When the upper and lower jaws do not develop in the right relationship, the resulting misalignment can affect the way the teeth meet, how you chew, facial symmetry, and sometimes other aspects of oral function. In mild cases, orthodontic treatment may be enough to improve the bite.
When the underlying problem involves the jaw bones themselves, however, moving the teeth alone may not provide the correction that is needed.
Orthognathic surgery is a specialized procedure used to reposition the upper jaw, lower jaw, or both to correct significant skeletal misalignment. The treatment is usually planned together with orthodontic care so that the jaws and teeth work together properly after treatment. You can also explore the broader treatment options on our jaw surgery page.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Is Jaw Misalignment?
Jaw misalignment occurs when the upper and lower jaws are not positioned or proportioned appropriately in relation to one another. The discrepancy may be forward or backward, vertical, side-to-side, or a combination of these.
Because the teeth are attached to the jaws, a skeletal discrepancy often affects the way the teeth come together. This can result in different forms of malocclusion, including:
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
- Underbite or skeletal Class III relationship
- Excessive overbite or skeletal Class II relationship
- Open bite
- Crossbite
- Significant facial or jaw asymmetry
- Transverse jaw discrepancy
- Vertical jaw discrepancy
Why Can't Orthodontics Always Correct Jaw Misalignment?
Orthodontic appliances such as braces and aligners are designed primarily to move teeth. They can correct many types of malocclusion when the underlying jaw relationship is suitable. They cannot, however, reposition a fully developed jaw bone in the same way that orthognathic surgery can.
This distinction is important. If the main problem is that the teeth are crowded or positioned incorrectly, orthodontic treatment may be sufficient. If the upper and lower jaws themselves have a significant skeletal discrepancy, treatment may require a combination of orthodontics and surgery.
In some cases, the teeth have naturally tilted or shifted to compensate for the underlying jaw discrepancy. This can make the bite appear less severe than the skeletal problem actually is. Detailed orthodontic and surgical assessment is therefore necessary before deciding on the treatment approach.
What Does Orthognathic Surgery Correct?
The purpose of orthognathic surgery is to correct the underlying skeletal relationship between the jaws. Depending on the patient's anatomy, the procedure may involve the upper jaw, lower jaw, or both.
Upper jaw misalignment
The upper jaw, or maxilla, may be positioned too far forward, too far backward, too high, too low, or asymmetrically. Surgery can reposition the maxilla to establish a more appropriate relationship with the lower jaw and teeth.
Upper jaw surgery may also be used to address certain open bites, vertical discrepancies, transverse problems, and facial asymmetries.
Lower jaw misalignment
The lower jaw, or mandible, may be positioned too far forward or backward or may develop asymmetrically. Corrective surgery can reposition the mandible to improve the relationship between the upper and lower teeth.
Misalignment involving both jaws
In some patients, both jaws contribute to the problem. In these situations, double jaw surgery, also called bimaxillary orthognathic surgery, may be considered.
Moving both jaws can allow the surgical team to correct the overall skeletal relationship rather than relying on one jaw to compensate for a discrepancy involving both.
How Does Orthognathic Surgery Correct an Underbite?
An underbite may occur because the lower jaw is positioned too far forward, the upper jaw is positioned too far backward, or because both factors are present.
When the discrepancy is primarily skeletal and significant, the surgical plan is designed around the actual source of the problem. Depending on the patient's anatomy, treatment may involve:
- Repositioning the lower jaw
- Advancing the upper jaw
- Combining upper and lower jaw surgery
How Does Orthognathic Surgery Correct an Overbite?
A significant overbite may be associated with the position of the upper jaw, lower jaw, or both. In some patients, the lower jaw is positioned too far backward relative to the upper jaw, while in others the vertical or skeletal relationship between the jaws contributes to excessive overlap of the front teeth.
When orthodontic treatment alone cannot adequately correct the underlying skeletal discrepancy, surgery may be used to reposition the affected jaw structures.
The exact movement is determined through detailed facial, dental, and skeletal analysis rather than from the appearance of the overbite alone.
Can Orthognathic Surgery Correct an Open Bite?
Yes. Some open bites are primarily dental, while others are associated with the skeletal structure of the jaws. When the open bite has a significant skeletal component, orthognathic surgery may be used to change the relationship between the jaws and create a more appropriate vertical relationship between the upper and lower teeth.
Because open-bite treatment can be complex, long-term stability and the underlying cause are important considerations during treatment planning.
Can Jaw Surgery Correct Facial Asymmetry?
When facial asymmetry is caused by differences in the development or position of the jaw bones, orthognathic surgery may be used to improve skeletal symmetry.
The asymmetry may involve one side of the lower jaw, the upper jaw, or both. The treatment plan is based on three-dimensional assessment of the facial skeleton and the relationship between the teeth and jaws.
Research has found improvements in skeletal and soft-tissue symmetry following orthognathic treatment for facial asymmetry, although individual outcomes vary and the long-term stability of correction depends on several factors.
What Happens Before Orthognathic Surgery?
