In facial malformations, the teeth in the maxillary and mandibular arch are usually misaligned. In these cases, the role of the orthodontist is essential, in order to align the teeth and prepare them for surgery.
The result of the combination of treatments, orthodontics and orthognathic surgery, is to recover the balance between all facial features, therefore a good diagnosis and a well-planned orthodontic treatment is key to successful orthognathic surgery.
The orthodontist must be in constant communication with the maxillofacial surgeon, and once the teeth have reached the ideal position for surgery, both of them will decide when the patient is ready to undergo surgery. Normally, after surgery there is a period of adjustment in which the orthodontic treatment is continued, to finish placing the teeth and adjusting them in their new position, although in some cases this is not necessary.
These are the different orthognathic surgery protocols:
Classic Approach: It is followed in the vast majority of surgeries, and consists of orthodontic treatment, followed by orthognathic surgery, and then more orthodontic treatment.
Surgery First: In this case, there is no prior orthodontic treatment before orthognathic surgery. Indicated in patients whose teeth are well aligned and the only thing they should correct is the existing disharmony between the jaw and maxilla.
Surgery Last: Orthodontic treatment followed by orthognathic surgery without subsequent orthodontic treatment. It is applied in patients who have already achieved a good orthodontic occlusion, but who do not have facial harmony due to a bad placement of the facial bones.
Surgery Only: Orthognathic surgery only. It is applied when the patient has a good occlusion and only needs a readjustment of the bone structure, either to treat problems such as Sleep Apnea or to achieve greater facial harmony.
It is important to emphasize that the protocol to be applied will be defined by the maxillofacial surgeon and the orthodontist, the patient can not choose between one and the other, since this is defined based on the position of the patient's bones and teeth.
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Video: Surgery First
