Is it possible for me to only receive orthodontic treatment?

This is actually a controversial issue. In summary, there are two primary types of facial profile including overjet facial profile and underbite facial profile, which are both resulted from abnormal bone development. Therefore, we refer these as “maxillary prognathism” or “mandibular prognathism”. However, there is a limitation to the extent of “bone” movement available through orthodontic treatment. Generally, surgery is necessary to move the facial bone if the desired bone movement is more than 3mm (0.3cm).

At the same time, there are two primary subjects including facial profile and dental occlusion. The crucial factor of facial profile is the facial bones. Therefore, correction for overjet or underbite originated from the bone can possibly lead to two results if orthodontic approach alone is adopted. Firstly, it may lead to function successful (improvement in occlusion and function) but esthetics failed (worsening of facial profile). Secondly, the treatment duration is too long, which may last for several years.

If your orthodontist tells you that you only need orthodontic treatment but you are not sure if your condition is caused by the skeletal or dental alone, you can ask the orthodontist to show you several clinical cases similar to your case. Besides, you can decide if the result will meet your expectation from the simulation diagram of the result for orthodontic treatment. In general, there are very few orthodontists who have concept of surgery. Furthermore, there are even fewer orthodontists who willing to cooperate with the surgeons for integrated surgical-orthodontic treatment. Many surgeons are worried that patients would run away by mentioning surgery (frequently happens if they are lack of experience). Therefore, a compromised treatment plan may be suggested.

Patients should be extremely careful with another type of orthodontic treatment plan – “Apply braces first and try pulling, if the result is not satisfying, then only consider the surgery”. Due to the different treatment approach of orthodontic treatment alone and “surgical – orthodontic treatment”, decision should be made in the beginning if surgery would be included in the treatment plan.

Therefore, what is the role of orthodontic treatment alone to the change of facial profile? The person with “dental” overjet has flared out teeth angle but teeth in regular person are vertically aligned. If the patients’ teeth angle is flared out, orthodontic treatment alone can achieve good result in this case. On the contrary, if your teeth angle is not flared out (regular vertical alignment) but the bone protrusion causes protruded teeth, you may have to consider surgery. For person with underbite facial profile, result from “surgical – orthodontic treatment” is often better than orthodontic treatment alone. Most doctors use orthodontic treatment alone to treat mandibular prognathism. Even though the upper and lower teeth can make contact after the treatment, the facial profile still remains “retruded”. This is because factors causing underbite facial profile (receded mid-face and protruded lower jawbone) are not eliminated and only the dental occlusion issue is treated.

In summary, maxillo-facial plastic surgery is a treatment approach based on aesthetics as leading factor. With the intimate cooperation with orthodontists, the ultimate objective of possessing both aesthetic appearance and function can be achieved. If the maxillofacial abnormality exceeds certain range but orthodontic treatment alone has been forcefully applied, the result is frequently disappointing. Sometimes, this may cause the facial appearance to worsen.