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.
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 start 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 image and closing disorder.
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, it should be known that even if an acceptable closure and aesthetics of the teeth are achieved with orthodontic treatment alone, the desired changes and improvements in the external appearance of the face, front or profile cannot be achieved. For example, if a patient with a forward lower jaw is given camouflage treatment with orthodontic treatment without any surgical procedure, the alignment and closing of the teeth can be corrected; however, the appearance of the pointed or long chin profile in the external appearance of the face will not change, and the lip relationship will not be improved.
Jaw Surgery Options:
Single Jaw Surgery:
The orthodontist, who analyzes the films and models taken at the beginning of orthognathic treatment and examines the patient's inside and outside the mouth, determines which jaw the skeletal problem originates from, the size of the problem, and what type of interventions should be performed on which jaw or jaws to correct it. According to this planning, if the problem will be solved by intervention in a single upper or lower jaw, this is called single jaw surgery and the surgery presents this plan to the plastic surgeon. If the plastic surgeon evaluates from his own perspective and does not see any harm in terms of the limits and returns of single jaw surgery, the treatment plan is finalized and orthodontic treatment is started according to this plan.
Single Upper Jaw Surgery; If surgically assisted expansion of the upper jaw is required, it can only be completed with an intervention such as surgically loosening the middle junction of the upper jaw bone, called midpalatal suture, and after this surgery, the orthodontist will apply fixed expansion screw appliances to the patient to expand the jaw in a healthy and healthy way. can provide it permanently. Then, he completes the treatment by correcting the tooth alignment and bite with fixed orthodontic treatments.
Or lowering the upper jaw in cases of skeletal open bite where the upper jaw is buried, or conversely, in the case of a gummy smile where the upper jaw is excessively long and the gums are visible during smiling, burying the upper jaw is also among the single jaw surgery options.
In cases of midface developmental delays where the upper jaw is smaller than normal or positioned backwards and causes a concave profile appearance, the upper jaw should be moved forward.
Sometimes combinations of single jaw surgery with clockwise or counterclockwise rotation movements, such as both sinking and advancing the upper jaw, or both extending and retracting it, may be required.
Single Lower Jaw Surgery is performed in cases where the lower jaw bone is larger or smaller than normal (compared to the person's own skull bones and face). It can be done by simply moving the lower jaw backwards or forwards, or it can be combined with repositioning the tip of the jaw (genioplasty).
Genioplasty (chin tip surgery); Especially in cases where the dimensions of the lower jaw are not too exaggerated and major surgical procedures are not desired, jaw tip surgery, which is a relatively simpler surgical procedure, aims to improve the profile image at the end of the treatment, after bringing the teeth into proper alignment and closure with camouflage treatment. It can be done alone.
Double jaw surgeries are; It is performed in cases where the differences in skeletal size and proportion are large, the difference cannot be closed with surgical procedures on a single jaw, or the results are thought to be not permanent, and intervention in both jaws is required in terms of both aesthetics, function and stability. For example, in an individual whose lower jaw is larger than normal and who also has a developmental delay in the upper jaw, only moving the lower jaw back will require a lot of intervention in the lower jaw, and the result will not be permanent or aesthetic. At the same time, since the lower jaw will have to be moved back too much, airway narrowing will occur, creating difficulty in breathing during sleep and the risk of snoring. Instead, by moving the lower jaw back a little and moving the upper jaw forward a little, better results are obtained in terms of both more aesthetic appearance and bone healing and stability, and the risk of airway narrowing is minimized. Sometimes combined surgical procedures can be performed by adding genioplasty to double jaw surgery.
As a result, in a patient whose need for orthognathic surgery has been determined through various analyses, the most appropriate treatment plan should be made together by the orthodontist and the plastic surgeon, and it should be explained that the treatments applied by adhering to this plan will give optimum results and that the patients can achieve satisfactory results in terms of both aesthetics and chewing function. The cost-benefit relationship of alternative treatments should be evaluated very carefully.