Oral and maxillofacial surgeons utilize orthognathic surgery, or corrective jaw surgery, to treat patients with severe malocclusions that involve misalignment of both the teeth and the jawbones.
As a board certified oral and maxillofacial surgeon, Dr. Robert M. Dolman is uniquely qualified to perform corrective jaw surgery combining his foundation of a dental education together with advanced and extensive surgical training.
Whenever there is an imbalance in the relationship between the upper jaw (maxilla) and lower jaw (mandible), individuals may benefit from procedures that align the jaws into a more functional and comfortable, balanced position.
This imbalance or disharmony is referred to as a dentofacial deformity. Although the objective of orthognathic surgery is to achieve balance and occlusal stability (stable bite), the results will generally yield improved esthetics as well.
Below, you’ll find more information on the types of dentofacial imbalances, how these imbalances can be corrected, as well as a typical treatment course through Dolman Oral Surgery.
Types of Dentofacial Imbalances
Not all, but most dentofacial imbalances will fall into one of the following categories:
- Retrognathism: This imbalance is often referred to as an overbite wherein the lower jaw appears retruded or shortened.
- Prognathism: This is the opposite situation in which the lower jaw appears more prominent or longer and is often referred to as an underbite.
- Apertognathism: This condition is defined as an open bite, where the front teeth do not meet. It is often combined with either condition 1 or 2 above.
- Asymmetry: This situation occurs when the jawbones appear tilted or rotated such that the face appears larger (or more prominent) on one side versus the other. It can occur in combination with any of the above categories.
- Vertical Excess and Deficiency: Relationships of the jaws and face appear long or short in a vertical direction. This also will occur in combination with any of the above situations.
Process for Correcting Dentofacial Imbalances
It is important to recognize that a dentofacial imbalance is a condition of bone development and consequently a misalignment beyond the teeth alone. When only the teeth are in an improper position, then orthodontics alone will be adequate to correct any existing problems. However, in the presence of a skeletal (bone) discrepancy or disharmony, the jawbones will need to be surgically repositioned as well.
Detailed dental and facial measurements combined with radiographic analysis and surgical simulation will allow the oral maxillofacial surgeon to determine the contributing elements of the deformity.
A surgical plan can then be mapped out to pre-determine all phases of the surgery. Correction of all imbalances can almost always be achieved by combining specific bony cuts and movements, including such procedures as:
- Lefort I Osteotomy of the Maxilla: An osteotomy is defined as a cut in the bone. A Lefort I osteotomy is a bony cut through the maxilla at a level just below the nose, extending around the entire aspect of the upper jaw.
- Osteotomy of the Mandibular Ramus: A sagittal split osteomy which allows the lower jaw to be slid forwards or backwards or a vertical osteomy which allows the lower jaw to be pushed backwards.
- Genioplasty: A bony cut through the chin allowing for its movement in any desired direction.
A combination of the above procedures, with modifications, will solve most dentofacial deformities and lead to a vastly improved comfort, function and esthetics.
Typical Orthognathic Surgery Procedure
Oftentimes, an orthodontist will evaluate a patient and recognize the need for corrective jaw surgery (orthognathic surgery). He will then refer the patient to a board certified oral and maxillofacial surgeon for evaluation.
At Dolman Oral Surgery, Dr. Robert M. Dolman has extensive training and a long-standing experience in the area of corrective jaw surgery. As always, Dr. Dolman will meet with you for a consultation. He will carefully listen to your concerns and answer all of your questions. Dr. Dolman will compile a detailed dental and medical history after which he will complete a thorough clinical examination. As needed, Dr. Dolman will obtain the required radiographs to support his clinical findings. If required, Dolman Oral Surgery has an I-CAT 3D CT Scanner on site.
Once Dr. Dolman has accumulated all necessary information, he will meet with your orthodontist to discuss his findings and create a comprehensive and coordinated orthodontic-surgical plan.
A period of orthodontic preparation will be required in advance of surgery. When proper tooth alignment has been achieved, Dr. Dolman will then plan the details of surgery and coordinate hospital admission and follow up care.
Consultation with a nutritionist will be required along with a physical therapist. Dr. Dolman will follow you closely throughout your recovery period, making himself easily available to address any questions or concerns that you may have, at any time.
After several weeks of bone healing, you will return to the orthodontist for the final phases of your treatment.