An incorrect bite can range from a minor difference in the way the teeth meet to a significant problem caused by the underlying position of the jaw bones. While many bite problems can be corrected with orthodontic treatment, some cannot be fully addressed by moving the teeth alone. In these situations, corrective jaw surgery may be considered.
Jaw surgery, also called orthognathic surgery, is used to correct skeletal problems involving the upper jaw, lower jaw, or both. Understanding when surgery is actually necessary starts with identifying whether the bite problem is mainly dental or skeletal.
Our jaw surgery guide provides a broader overview of corrective procedures and their role in treating jaw-related problems.
What Is an Incorrect Bite?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
An incorrect bite, or malocclusion, occurs when the upper and lower teeth do not come together in their expected relationship. This can happen because the teeth are positioned incorrectly, because the jaws have developed differently, or because both factors are involved.
Common forms of malocclusion include:
- Overbite: The upper front teeth extend too far over the lower teeth.
- Underbite: The lower teeth or jaw extend in front of the upper teeth.
- Open bite: Some upper and lower teeth do not meet when the mouth is closed.
- Crossbite: Some upper teeth sit inside the corresponding lower teeth rather than outside them.
- Deep bite: The upper front teeth cover an excessive portion of the lower front teeth.
- Asymmetrical bite: The jaws or teeth are positioned unevenly from one side to the other.
The presence of one of these bite patterns does not automatically mean that surgery is necessary. The important question is what is causing the abnormal bite and whether it can be corrected without changing the position of the jaw bones.
When Is an Incorrect Bite a Jaw Problem?
Teeth can sometimes compensate for differences in the underlying jaw structure. For example, the teeth may tilt or shift in an attempt to establish contact even when the upper and lower jaws do not have an ideal skeletal relationship.
When the discrepancy between the jaws is significant, however, simply moving the teeth may not provide an appropriate long-term correction. In such cases, the problem is considered skeletal malocclusion.
A skeletal bite problem may involve:
- A lower jaw that is positioned too far forward or backward
- An upper jaw that is positioned too far forward, backward, upward, or downward
- A significant difference in jaw size
- Unequal development of the two sides of the jaw
- A vertical discrepancy between the jaws
- A mismatch in the width of the upper and lower jaws
Can Braces or Aligners Fix an Incorrect Bite?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
In many cases, yes. Orthodontic treatment can move teeth into better positions and correct a wide range of bite problems.
However, orthodontic appliances primarily move teeth. They cannot reposition a fully developed jaw bone in the same way that orthognathic surgery can. This creates an important distinction:
| Type of problem | Potential approach |
|---|---|
| Teeth are misaligned but the jaws have a suitable relationship | Orthodontic treatment may be sufficient |
| Mild jaw discrepancy with dental compensation | Orthodontics may sometimes provide adequate correction |
| Significant skeletal discrepancy affecting the bite | Orthodontics combined with jaw surgery may be considered |
| Severe asymmetry involving the jaw bones | Corrective jaw surgery may be required as part of treatment |
The exact treatment depends on the individual's dental and skeletal anatomy rather than the appearance of the bite alone.
Signs That Jaw Surgery May Be Needed
There is no single symptom that proves jaw surgery is necessary. Instead, several findings may indicate that the underlying jaw structure is contributing significantly to the bite.
1. The bite cannot be adequately corrected with orthodontics alone
This is one of the most important considerations. If the jaw discrepancy is too significant for tooth movement alone to establish a functional and stable bite, corrective jaw surgery may be recommended.
2. There is a significant underbite or overbite
A pronounced underbite or overbite may result from the position or development of the jaws rather than simply the position of the teeth. When the underlying skeletal relationship is significant, moving the teeth alone may not address the problem adequately.
3. The teeth cannot meet properly
In some people, an open bite or another severe discrepancy prevents appropriate contact between the upper and lower teeth. If the problem is caused by the skeletal relationship of the jaws, surgery may be part of the corrective treatment.
4. There is significant facial asymmetry
When one side of the jaw develops differently from the other, the resulting asymmetry may affect both facial balance and the bite. Depending on the underlying cause, jaw surgery may be used to reposition the affected jaw structures.
