The ultimate discipline

Complex malocclusions are sometimes treated with combined orthodontic and surgical treatment (orthognathic surgery). It is good to know that this is one of the main areas of focus at our institute. With over 100 cases a year, we are leading the way in Europe in this field.

Orthodontics on its own deals with the treatment of misaligned jaws and teeth. Sometimes, however, orthodontic treatment alone is not enough – for example, when natural jaw growth has already come to an end in adulthood. In these cases, it is often advisable for health reasons to combine orthodontic treatment with a jaw surgery procedure. For which malocclusions is this combination necessary? Why is treatment important for health reasons? And how does the treatment work?

Malocclusions

There are four malocclusions for which combined orthodontic and surgical treatment can be advisable:

• Class II (also known as retrognathia, mandibular retrognathism or maxillary prognathism). Occurs when the upper jaw is positioned forward in relation to the lower jaw.
• Class III (also known as mandibular prognathism). Occurs when the lower jaw is positioned forward in relation to the upper jaw. Learn more
• Facial asymmetry: A change defined by the presence of a disharmony between the two halves of the face. Learn more
• Gummy smile: When excess gum is visible on smiling. Learn more

These deformities can be accompanied by other dental misalignments, such as a narrow palate, an open bite, a crossbite, an edge-to-edge bite, an increased overjet or crowding of the teeth.

Health first

There are three medical reasons to correct these malocclusions:

• Functional reasons: If the misalignment is not treated in time, damage to the teeth and the periodontium (the tissues that support the teeth) can occur, which can lead to premature tooth loss. Furthermore, the misalignment can impair your ability to chew and speak. Finally, it can lead to jaw joint problems (TMJ): a condition that causes pain (e.g. jaw joint pain, headaches, neck and back pain) and muscle cramps.
• Psychological reasons: Because the misalignment is also visually unappealing, it affects the self-esteem and self-confidence of many of those affected.
• Health reasons: The risk of sleep apnoea should not be underestimated. Jaw misalignments can lead to breathing problems during sleep because the airways are narrower than normal. In those affected, breathing often stops several times a night. Snoring is usually the only indicator of this condition. Because of the apnoea, you sleep badly and therefore feel drowsy and tired during the day. In extreme cases, this condition can even be fatal.

Whether you already suffer from it today or only will in the future: from a medical point of view, it is important to align the jaws correctly – for example, to avoid overloading and overstretching of the jaw joint and wear of the teeth caused by grinding.

Beauty follows automatically

The results of combined orthodontic and surgical treatment are almost astonishingly beautiful. Beauty, after all, is a question of healthy function. Our focus is always on the function of the masticatory system, the muscles and the jaw joint. Once this has been restored, however, optimal aesthetic results always follow as well. See our treatment results here.

Expertise in harmony

Combined orthodontic and surgical treatment is regarded as the ultimate discipline in the treatment of complex malocclusions. Here, two specialist experts work closely together:  On the one hand, the orthodontist: a dentist who, in addition to their dental degree, has had to complete several years of training in orthodontics. On the other hand, the oral and maxillofacial surgeon, who must have completed degrees in medicine and dentistry as well as specialist training in oral and maxillofacial surgery. This training path is one of the longest in Austria. This is why, in Lower Austria for example, there are currently approx. 760 dentists but only 10 specialists in oral and maxillofacial surgery.

A precise process

The process takes place in five steps:

1. Check supplementary insurance

Before you attend a consultation, it may make sense for you to take out supplementary (private) insurance that also covers jaw surgery.

2. Initial outline planning

• We get to know each other during an initial consultation. We discuss your wishes and analyse which treatment options are suitable for you.
• In the next step, we take what are known as records. This involves a surgical photo analysis as well as a cephalometric X-ray and a panoramic X-ray.
• Our orthodontists then measure the data very precisely and draw up an initial outline plan
• This plan is then discussed together with you, and a decision is made as to whether purely orthodontic treatment or surgically assisted treatment makes sense.

3. Detailed planning

• Based on a 3D scan, we create models of your teeth using 3D printing
• We then import the model data into special software and create a simulation in which we can also simulate the surgical movements
• Joint surgical and orthodontic consultation: one of the things that sets us apart is that the results of the planning are agreed together with you, an experienced oral and maxillofacial surgeon and an experienced orthodontist. This appointment is so important because the outcome of the treatment ultimately depends very much on how well the medical experts coordinate. The aim is to coordinate the treatment protocol between the oral and maxillofacial surgeon and the orthodontist. You will also be shown educational videos, and the procedure will be explained on a skull model.

4. Treatment

Three treatment protocols can be considered:

• Surgery Late (long orthodontic treatment, then surgery, then orthodontic fine-tuning)
• Surgery First (surgery first, then orthodontic treatment)
• Surgery Advanced (short orthodontic treatment, then surgery, then orthodontic fine-tuning)

5. Retention

During the retention phase, we use state-of-the-art appliances such as Hawley retainers, Memotain wires or Vivera retainers to make sure that the result achieved is maintained. At the Eltz Institut, you also benefit from our 1-year retention guarantee.