View Patient Case Studies Group 1: AC, AF, DD, JH, PL Group 2: AR, FP, NP, SM, SO, TM Group 3: CC, ED, JC, JB, KD, ND Group 4: AF, BF, DG, IF, SD, SG Group 5: CM, JJ, KP, RK, RM, SH Group 6: GG, JCM, SR, SS, ST

What is Orthognathic Surgery?

Patients require orthognathic surgery when one or both of their jaws are misaligned due to either excessive overgrowth or undergrowth. This misalignment results in teeth which don't seem to fit together properly. The goal of orthognathic surgery is to correct this mismatch of the jaws and teeth. Not only will this allow the teeth to meet correctly and function properly but also it will improve facial appearance as well.

Why won't Orthodontics alone work to correct this jaw mismatch?

The goal of orthodontics is to correct the crowding of teeth and abnormal tooth angulations and rotations. Orthodontics cannot correct an abnormal jaw position, only orthognathic surgery can fix misaligned jaws. In summary, orthodontics corrects abnormal tooth position; orthognathic surgery corrects abnormal jaw position.

What are typical symptoms that may result from misalignment of the jaw?

Different misalignments in a jaw's position can produce different symptoms. Common problems associated with misaligned jaws include:

• Difficulty in biting and chewing food
  
• Chronic jaw or TMJ pain
  
• Breathing problems
  
• Speech problems
  
• Abnormal wear and tear on teeth
  

What do I need to do to get started?

Over the years I've performed many orthognathic consultations. I find the challenge in doing these consultations and treatment plans has always remained the same. First how do I describe the way a patient's bite differs from a normal bite? Secondly, how do I describe the changes in function as well as dental and facial appearance in terms that a patient will understand? It is my wish for my future patients to gain further insight and education by viewing other patient's pre and post-surgical dental and facial pictures. All of these cases are patients whom I have personally treated and photographed. In some cases I have included photos of study models and x-rays to help identify a problem or show some of the intermediate steps required prior to the surgical end result. Most cases, however, are simple before and after photos. You will note orthodontic braces are a common feature present in many of these case studies. In order to produce quality surgical outcomes, I have to work closely with the orthodontist. I've been fortunate to work with many fine orthodontists. I have given them credit, too, as they are an integral part of the surgical outcome.

I recommend trying to find dental and facial appearances which you feel are similar to yours. In describing the patients' condition, and treatment plans, I purposely tried to avoid using medical or dental terminology but unfortunately some professional jargon is unavoidable. So we can all speak the same language I've tried to "hyperlink" the dental terminology directly to its definition. If you can't remember what a "Crossbite" is then click on crossbite and its definition will pop up. Also if you wish to focus on just one specific clinical feature, let's say for example, "Underbite", you can hyperlink to specific cases of Underbites which are listed below the definition of "Underbite" on the terminology page.

Finally I want to thank my patients for allowing me to use their photographs. Many of these patients have told me the surgery I performed has changed their life in a very positive meaningful way. Recently, one of my assistants told me you can see these changes in the eyes of the patients post-operatively. In reality, sometimes I feel these patients have a greater change on me than I have on them. There has never been a greater thrill for me than to be involved in giving a patient a pleasing smile. I am grateful for the chance to do so and to have had the opportunity to make a positive impact in the lives of my patients.

AC-PROBLEM LIST

1. Overbite caused by a small severely backward positioned lower jaw.
   
   
2. Chronic trauma to the roof of the mouth resulting from a Deep bite in which the lower front teeth chew on the palatal gum tissue.
   
   
3. Outwardly turned lower lip resulting from the chronic trauma when the upper front teeth repetitively hit against an abnormally positioned lower lip.
   
   
4. Twelve year old child not compliant with conventional orthodontic therapy.

July, 1988			Excellent demonstration of how teeth chew on the roof of the mouth with this type of mouth deformity
Sept, 1989

PRE AND POST-SURGICAL ORTHODONTICS BY DR. BRAD WATTERWORTH.

SURGICAL TREATMENT PLAN

1. Lower jaw advancement to eliminate both the overbite and deep bite as well as position the lower lip and chin in a more favorable forward position.
   
   
2. Total treatment time including surgery and pre and post-operative orthodontics is less than 13 months.
   

DD-PROBLEM LIST

1. Severe downward vertical growth of the upper jaw resulting in long facial appearance, with lip incompetence, and a gummy smile.
   
