Correction of pathologies of the bite and dentition is one of the most important areas in modern dentistry. Surgery is considered to be one of the most popular methods in orthodontics to correct these problems. In some cases, an operation on the jaw is the only way to achieve any noticeable and significant positive changes.
Orthognathic Surgery
Usually, this concept means a number of certain operations that are designed to correct the external symmetry of the face and the wrong bite. During osteotomy, soft tissues are transformed, which allows the external features of the face to become more aesthetically attractive. Changing the bone structures makes it possible to perform some manipulations, for example, to extend or shorten the jaw, correct the size of the chin, and also move the jaw to the most suitable position.
Such changes cannot be achieved with braces, plates or other special devices. In addition, often there is a need for surgery on a broken jaw if the damage is serious enough. An osteotomy requires clear indications and is subject to a number of limitations, mainly related to the patient’s physical health.
General indications for surgery
The doctor may recommend surgery for skeletal deformities of the jaw of the second and third class, which are characterized by visually distinguishable abnormal sizes of the chin and jaw. An operation on the jaw to correct the bite is usually performed only after unsatisfactory results of treatment with other methods.
Preliminary treatment takes place with the help of orthopedic structures such as crowns and veneers, as well as with the use of braces. If the desired effect after treatment could not be achieved, or if it only leads to a deterioration in the patient’s well-being, the doctor decides to conduct the appropriate operation.
Sufficiently serious anomalies in the structure of the jaws are not corrected with braces. The protruding chin or gingival smile can only be corrected surgically. In favor of the operation, the fact that the correction of skeletal deformities by conventional methods of orthodontic treatment can often provoke pathologies of the TMJ (temporomandibular joint) or tooth dislocation is also in favor . In turn, some of the TMJ pathologies cause severe pain in the back and head, problems with the gastrointestinal tract, and are also accompanied by other complications.
Contraindications for surgery
Among the contraindications, the patient’s age is considered the most basic. Such operation is not performed for minors, because at the age of 18 years bone formation processes are actively going on. Problems and visual defects associated with the jaw apparatus can themselves be corrected by the time the bite is completely formed and the jaw growth process is complete. Other causes of possible jaw surgery failure to correct deformities and abnormalities include:
- HIV and tuberculosis;
- the presence of diabetes;
- any infectious diseases;
- clotting problems or oncology;
- diseases of the endocrine, immune and cardiovascular systems;
- mental abnormalities and disorders in the central nervous system;
- incomplete and slow healing of bone tissue, the presence of related pathologies;
- rows of teeth unprepared for surgery.
The last point is most often a temporary problem, for the elimination of which bracket systems are used. If simply aligning the dentition with braces is not enough, then doctors prescribe the removal and prosthetics of the teeth, as well as plastic corrections of the lateral cords.
Operation Preparation Process
After the appointment of a surgical intervention, the process of determining the necessary parameters of the jaw and face bones begins, which will combine the possibility of high-quality synchronization of the work of the entire temporomandibular joint, the correct abutment of teeth to each other and harmonious facial expression from an aesthetic point of view.
Special software will build a three-dimensional model of the future corrected jaw. Doctors follow this model directly during an operation on the jaw. The use of modern technologies makes it possible to reproduce previously made calculations with an accuracy of 99 percent.
The drawn up plan and the constructed model are just the first stage in the preparation process. This is followed by the second and longest step, which is required in almost every case. The doctor proceeds to preliminary alignment of the dentition with the help of braces and other necessary tools. The duration of preparation for the operation takes from 2 to 18 months.
The consequences of refusing an operation
According to statistics, most of the patients who refused dental surgery recommended by dentists to correct the occlusion, sooner or later face additional complications that exacerbate the pathology. The list of complications includes the following:
- Gum disease. Destruction and loss of some teeth.
- Disturbances in the digestive tract due to improper chewing of food.
- Frequent pain in the area of the ears, temples, and jaws. Toothache
- The appearance of problems with speech. Violations of pronunciation and diction.
The methods of the operation and the latest equipment allow surgical intervention to be carried out as quickly and safely as possible, therefore the patient’s refusal without contraindications is an extremely dubious step.
