Surgery vs. Orthodontic Treatment: Which should be done first?

Hello! This is Dr. Jong Yun Kim of EU Oral & Maxillofacial Surgery :)

Let’s discuss today’s topic: the surgery-first approach and the orthodontics-first approach to double jaw surgery. 

What is the Surgery-First Approach? 

Surgery is undertaken first and orthodontic treatment is done afterwards.

What is the Orthodontics-First Approach? 

This refers to receiving orthodontic treatment before surgery. 

Which would be better to do first? 

 

When people undergo double jaw surgery, their faces change a lot so it’s easy to think that its purpose is to become prettier. 

Although becoming prettier is a given, the actual reason double jaw surgery was developed was to treat malocclusion.

Regarding malocclusions, skeletal malocclusions in particular are difficult to resolve with orthodontic treatment only. 

If the upper and lower jaws don't grow in a balanced way during development, the teeth will not fit together in their positions, resulting in skeletal malocclusion.

Most people with lantern jaw, recessed jaws, and facial asymmetry are diagnosed with skeletal malocclusions. 

What we mean when we say that the upper jaw and lower jaw are imbalanced during development, is that a lantern jaw forms if the lower jaw grows too much, and the upper jaw hasn’t developed enough.

In these cases, all of the lower teeth are positioned in front of all of the respective upper teeth.

These growth changes don’t happen suddenly overnight, but the gap slowly appears as the upper and lower jaws develop, and the teeth adapt to the difference in growth in the bones.

 

Typically, the upper and lower incisors are supposed to meet at the same place to bite food.

The lower front teeth gradually slant forward as there is a discrepancy in growth and will eventually reach a state where they can no longer reach the upper front teeth.

The teeth try to adapt by slanting the upper front teeth outwards while leaning the lower front teeth inwards so that they can touch each other.

 

This is called “compensation.”

Compensation isn’t limited to the front teeth as all teeth will try to compensate or make up for the discrepancy. 

If we look at each tooth, every tooth on the left has a corresponding tooth on the right, and each set of teeth has space between them in the middle.

The width between the teeth is narrow where the front teeth are, and wider towards the back of the mouth where the molars are. 

For lantern jaws, because the lower jaw is protruding, the molars in the lower jaw are able to touch the upper front teeth. 

Since the narrow area of the upper jaw touches the wider area of the lower jaw, compensation occurs here as well as the upper front teeth try to spread out to become wider while the molars in the lower jaw slant inwards, reducing the width between them.

Since being able to chew is important, compensation occurs as the teeth adapt out of necessity.

As the teeth are adjusted to their abnormal positions, the teeth will not align if the jaw bone is moved to a normal position.

The decision can be made after these considerations:

Whether you undergo surgery even though the upper and lower teeth don’t align, or undergo surgery after the teeth have been repositioned, there are compelling advantages and disadvantages to each approach, so we have to carefully consider each option and weigh the pros and cons of each method.

In the past, there were many disadvantages to the surgery-first approach so orthodontic treatment was done before first! 

The orthodontic treatment was done for a long time, too! 

If teeth are extracted, there is more space to move the teeth into the resulting gap, but it was difficult to accurately predict where the teeth would ultimately move to.

Now, because there are methods to perform surgery without extracting teeth, there is a significant reduction in the movement of teeth and it is possible to more accurately predict where the teeth will move after surgery.

 

Additionally, it is also possible to move teeth into their desired positions within a short period of time.

Orthodontic techniques have become more advanced, resulting in minimal preoperative orthodontic treatment time.

There are also methods involving moving only a few, relevant teeth to prepare for surgery in a short period of time.

There have been many advancements but the surgery-first approach is not applicable for all cases.

If surgery is to be considered the beginning of treatment, orthodontic treatment can be considered as the finishing touch.

  

If the teeth that have grown out of their normal positions due to compensation

are moved back to their proper positions through surgery, there can be many different outcomes.

The jaw can protrude, facial asymmetry can recur, and the chin can become recessed again.

Considering these factors, the surgery-first approach can only be selected if the bite is determined to be stable after surgery.

Therefore, there are criteria regarding whether surgery or orthodontic treatment should be done first, but there is no definitive answer to which is better.

At EU Oral & Maxillofacial Surgery, our doctors have extensive experience in both the surgery-first and orthodontics-first approaches and are always striving to provide the most appropriate treatment for each patient :)

More information can be found on our YouTube channel, EU Surgery. For any further clarification, visit us for an in-person consultation at EU Oral & Maxillofacial Surgery. Thank you!