Casual Comments for Surgical vs. Orthodontics

Beauty is very subjective, and also intangible. However, you can only believe your doctor’s aesthetic sense. Generally, everyone can use their direct instinct (and maybe other senses) to select a doctor who emphasizes aesthetic sense, which is similar in the case of identifying the different artistic senses in make-up artists, interior designers and architects. As a matter of fact, every person who enters medical school has certain intelligence and graduated by going through a lot of hard work. However, not every graduated doctor is suitable to process and transmit every messages generated by the left and right brain to the scalpel for the sculpting of face with aesthetic sense.

As I have mentioned in various articles, the critical point to determine “surgical-orthodontic” depends if the orthodontist “clearly” understands the limitation of orthodontics alone to the change of facial profile. The modern medical trend is multi-discipline treatment as the generation of treating patient from a specialized unit alone has been annihilated. From the patient’s perspective, the most concerning issue of the majority patients are the attractiveness and harmony of the overall facial profile, which surpasses the neatness and beauty of dental alone. It is not hard to come across people with underbite and overjet facial profile around us. However, their teeth alignments are in good condition because they neglect the abnormality of jawbone and only receive treatment to correct dental occlusion. The objective of coupling surgical-orthodontic is to perform treatment plan based on facial appearance and harmony without affecting the dental appearance and function.

Most adults who seek for cosmetic surgery expect immediate results. Therefore, “surgical before orthodontics” is a treatment plan favoring the patients. Surgery is first performed so that satisfying and regular appearance can be achieved. Subsequently, orthodontic treatment is administered to gradually adjust the dental neatness and optimal dental occlusion. I frequently adopt this type of treatment approach on working adults who have social pressure. However, people with crowded or extremely crooked teeth alignment may have to receive some pre-surgery orthodontics. The burden of orthodontist can be reduced by correcting the teeth alignment before surgery. On the contrary, some patients choose to not receive orthodontic treatment after the orthognathic surgery. This type of patients is mostly those with overjet facial profile.

I extremely value multi-discipline treatment as I regularly treat patients together with orthodontists to discuss the potential of treatment plan and bridge the gap between different opinions. In fact, generation of the ultimate treatment plan requires various decision-making including sequences of orthodontics and surgery, time (I believe my patient’s time and my time are equally important. Only fine and comprehensive planning can produce the most efficient and time effective treatment.), teeth removal (frequently involves the removing of premolars and wisdom tooth), dental treatment with other teeth in bad condition (endodontic treatment, periodontal treatment or tooth-filling), displacement range of jawbone, post-surgical occlusion, and potential for rhinoplasty, genioplasty or coupled with bone reduction. There are too many issues requiring the agreement of treatment plan among three parties (surgeon, orthodontist and patient), hence, the treatment plan can be administered in the most efficient and accurate manner.

Certainly, there are some borderline cases which are between orthodontics alone and coupled surgical-orthodontics. Frequently, I will consult patient together with my orthodontist and analyze the case from various angles to assist the patient. Therefore, the patient can decide if surgical-orthodontic treatment or orthodontics alone is appropriate by taking considerations with function (occlusion, chewing and pronunciation function), attractiveness (generally this factor accounts for a large portion in decision-making and it is my most emphasized factor), stability (refers to the possibility of restoring the dental alignment and face after the orthodontics), and decisions in extending or shortening the treatment duration.