Orthognathic Surgery: treatment of dentofacial skeletal anomalies

Orthognathic surgery involves surgical manipulation of the maxilla and mandible in patients with dentofacial skeletal anomalies to restore the proper anatomical and functional relationship of their face. Clínica Dental Doctora Población is a pioneer in Spain in the treatment of these patients with more than 25 years of experience.

The craniofacial growth should be balanced, the face grows, more or less, as a balloon swells, that is, the same growth at all points. There are people in whom this is not fulfilled and their growth is anomalous; a greater or lesser growth of the maxilla or mandible, that is to say, dentofacial skeletal anomalies that become evident as the patient grows, and this is accompanied by the consequent dental malocclusion. This is so severe that the usual orthodontic techniques are not sufficient to solve the problem.

Scientific studies have shown that these patients also suffer from a variety of functional deficiencies:

  • Digestive:
    • Abnormal chewing patterns.
    • Decreased chewing forces.
    • Restriction of jaw movements.
  • Dental:
    • Dental losses
    • Bone loss
    • Cuspid losses
  • Sleep:
    • Sleep apnea
    • TMJ Disorders, temporomandibular joint disorders
  • Pain:
    • Neck and back contractures
    • Meniscus dislocation
    • Arthrosis

In other words, the decision to intervene is due to your functional problems, not just for aesthetics. The main goal of treatment is to improve function by correcting the underlying skeletal deformity.

Facial imbalances are added: the soft tissues, expression of their bony deformity, transmit disharmonious faces, producing in the patient a rejection of their own image. It influences their daily life, characterized by a lack of self-confidence. We live in a very competitive society and adolescence is a very difficult and sometimes very cruel age for these patients. The intervention is performed from the end of growth and they come to us with great desire and enthusiasm to begin treatment, due to the baggage of rejections, jokes …. for their facial image.

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Once they are treated and their face acquires facial harmony, the great physical changes expected are secondary compared to the psychological ones. It is a privilege for us, the architects of change, to experience the transformation of these people: how they gain confidence, increase their happiness and desire to “eat the world”.

What is orthodontic treatment like?

They are performed with “fixed appliances” and last between 24 and 30 months. In some cases it can be done with “invisible orthodontics”, although it slightly delays the process.

The treatment consists of moving the teeth to their perfect position in the bony bases where they have erupted, not in relation to the antagonist teeth, so when these bases are repositioned in the operating room, the teeth occlude in the physiological position.

It is a slightly more expensive treatment because it is more complex, the brackets that are used for the 3D records are the most expensive on the market, the appointments are more frequent and the costs increase.

Is orthodontic treatment more expensive than orthognathic surgery?

Orthodontic treatment is more expensive for three reasons:

  1. The brackets to be used are the most expensive on the market: synthetic sapphire. They are aesthetic brackets, tooth-colored and of the most resistant quality, since in the operating room many instruments enter the mouth and must withstand the blows. Why these brackets? Surgical splints are used in the operating room, which require a 3D X-ray of the patient’s face, and if they have metal, they produce artifacts, unreal, aberrant images that hide the real anatomy.
  2. On the other hand, there are the surgical splints, which are essential devices for the realization of the intervention, since they are the ones that provide the necessary precision at the time of placing the jaws in the new position. These appliances are difficult to make and very precise, so they are expensive and are not covered by Social Security, they are made by a laboratory under our prediction and direction. We usually bill the patient for them.
  3. I have always compared surgery to a one-performance theater premiere. Everything has to be perfectly prepared for that day, it is the day on which the patient’s new face is going to be restructured, his or her sign of identity, and it is the orthodontist’s great responsibility to ensure good coordination of the arches, which is why he or she has to check appointment after appointment, carrying out continuous tests, which increases the time spent in the office and, obviously, the consequent increase in the cost of treatment.
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Who performs Orthognathic Surgery?

The surgery is performed by a maxillofacial surgeon. The orthodontist prepares the dental arches with a previous orthodontic treatment, therefore the close communication between orthodontist and surgeon is part of the key to success.

Just as we can answer all the questions regarding this operation, we are not prepared to explain the orthodontist’s behavior in these cases, since the behavior of this practice is different from the rest. We are probably the only orthodontic clinic in which the orthodontist always goes to all the operating rooms of his patients, sharing decisions and even the smallest detail with the surgeon.

Clínica Dental Doctora Población is formed by a team and the responsibility is shared, so we understand it and we work with surgeons who agree. This behavior also has an effect that we believe is essential, the assistance to the relatives: we inform them in real time of the evolution of the surgery. This leads to a deep gratitude from the patients and their families, they are delighted to see us there, we transmit tranquility and affection.

Are there risks in Orthognathic Surgery?

Nowadays they are maxillofacial surgeons, a specialty within surgery, which specifically qualifies them to perform them. The diagnosis is made with 3D technology and the surgeries are programmed after we, the orthodontists, have made the necessary dental movements so that after the intervention the teeth occlude perfectly. All these advances give security and, therefore, peace of mind to patients, since the risks are minimized to the maximum.

Does Orthognathic Surgery hurt?

Believe it or not, this surgery does not hurt. The first week is uncomfortable due to inflammation and tiredness after the blood loss.

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It takes a few weeks to be able to open your mouth wide enough to use a spoon, so you will have to eat a liquid diet with a straw for the first few days.