A misaligned jaw can affect much more than the appearance of your smile. When the upper and lower jaws do not develop in the right relationship, the teeth may not meet properly, making it difficult to bite, chew, speak, or keep the teeth in a healthy position. In some people, the difference between the jaws is mild and can be managed with orthodontic treatment. In others, the underlying problem is skeletal and may require corrective jaw surgery.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Also known as orthognathic surgery, jaw surgery is designed to correct the position or relationship of the upper jaw, lower jaw, or both. It is usually planned as part of a combined orthodontic and surgical treatment process. You can learn more about the broader treatment approaches on our jaw surgery page.
What Does a Misaligned Jaw Mean?
A misaligned jaw means that the bones of the upper and lower jaw are not positioned in a way that allows the teeth and jaws to function together normally. The problem may involve the size, position, shape, or relationship of one or both jaws.
Jaw misalignment can occur as the face develops during childhood and adolescence. It can also be associated with certain congenital conditions, previous facial trauma, or other factors affecting facial growth.
The resulting bite problem is called malocclusion. Depending on the underlying jaw relationship, a person may have an underbite, overbite, open bite, crossbite, or significant facial asymmetry.
How Can Jaw Misalignment Affect Your Bite?
The teeth are designed to work together as a coordinated system. When the jaws are not properly aligned, the teeth may compensate for the skeletal difference, but this compensation does not always provide normal function.
Some people with significant jaw discrepancies may experience:
- Difficulty biting or chewing food
- Teeth that do not meet evenly when the mouth is closed
- An underbite or prominent overbite
- An open bite, where some teeth do not come together
- Difficulty keeping the lips comfortably closed
- Speech or swallowing difficulties in some cases
- Uneven tooth wear or excessive pressure on certain teeth
- Difficulty maintaining an appropriate dental alignment
- Facial asymmetry associated with the underlying skeletal problem
- Jaw-joint or muscle symptoms in some patients
Not everyone with a bite problem will experience all of these symptoms. The significance of the problem depends on the individual's jaw structure, dental alignment, function, and overall treatment needs.
When Can Orthodontics Correct a Misaligned Bite?
Orthodontic treatment moves teeth within the supporting bone. This can correct many forms of dental malocclusion, particularly when the underlying relationship between the upper and lower jaws is reasonably balanced.
Braces or clear aligners may therefore be sufficient when the primary problem is the position of the teeth rather than the position or size of the jaw bones.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
However, orthodontic treatment cannot reposition a fully developed jaw bone in the same way that corrective jaw surgery can. If the bite problem is caused mainly by a significant skeletal discrepancy, attempting to correct it with tooth movement alone may not address the underlying problem.
When Is Jaw Surgery Considered?
Corrective jaw surgery is generally considered when the skeletal relationship between the jaws contributes significantly to the bite problem and orthodontic treatment alone cannot achieve a satisfactory functional result.
Depending on the individual situation, surgery may be considered for conditions such as:
- Significant underbite: The lower jaw or lower teeth extend substantially in front of the upper teeth.
- Severe overbite: The upper teeth extend excessively over the lower teeth because of an underlying jaw discrepancy.
- Open bite: Certain upper and lower teeth remain separated when the mouth is closed.
- Crossbite: The upper and lower teeth do not align normally from side to side.
- Jaw asymmetry: One side of the jaw or face develops differently from the other.
- Vertical jaw discrepancies: The jaws have an abnormal vertical relationship that affects the bite or facial proportions.
- Severe transverse discrepancies: The width or position of the upper and lower jaws is significantly mismatched.
What Does Jaw Surgery Correct?
The purpose of orthognathic surgery is to reposition the jaw bones so that the upper and lower jaws have a more functional relationship. The exact procedure depends on which part of the jaw is contributing to the problem.
Upper jaw surgery
Surgery involving the upper jaw, or maxilla, can be used to correct certain vertical, horizontal, or transverse discrepancies. It may also be considered when the upper jaw is positioned too far forward, too far backward, too high, too low, or asymmetrically.
Lower jaw surgery
Lower jaw surgery, involving the mandible, can change the position of the lower jaw in relation to the upper jaw. It may be used for significant mandibular underdevelopment, excessive mandibular projection, or certain forms of asymmetry.
Double jaw surgery
When both jaws contribute to the skeletal discrepancy, surgery may involve the upper and lower jaws. Moving both jaws allows the treatment team to establish a more balanced relationship between them rather than trying to compensate for one jaw through movement of the other.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Why Is Orthodontic Treatment Often Part of Jaw Surgery?
Jaw surgery changes the position of the bones, but the teeth also need to be positioned correctly within those jaws. This is why orthodontic treatment is commonly combined with orthognathic surgery.
In a conventional treatment pathway, orthodontic treatment may begin before surgery to prepare the teeth and remove dental compensations. Surgery then corrects the underlying skeletal relationship, followed by further orthodontic treatment to refine the bite.
In selected patients, a surgery-first approach may be considered, in which surgery takes place before the usual period of presurgical orthodontic treatment. This approach is not appropriate for everyone and requires careful case selection and coordinated planning between the orthodontic and surgical teams.
What Happens During Jaw Surgery?
Orthognathic surgery is performed under general anaesthesia. The surgeon makes carefully planned incisions, generally inside the mouth, to access the jaw bones. The affected jaw segments are then separated, repositioned according to the treatment plan, and secured in their new position.
The exact technique depends on whether the upper jaw, lower jaw, or both are being treated. The objective is to establish a stable skeletal relationship and improve the way the teeth come together.
Modern planning may also use digital imaging and three-dimensional surgical simulation to help visualize the intended jaw movements before the procedure. These tools support surgical planning but do not replace clinical assessment and surgical judgment.
What Can You Expect After Jaw Surgery?
Recovery varies according to the type and extent of surgery. Swelling, bruising, facial tightness, temporary numbness, and changes in eating are common during the early recovery period.
Your diet may initially be restricted to liquids or soft foods before gradually progressing as healing takes place. Oral hygiene instructions and follow-up appointments are important during this period.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Orthodontic treatment may continue after surgery to fine-tune the position of the teeth and establish the final bite. The overall treatment timeline therefore includes both surgical healing and orthodontic adjustment.
Does Jaw Surgery Improve Only the Bite?
No. Although the primary purpose of orthognathic surgery is to correct the underlying skeletal and functional problem, repositioning the jaws can also change the appearance of the face.
Changes may occur in the profile, facial symmetry, chin position, or relationship between the lips and teeth. These changes are a consequence of moving the facial skeleton rather than the primary reason for treatment.
For this reason, treatment planning considers both function and facial proportions. The goal is to create a jaw relationship that is stable and functional while maintaining an appropriate facial balance.
The Bottom Line
A misaligned bite does not always mean that jaw surgery is necessary. The most important distinction is whether the problem comes mainly from the teeth or from the underlying relationship between the jaws.
When a significant skeletal discrepancy affects the bite and cannot be adequately corrected with orthodontics alone, orthognathic surgery may provide a way to reposition the jaws and establish a more functional relationship.
Treatment is usually carefully planned as a combined orthodontic and surgical process, with the approach tailored to the individual's facial structure, bite, functional needs, and overall treatment goals.
