Facial Bone Reduction Surgery & Orthognathic Surgery

This is actually a huge topic. Generally, there are overjet facial profile and underbite facial profile. These two types of facial profile originate from abnormal bone development, which also known as “mandibular protrusion” or “maxillary retrusion”. However, orthodontic approach alone has limited results in correcting the location of “bone”. Therefore, surgery is required if the desired bone movement is larger than 3mm (0.3cm).

Besides, there are two main topics including facial profile and dental occlusion with facial bones as the key factor of facial profile. Therefore, there are two possible outcomes when orthodontic approach alone is adopted to treat overjet or underbite caused by abnormal bone development.
Firstly, it may lead to function successful but esthetics failed or partial improvement.
Secondly, the treatment duration will last for long time and frequently lasted for several years.

If your orthodontist suggests you to undergo orthodontic treatment alone but you are uncertain of the origin of your condition (if it is caused by bone or teeth), you should ask the orthodontist to show you similar clinical cases or refer to the simulation diagram of orthodontic treatment. Therefore, you can decide if the treatment result will meet your expectation. As a matter of fact, there are very few orthodontists who understand the surgical approach. Nevertheless, there are fewer orthodontists who have had experience in cooperating with surgeons for integrated surgical-orthodontic treatment. Most surgeons are worried that their patients are reluctant to undergo surgery (generally these surgeons are lack of experience). Eventually, they will suggest a compromised treatment plan to their patients.

Another concern for the orthodontic treatment is “try with orthodontic treatment alone and consider for surgery only when the result is not satisfying”. Since the treatment approach with orthodontic treatment alone and “surgery – orthodontic treatment” is very different, the decision to include surgery in the treatment plan should be made at the very beginning.

So, how to change your facial profile with orthodontic treatment alone? Person with teeth-related overjet has teeth angle flaring out but normal teeth should be vertically aligned. For flared out teeth, orthodontic treatment alone can achieve good result. However, for teeth which do not flare out (teeth with normal vertical alignment) and protruded teeth from bone protrusion, patients should consider the surgery approach.

For instance, person with underbite facial profile generally achieve better result with “surgery – orthodontic treatment” than orthodontic treatment alone. Frequently, the facial profile may still appear as underbite even though treatment has allowed the upper and lower teeth to make contact. This is because only dental occlusion has been treated but the fundamental issue of underbite facial profile from abnormal bone development (receded mid-face with protruded lower jawbone) still exists.

In conclusion, maxillo-facial plastic surgery is a treatment approach based on aesthetical factors. The optimal aesthetic appearance and function can be achieved with the intimate cooperation of orthodontists. If the maxilla-facial abnormality exceeds certain range and orthodontic treatment alone is implemented, the outcome is often disappointing and may even worsen the facial appearance.