Complications during and after surgery
Since orthognathic surgery is considered the only predictable surgery among all other types, the risks of any complications naturally reduce to an acceptable minimum. During the work of surgeons, the patient is under general anesthesia. Only certain cases of mild interference with the bone structure allow the use of local anesthesia.
Some patients noted that after surgery there was a temporary numbness of the upper and lower lips. Doctors call this effect absolutely safe and in some ways even useful: the lack of sensitivity after surgery for a bite of the jaw quite logically leads to the absence of pain at first. By the time of restoration of sensitivity, as a rule, the pain either recedes completely, or is not so pronounced.
It is worth noting that when changing the size of the jaw during surgery, the recovery process will always take longer, as doctors are forced to damage the integrity of bone and soft tissue.
Operations for fracture of the jaw
Assign an operation only in a situation where all orthopedic methods do not bring a positive result or are not applicable. With multiple injuries and severe fractures of the jaw, surgery is a necessary measure. The following cases fall under this classification:
- bone defects;
- insufficient number of teeth to apply the tire;
- a difficult fracture that cannot be repaired.
Four main surgical procedures are used:
- Fastening the jaw with a steel needle or rod through the bone.
- Imposing bone sutures with kapron or polyamide thread.
- Fastening to the bone and subsequent fixation with metal plates or tires.
- Bone fixation using Vernadsky, Uvarov, Rudko and other similar devices.
Cyst removal surgery
There are two relevant methods for performing such an operation: cystotomy and cystectomy. In the presence of extensive cysts, prone to degeneration and relapse, doctors mainly use a two-stage operation to remove the jaw cyst. This method includes both of the above, is saving and non-traumatic. Intervention is acceptable on an outpatient basis. The result of a successful operation is the complete recovery of the patient while maintaining the visual contours and size of the jaw.
The first stage of the operation is decompression - the creation of a message with the oral cavity according to the cystotomy type. However, unlike the cystotomy method, the canal is made of a smaller diameter, which in this case will be sufficient for outflow from the cyst cavity for a long time. The second stage is a standard cystectomy. Between stages, a time period of about 12-18 months is maintained.
Maxillary osteotomy
An operation on the jaw is performed in this case if one of the following indications is available:
- too small or, conversely, intensely developed jaw;
- the upper jaw protrudes forward;
- There is an open type of bite.
The doctor cuts the oral mucosa just above the transitional folds, pushes the edges of the cut, and cuts the front wall of the jaw. After separation of the previously sawn fragment, the doctor fixes the new position of the jaw and fastens it with titanium plates. Usually, surgery on the upper jaw is prescribed as one of the stages in a complex orthodontic treatment.
Lower jaw osteotomy
Intervention is recommended for severe deformity of the lower jaw and significant malocclusion. In some cases, doctors splint between the jaws to fix them. There is only one minus in such manipulation after surgery on the jaw - the inability to fully open the mouth and the need for about two weeks to eat exclusively liquid food.
The technique is generally similar to osteotomy of the upper jaw. The surgeon cuts the periosteum and mucous membrane, thereby gaining direct access to the jaw. Then, cuts are made in previously designated places, extra bone fragments are separated, the jaw is set in a new position and fastened with titanium plates. If necessary, the doctor may additionally prescribe in combination with an osteotomy and plastic surgery on the jaw.
Postoperative period
After an osteotomy, the patient is required to be held in a hospital for three days. Complications can extend this period up to 10 days. Doctors will only judge the final success of an operation six months after it has been completed.
On the first day, doctors will fix the jaw with a pressure bandage and remove it after 24 hours. During rehabilitation, the patient will be prescribed antibiotics to avoid infectious diseases. In this case, special elastic gum will be placed between the teeth for better fastening of the jaws. Postoperative sutures are removed after 14 days, and fastening screws - only after three months.
Over the course of one month, swelling of the tissues will continue, and a violation of the sensitivity of the chin will be present for four months from the day of surgery on the jaw. These symptoms are not complications and in the course of recovery will begin to gradually disappear.
At the moment, jaw surgery is recognized as one of the safest for patients, and the positive effects after the necessary surgery are very noticeable both in terms of life comfort and aesthetically.