   
2. Crossbite caused by inadequate upper jaw width.
   
   
3. Overbite caused by the backward positioned lower jaw and forward positioned upper jaw.
   
   
4. Paranasal deficiency and narrow base of the nose.
   
   
5. Gum inflammation of upper front gum tissue caused by chronic exposure to air.
   

The Problem
The Solution

Diagram of Procedure

Predictive Model Surgery

Pre-Op

Post-Op

Final Bite After Braces and Surgery
PRE AND POST-ORTHODONTICS BY DR. RICHARD NAMEY.

SURGICAL TREATMENT PLAN

1. Significant superior repositioning of the upper jaw to correct the long facial appearance, lip incompetence, and gummy smile.
   
   
2. Upper jaw setback to help correct the overbite associated with a forward positioned upper jaw.
   
   Surgically widen the upper jaw to eliminate the crossbite associated with inadequate upper jaw width.
   
   
3. Significant forward autorotation of the lower jaw to help eliminate the overbite and to bring chin point forward.
   
   
4. Surgically allowing nasal base to widen with the superior repositioning of the upper jaw .

AF-PROBLEM LIST

1. Underbite caused by a backward positioned small upper jaw.
   
   
2. Crossbite caused by the inadequate width of the upper jaw.
   
   
3. Paranasal deficiency caused by a backward positioned small upper jaw.
   

Pre-Op

Post-Op

Pre-Treatment Bite
Post-Treatment Bite
PRE AND POST-ORTHODONTICS BY DR. JAY RICHARD.

SURGICAL TREATMENT PLAN

1. Advancement of the upper jaw to eliminate underbite and paranasal deficiency associated with a backward positioned small upper jaw.
   
   
2. Surgically widen the upper jaw to eliminate the crossbite associated with the inadequate width of the upper jaw.
   

JH-PROBLEM LIST

1. Overbite caused by a small backward positioned lower jaw.
   
   
2. Outwardly turned lower lip resulting from the chronic trauma when the upper front teeth repetitively hit against an abnormally positioned lower lip.
   
   
3. Chronic trauma to the roof of the mouth from a Deep Bite in which the lower front teeth chew on the palatal gum tissue.
   
   

Pre-Op

Post-Op

Pre-Treatment Bite

Above photo shows how lower teeth can chew on the roof of the mouth with this type of jaw deformity

Post-Treatment Bite
PRE AND POST-SURGICAL ORTHODONTICS BY DR. TOM CHOU.

SURGICAL TREATMENT PLAN

1. Lower jaw advancement using rigid fixation to eliminate the overbite, and deep bite, as well as position the lower lip and chin in a more favorable forward position.
   
   

1. Underbite caused by a severely backward positioned small upper jaw.
   
   
2. Underbite caused by a severely forward positioned large lower jaw.
   
   
3. Open bite caused by the excessive vertical downward growth of the back portion of the upper jaw.
   
   
4. Crossbite due to the inadequate width of the upper jaw.
   
   
5. Upper jaw asymmetry with the upper jaw's dental midline shifted to the left.
   
   
6. A long facial appearance caused by the excessive vertical downward growth of the back portion of the upper jaw as well as a vertically long chin height.
   
   
7. Severe dental compensation.
   
   
8. Dental decay and abnormal tooth wear caused by an abnormal bite relationship.
   
   
9. Paranasal deficiency associated width a backward positioned small upper jaw.
   
   
10. An unsupported upper lip, lip strain, and lip incompetence.
    
    

Initial Presentation
Presurgical Orthodontic Decompensation
Predictive Model Surgery
demonstrating the planned correction of malaligned jaws and bite disorder
Immediate Surgical Changes
demonstrated at time of surgery (patient shaved his mustache off on the morning of surgery)
Pre-Treatment Bite
Post-Treatment Bite
PRE AND POST-SURGICAL ORTHODONTICS BY DR. CHARLES CAPPETTA.

SURGICAL TREATMENT PLAN

1. Upper jaw advancement with a bone graft to help eliminate the underbite and paranasal deficiency associated with a backward positioned small upper jaw.
   
   
2. Surgically widen the upper jaw to eliminate the crossbite.
   
   
3. Rotation of the upper jaw's dental midline to the right to correct the asymmetry of the upper jaw.
   
   
4. Superiorly reposition the upper jaw and autorotate the lower jaw forward to close the open bite.
   
   
5. Lower jaw setback to correct a forward positioned lower jaw and the eliminate the underbite.
   
   
6. Genioplasty to reduce the chin's vertical facial length and reposition the chin point forward 1/2 the total distance of the amount of the lower jaw setback.