Two things move, and only one of them is the teeth
Orthodontics moves teeth through bone. It is very good at that. What it cannot do is change the size or position of the jaw itself — and in some patients the jaw is precisely the problem.
When the lower jaw sits noticeably too far forward or too far back, when the upper jaw is underdeveloped, or when the bite is open at the front, straightening the teeth alone will not hold. The teeth end up in a correct relationship with each other but a poor one with the jaws, and the bite relapses.
That is the case for surgical orthodontics — also called orthognathic treatment — where the orthodontic work and corrective jaw surgery are planned together as one course rather than two separate opinions.
The sequence, and why the order matters
Braces or aligners go on first. That sounds backwards — why straighten teeth that are going to be repositioned anyway? Because the surgeon needs the teeth in a known, aligned position to plan where the jaws must go. The pre-surgical phase usually takes 9 to 15 months.
The surgery is performed by an oral and maxillofacial surgeon in a hospital or accredited facility. It usually means one night in hospital and about two weeks away from your normal routine.
Then a finishing phase of orthodontics — roughly 6 to 12 months — settles the bite and fine-tunes how the teeth fit now the jaws are in their corrected position. Retainers follow, and hold the result for life.
Who it is actually for
The signs are functional more than aesthetic: an underbite, a significant overbite with a receding chin, an open bite where the front teeth do not meet, a chin that shifts to one side on closing, persistent difficulty chewing or biting through food, or severe jaw joint problems.
Most adult orthodontic cases need no surgery at all. If you recognize a couple of these signs it is worth a consultation — and if surgery is not indicated, we will say so plainly and treat you with braces or aligners alone.
Book the complimentary exam. Photographs, an x-ray, a digital iTero scan and a written plan with fees — at no charge, with no obligation to treat. Book a time or call (615) 814-4884.