Who Is a Candidate for Orthognathic Surgery?

Orthognathic surgery is considered when the position or development of the jaw bones causes a significant problem that cannot be adequately corrected with orthodontic treatment alone. It can improve the relationship between the upper and lower jaws and, as a result, help improve the way the teeth meet and function.

However, having an overbite, underbite, open bite, or facial asymmetry does not automatically make someone a candidate for surgery.

Candidacy depends on the underlying skeletal problem, the severity of the bite discrepancy, facial growth, oral function, overall health, and whether a predictable correction can be achieved through a coordinated surgical and orthodontic treatment plan. A broader overview of these procedures is available in our jaw surgery guide.

What Makes Someone a Candidate for Orthognathic Surgery?

In simple terms, a person may be considered for orthognathic surgery when the jaw bones themselves are significantly misaligned and this skeletal discrepancy affects the bite, facial structure, or oral function. The most common situations include:

• Significant underbite caused by a skeletal jaw discrepancy
• Severe overbite associated with abnormal jaw development
• Open bite that is primarily related to the skeletal structure
• Significant crossbite or transverse jaw discrepancy
• Marked facial or jaw asymmetry
• Disproportion between the upper and lower jaws
• Jaw abnormalities associated with congenital or developmental conditions
• Jaw changes resulting from certain injuries or other underlying conditions

1. The Problem Should Be Primarily Skeletal

This is one of the most important factors in determining candidacy. Some bite problems occur because the teeth are crowded, rotated, tilted, or positioned incorrectly even though the upper and lower jaws have a reasonably appropriate relationship. These problems can often be managed with orthodontic treatment.

In contrast, orthognathic surgery is designed to correct problems involving the underlying facial skeleton. If the upper jaw, lower jaw, or both have developed in an abnormal position or proportion, moving the teeth alone may not adequately correct the problem.

For this reason, the assessment focuses on the relationship between the teeth and the facial skeleton, rather than simply looking at whether the teeth appear straight.

2. The Bite Discrepancy Is Significant

A person may be considered for surgery when the difference between the upper and lower jaws produces a substantial malocclusion. This may include:

Severe underbite

The lower jaw or lower teeth extend significantly beyond the upper teeth, often because of a discrepancy in the development or position of the jaws.

Severe overbite

The upper teeth extend excessively over the lower teeth because of an underlying skeletal relationship that cannot be adequately corrected through tooth movement alone.

Open bite

Some upper and lower teeth remain apart when the mouth is closed. When an open bite is caused predominantly by the skeletal structure, jaw surgery may form part of treatment.

Significant asymmetry

The two sides of the jaw or face may develop differently, affecting both facial balance and the way the teeth meet. The severity of these conditions is assessed through clinical examination, dental measurements, facial analysis, and appropriate imaging rather than by appearance alone.

3. Orthodontic Treatment Alone May Not Be Enough

Orthodontic treatment is an important part of many jaw-surgery treatment plans. However, braces and aligners primarily move teeth; they do not reposition fully developed jaw bones in the same way that orthognathic surgery does.

Therefore, a person may be a surgical candidate when:

• The skeletal discrepancy is too significant for orthodontics alone to correct.
• Moving the teeth alone would require excessive dental compensation.
• A functional bite cannot be established predictably through orthodontic treatment alone.
• The desired correction requires repositioning the upper jaw, lower jaw, or both.

4. The Person Has Reached Appropriate Skeletal Maturity

Timing is an important part of candidacy. Because orthognathic surgery changes the position of the jaw bones, it is generally planned after significant facial growth has been completed. Performing definitive jaw surgery while substantial growth remains can affect the long-term result.

The exact timing is not identical for everyone. Skeletal maturity, the individual's pattern of facial growth, the severity of the jaw discrepancy, dental development, and the orthodontic plan all influence when surgery should be considered.

Children and adolescents may still receive orthodontic assessment and treatment before they are ready for definitive jaw surgery. In some cases, early treatment is used to guide dental development or monitor the evolving jaw relationship.

5. The Bite Causes Functional Difficulties

The decision to consider surgery is not based only on how the face or teeth look. Functional problems can be an important part of the assessment. A significant jaw discrepancy may contribute to difficulties such as:

• Chewing food effectively
• Maintaining appropriate contact between the teeth
• Moving the lower jaw normally
• Swallowing in some cases
• Producing certain speech sounds in some patients
• Maintaining an appropriate and stable bite

6. The Facial Skeleton Has a Significant Asymmetry

Orthognathic surgery may also be considered when the jaw bones contribute to noticeable facial asymmetry. Asymmetry can involve differences in the position or development of the right and left sides of the lower jaw, upper jaw, or both. It may affect the bite as well as the overall facial proportions.

When the asymmetry is skeletal rather than simply related to tooth position, repositioning the jaw bones may be necessary to address the underlying problem.

7. The Person Is Healthy Enough for Major Surgery

Orthognathic surgery is a major surgical procedure performed under general anaesthesia. Overall health is therefore considered before treatment is recommended. The surgical team may review:

• Existing medical conditions
• Current medications
• Previous surgeries and anaesthesia history
• Oral and dental health
• Smoking or tobacco use
• Any factors that could affect healing or recovery

8. The Teeth and Gums Are Suitable for Treatment

Healthy teeth and supporting tissues are important because orthodontic treatment is commonly required before and after jaw surgery.

Existing dental problems may therefore need to be addressed before the surgical phase. This can include treating active dental disease or managing other oral-health concerns that could interfere with orthodontic or surgical treatment.

The goal is to enter the surgical phase with the teeth and surrounding tissues in an appropriate condition for the planned treatment.

9. The Person Understands the Treatment Process

Orthognathic treatment is usually not a single procedure followed by immediate completion of treatment. It is a coordinated process involving orthodontic planning, surgery, recovery, and further orthodontic refinement.

Depending on the individual's treatment plan, orthodontic treatment may take place before surgery to prepare the teeth for the new jaw relationship. Further orthodontic treatment is often required after surgery to fine-tune the bite.

Some appropriately selected patients may undergo a surgery-first approach, in which jaw surgery is performed before conventional presurgical orthodontic treatment. This is a specialized approach and requires careful case selection and planning rather than being suitable for every patient.

Can Someone Be a Candidate Even Without Severe Pain?

Yes. Pain is not a requirement for orthognathic surgery. A person may have a significant skeletal discrepancy that primarily affects the bite, chewing, speech, facial symmetry, or other aspects of oral function without experiencing significant pain.

Conversely, having jaw pain does not automatically mean that orthognathic surgery is appropriate. The cause of the pain needs to be established separately, because different jaw and temporomandibular conditions may require different treatments.

The Bottom Line

Being a candidate for orthognathic surgery is about more than having an incorrect bite. The most important factor is whether a significant skeletal jaw discrepancy is responsible for the problem and whether orthodontic treatment alone can provide an appropriate and stable correction.

Suitable candidates are generally assessed for the severity and type of jaw discrepancy, functional effects, skeletal maturity, oral health, overall medical condition, and ability to undergo the complete orthodontic-surgical treatment process.

Because every jaw relationship is different, there is no single measurement or symptom that determines candidacy on its own. A detailed assessment by an orthodontist and oral and maxillofacial surgeon is the best way to establish whether orthognathic surgery is appropriate and, if so, which surgical approach may be suitable.