5. Chewing is significantly affected
A severe skeletal malocclusion can interfere with normal chewing mechanics. Difficulty breaking down food or maintaining effective contact between the teeth may be considered when evaluating the functional impact of the jaw discrepancy.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
6. There are associated functional difficulties
Significant skeletal jaw discrepancies can sometimes be associated with problems involving chewing, swallowing, speech, jaw movement, or other aspects of oral function. These symptoms do not automatically mean surgery is needed, but they may be relevant to the overall assessment.
Does the Severity of the Bite Determine the Need for Surgery?
Severity is important, but it is not the only consideration. Orthognathic surgery guidelines use measurements and clinical findings to help identify significant skeletal discrepancies.
However, these measurements are generally treated as clinical guidelines rather than absolute cut-off points. A person's overall facial skeletal relationship, dental compensation, functional problems, and treatment objectives also matter.
This means that two people with a similar-looking bite may receive different treatment recommendations. One person may have a primarily dental problem that can be corrected orthodontically. Another may have a substantial skeletal discrepancy that requires repositioning of the jaw bones.
What Happens If You Try to Treat a Skeletal Problem With Orthodontics Alone?
Orthodontic treatment can sometimes compensate for a skeletal discrepancy by moving the teeth into positions that make the bite appear more acceptable. This approach may be appropriate for certain patients.
However, when the skeletal discrepancy is substantial, excessive dental compensation may not provide the desired functional or structural result. In such situations, treatment planning may involve orthodontic preparation followed by surgical correction of the jaw relationship.
The objective is not simply to make the teeth look straight. It is to establish a relationship between the teeth and jaws that supports appropriate function and stability.
At What Age Is Jaw Surgery Usually Considered?
Corrective jaw surgery is generally considered after facial growth is substantially complete. The appropriate timing varies between individuals and depends on factors such as skeletal maturity, the type of jaw discrepancy, dental development, and the treatment plan.
Orthodontic assessment may begin earlier, particularly when a developing bite problem needs to be monitored or treated. However, definitive jaw repositioning is generally planned only when the jaw has reached an appropriate stage of development.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Does Jaw Surgery Involve?
If surgery is considered necessary, the procedure is tailored to the source of the skeletal discrepancy. Upper jaw surgery may be used when the position or development of the maxilla contributes significantly to the incorrect bite.
Lower jaw surgery may be used when the mandible is contributing to an underbite, overbite, or another skeletal discrepancy.
Double jaw surgery may be considered when both jaws need to be repositioned to establish the appropriate relationship.
Orthodontic treatment is commonly part of the overall process. Depending on the case, braces or aligners may be used before surgery to prepare the teeth and after surgery to refine the final bite.
Does Every Severe Bite Need Jaw Surgery?
No. A severe-looking bite does not automatically mean that surgery is the only option. The decision depends on the underlying anatomy, the degree of skeletal discrepancy, functional effects, dental compensation, treatment objectives, and whether a stable correction can be achieved without surgery.
Likewise, a person does not necessarily need to have severe pain or major symptoms before jaw surgery can be considered. Some significant skeletal discrepancies are identified primarily through the relationship between the jaws and teeth.
What If the Bite Problem Is Mainly Cosmetic?
Appearance can be an important part of how a person experiences a jaw discrepancy, but orthognathic surgery is primarily intended to correct an underlying skeletal problem and improve function.
Changes in facial appearance can occur because the jaw bones are repositioned, but these changes are a consequence of the skeletal correction.
A thorough treatment discussion should therefore consider both functional and facial considerations rather than treating appearance in isolation.
The Bottom Line
Jaw surgery is not required simply because your teeth do not meet perfectly. The more important question is whether the incorrect bite is caused by the teeth, the underlying jaw bones, or a combination of both.
When a significant skeletal discrepancy prevents orthodontic treatment alone from establishing an appropriate and stable bite, orthognathic surgery may be considered. A detailed orthodontic and surgical assessment can determine the source of the problem and whether treatment with braces or aligners alone is sufficient or whether repositioning the jaw bones is necessary.
The goal is ultimately more than straight teeth. It is to establish a healthier relationship between the jaws and teeth that supports comfortable, effective oral function while taking the individual's overall facial structure into account.
