Get It Straight!

Terry A. Giangreco, DDS, MS
J. Ronald Cortese, DDS
Janis P. Preston, DDS

750 Pittsford Victor Rd.
Pittsford, NY 14534
Ph: 585-248-5100
Fax: 585-248-8066

1213 Mayberry Place
(off Canandaigua Rd)
Macedon, NY 14502
Ph: 315-986-5800

If your jaws don’t meet together correctly and your teeth don’t seem to fit together with your jaws, you may have a skeletal orthodontic problem that makes eating difficult and can result in premature wear of teeth, gum problems and bone loss.  Your face also may not appear symmetrical and you may not be happy with the way you look.  Your jaws and teeth may have grown that way when you were a child or you may have sustained an injury.  Whatever the reason, your teeth and facial bones can be surgically repositioned to create a more balanced appearance and jaws that work well together.  The surgical treatment is performed on adults and teens after the jaws are fully developed and growth is complete.

Drs. Giangreco, Cortese and Preston use braces initially to move your teeth into the correct position on the upper and lower arches.  They are moved into the position required to fit together properly after the surgery is completed.  Your oral surgeon, specially trained in this type of corrective jaw surgery, repositions your jaws to improve the bite and create a more balanced appearance.  You will be pleasantly surprised at the difference it makes in how your face looks and feels.
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ARE YOU A CANDIDATE FOR ORTHOGNATHIC SURGERY?

• Do you have problems with chewing or biting into food?
• Do your lower teeth hit into the roof of your mouth while eating and cause discomfort?
• Do you have premature wearing of the enamel on your teeth?
• Do you like the way you look from the front?
• Do you like your profile?

Thinking about these questions may be the impetus for discussing the possibility of orthodontic treatment in conjunction with jaw surgery to improve your bite. 

FACIAL IMBALANCE
Incorrectly shaped bones are usually caused by uneven development of your jaws while growing as a child or may have been caused by an injury to the face.  You may have one or a combination of these facial imbalances.

A well-proportioned face is divided into equal thirds from (1) the hairline to the eyebrows, (2) the eyebrows to the base of the nose and (3) the base of the nose to the chin.  If your face is divided down the middle, each side should closely resemble the other.

Underdeveloped lower jaw may cause bite problems, such as not being able to bite into food.  It may also cause your chin to look receded.  A large overjet (buckteeth) may be apparent.  Surgical advancement of the lower jaw by the oral surgeon will correct the skeletal discrepancy and allow the orthodontist to realign the teeth in their proper esthetic and functional position.  At times, the chin will require forward movement also to complete the esthetic correction.

Overdeveloped upper jaw (long upper jaw) may result in a gummy smile or your teeth may not meet together in the front (openbite), making it difficult to chew food.  With an openbite, you may not be able to close your lips without straining.  If you have an underdeveloped upper jaw (small upper jaw), your upper lip may look sunken in and your upper teeth may look receded.  The repositioning of the upper jaw enables the oral surgeon to reduce or increase your smile line while bringing your teeth together to improve function and esthetics.  Orthodontics will complete tooth movement prior to and after surgery.

Uneven jaw or facial asymmetry may occur if your jaws are overdeveloped on one side or undeveloped on the other side.  Your face may appear off center, resulting in your upper or lower teeth shifting over to one side.  This can make biting and chewing awkward and encourage TMJ problems.  In addition, the bones around your eyes may also be shaped incorrectly.  Surgery on both jaws is required, by the oral surgeon, to balance the facial symmetry and eliminate the cant (slant).  Orthodontics is completed to realign teeth and improve function.

Please click here to view before and after surgical photos.

Overdeveloped lower jaw (pronounced lower jaw causing underbite) may result in chewing problems and your jaw may appear too far forward.  A good example is Jay Leno.  Your lower teeth may be in front of your upper teeth causing premature wear of the upper teeth.  The oral surgeon may opt to move the upper jaw forward or reposition the lower jaw backward.  Surgery on the lower jaw would be the opposite of an underdeveloped lower jaw.  Orthodontics will complete the correction to improve function.

Once you have made the commitment to begin orthodontic treatment in conjunction with orthognathic surgery, the process will proceed as follows:

• Orthodontic surgical records (x-rays, study models and photos) to help Drs Giangreco, Cortese and Preston decide how far your teeth should be moved prior to surgery.  Additional records will be required, as treatment progresses, to re-evaluate the position of teeth and aid the oral surgeon in determining his final treatment plan prior to surgery. 
• Placement of braces to realign your teeth on each jaw prior to surgery.  Timeline for braces prior to surgery, is 6-12 months depending upon the severity of the tooth position at the start of treatment.  During this time, you will be consulting with your oral surgeon to evaluate the progress.  Drs Giangreco, Cortese and Preston will also be conferring with your oral surgeon and discussing treatment recommendations.
• As surgery approaches, your oral surgeon will simulate your surgery on plaster casts to aid in determining the precise amount of bone movement necessary to correct the jaw discrepancy.
• When your orthodontist and oral surgeon feel your teeth have moved into the correct position, your surgery will be scheduled.  The surgical procedure is usually performed on an in-patient hospital basis and takes approximately 1-3 hours, depending upon the correction.  The average hospital stay is 1 day with healing time over a few weeks.  Many patients leave the hospital within a few hours of the surgery.  Depending upon the individual, most patients are back to school or work within 1-2 weeks with limited lifting and athletics to avoid injury to the area.
• To aid in healing, your bones are kept from moving with fixation appliances.  Your surgeon will use removable surgical rubber bands, along with dissolvable screws or plates.  A splint may also me used to temporarily secure your bite.  Follow your surgeon’s recommendations for diet and drink lots of water to prevent dehydration.

Please click here to view before and after surgical photos.

Removable rubber bands to keep the jaws from moving during the healing process.

• Your oral surgeon will continue to evaluate the healing process after surgery.  Drs Giangreco, Cortese and Preston will continue orthodontic treatment to complete final alignment and stabilization of teeth in the new jaw position.  Final orthodontic treatment timeline is approximately 6-12 months.  On average, start to finish, most surgical orthognathic cases are completed in 21-24 months. 
• Braces are removed and removable retainers are placed to maintain the integrity of the tooth position.  

As with any surgery, there are some risks and complications.  Post-surgery, you may experience some pain and swelling in your face and neck.  Most discomfort is usually gone within a few weeks.  Your surgeon will discuss these and any other risks and complications with you prior to surgery.

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