw bones in a healthy and ideal angles and inclinations, and this process is called decompensation. In fixed orthodontic treatments that begin with brackets attached to the lower and upper jaw teeth, permanent tooth extraction may sometimes be required to provide this decompensation during the leveling phase of the teeth, and while the gaps of these extracted teeth are closed and decompensation is achieved, the real dimensions of the underlying skeletal problem are revealed. Although at this stage, a worse bite and jaw appearance may be encountered compared to the beginning of the treatment, it should be remembered that this situation will improve when the jaws are brought to normal closure with surgery in the second stage of the treatment, and it is a temporary appearance and closing disorder.
Camouflage Treatment:
When talking about orthognathic treatment, it is necessary to mention the alternatives of this treatment. Although individuals who need orthognathic surgery may have skeletal incompatibilities, the type of treatment that can camouflage the existing problem and make it less obvious in people who do not want a surgical operation to be included in the treatment, who are hesitant, or who cannot have this operation due to health problems or financial reasons, is called camouflage treatment. But here. On the contrary of decompensation, it is to further increase the existing natural compensation and to bring the closure and aesthetics of the teeth closer to acceptable levels, even at the expense of sometimes moving the angles of the teeth in the jawbone further away from ideal. However, the point that should not be forgotten here is that this type of treatment cannot provide healthy and stable positions for the teeth and surrounding soft and hard tissues, and it will not be possible to ensure lifelong permanence of the results. In addition, even if an acceptable closure and aesthetics of the teeth are achieved only with orthodontic treatment, the external appearance of the face may be affected.