Jaw surgery is carefully planned well before the operation takes place. The treatment team needs to understand exactly how the jaws and teeth relate to each other and determine the movements required to establish the planned result. Assessment may include:
- Detailed examination of the bite
- Evaluation of facial proportions and symmetry
- Dental photographs
- Panoramic and cephalometric X-rays
- Three-dimensional imaging when appropriate
- Orthodontic measurements
- Assessment of jaw movement
- Digital or virtual surgical planning in suitable cases
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Why Is Orthodontic Treatment Usually Combined With Jaw Surgery?
The jaws and teeth need to be considered together. Even when the jaw bones are repositioned correctly, the teeth may not initially be in their ideal positions for the new skeletal relationship. For this reason, conventional treatment commonly involves three broad phases:
1. Orthodontic preparation
Braces or another orthodontic appliance may be used to align the teeth and reduce dental compensation before surgery.
2. Jaw surgery
The upper jaw, lower jaw, or both are repositioned according to the surgical plan.
3. Postoperative orthodontic refinement
After the jaws have been repositioned and healing progresses, orthodontic treatment can continue to refine the relationship between the teeth and establish the final bite.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The exact sequence varies between patients. A surgery-first approach may be appropriate for selected patients, allowing surgery to take place before conventional presurgical orthodontic preparation. It is a specialized approach that requires careful case selection rather than being suitable for everyone.
What Happens During Orthognathic Surgery?
Orthognathic surgery is performed under general anaesthesia. The surgical approach depends on which jaw structures need to be corrected.
The surgeon accesses the jaw through carefully planned incisions, commonly inside the mouth, and makes controlled cuts in the jaw bone to create movable segments. These segments are then repositioned according to the treatment plan.
Once the desired position has been established, the bone segments are secured using fixation devices such as small plates and screws. The incisions are then closed.
The exact surgical technique varies according to the type of jaw discrepancy and the movements required. Some patients require surgery involving one jaw, while others require both.
What Is Recovery Like After Jaw Misalignment Surgery?
Recovery varies depending on the type and extent of surgery and the individual's overall health. Swelling, bruising, facial tightness, temporary numbness, and changes in eating are common during the early postoperative period.
Eating may initially involve liquids or soft foods, with gradual progression according to the surgical team's instructions. Oral hygiene is particularly important because the surgical areas are often accessed through the mouth.
Follow-up appointments allow the surgical and orthodontic teams to monitor healing and the developing bite. Orthodontic treatment may continue during the recovery period to refine the final occlusion.
Some numbness, particularly around the lower lip or chin after lower-jaw surgery, can occur because nerves run through the jaw. Sensation often improves with time, although the extent and duration vary between patients.
Does Orthognathic Surgery Change the Appearance of the Face?
Yes. Moving the jaw bones naturally changes the soft tissues that cover them, so facial appearance can change after surgery. The changes may affect:
- Facial profile
- Chin position
- Relationship between the lips and teeth
- Facial symmetry
- Overall facial proportions
What Are the Potential Benefits of Correcting Jaw Misalignment?
When appropriately indicated, orthognathic surgery can address the skeletal component of a malocclusion rather than simply compensating for it through tooth movement.
Potential treatment goals include:
- Improving the relationship between the upper and lower jaws
- Establishing a more functional bite
- Improving chewing mechanics
- Correcting significant skeletal asymmetry
- Improving certain speech or swallowing difficulties associated with the skeletal discrepancy
- Improving facial balance as a consequence of skeletal correction
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Are the Risks of Orthognathic Surgery?
Like any major surgical procedure, orthognathic surgery has potential risks. These depend on the specific operation, the patient's anatomy, and individual health factors. Potential complications may include:
- Bleeding
- Infection
- Swelling and pain during recovery
- Temporary or persistent altered sensation
- Changes in the bite or need for further orthodontic adjustment
- Relapse or movement of the jaw from the planned position
- Temporomandibular joint symptoms in some patients
- Problems related to anaesthesia
When Is Orthognathic Surgery Considered for Jaw Misalignment?
Surgery may be considered when the jaw discrepancy is significant enough to affect the bite or function and cannot be adequately corrected through orthodontic treatment alone. The assessment generally considers:
- The severity and type of skeletal discrepancy
- The relationship between the upper and lower teeth
- Facial symmetry and proportions
- Chewing and other functional concerns
- The amount of dental compensation already present
- Skeletal maturity
- Overall oral and medical health
- The expected stability of the proposed correction
The Bottom Line
Orthognathic surgery treats jaw misalignment at its source when the underlying problem is skeletal. Rather than simply moving the teeth to compensate for an incorrectly positioned jaw, the procedure repositions the upper jaw, lower jaw, or both to create a more appropriate relationship between the facial bones and teeth.
The treatment is usually part of a carefully coordinated orthodontic and surgical process. Detailed imaging, bite analysis, facial assessment, and treatment planning help determine which jaw movements are required and whether one-jaw or double-jaw surgery is appropriate.
For patients with significant skeletal jaw misalignment, the goal is to improve the relationship between the jaws and teeth, support better oral function, and establish a stable result while taking facial balance into account.
