What are the implications if I undergo braces treatment without jaw surgery, even though the latter has been recommended to me to fix a misaligned jaw? (photo)

Thank you for your question. You may be interested in this article that I had written previously about on jaw surgery in Singapore.

Braces treatment is only able to correct the teeth position while jaw surgery corrects the bone/skeletal discrepancy. Many patients that I see do present with a combination of teeth malposition as well as jaw malposition. While it is my responsibility to explain all the various treatment options, I understand that not everyone accepts jaw surgery due to its invasive nature. Hence you have asked the right question on what are the implications should you choose an option without jaw surgery.

As jaw surgery aims to correct the bony problem, not going ahead with it may mean that:

1. Your dentist/orthodontist will have to move the teeth to fit the current jaw position. This may sometimes mean the teeth are not positioned in the most ideal inclination, in some situations may cause the teeth to have lesser bony support.
2. There will be no facial change, often a large skeletal discrepancy will be visible from the facial structures e.g a long lower jaw or an occlusal cant where the upper jaw is slanted. Hence not correcting the jaw will mean that there will not be any improvement in the facial structures which may or may not be desirable to some patients.
3. Accepting a less than ideal occlusion may sometimes be needed. Sometimes if the bony discrepancy is too large, your dentist or orthodontist may not be able to camouflage the teeth position and may have to accept a less than ideal bite. However, this may not always result in a functional deficit as long as there are enough contacts between the teeth.

Not everyone is looking for a perfect occlusion, and some of my patients are satisfied with just better teeth alignment and can accept the limitations. It is best to discuss the various treatment options with your dentist/orthodontist and choose the treatment plan that best addresses your concerns.

Hope this helps your decision making and all the very best,

Dr Priscilla Lu

Jaw surgery (orthognathic surgery) is intended to correct skeletal issues that cannot be fixed with braces alone. These include:

1) Correction of upper/lower or both jaw size proportion

Some patients may have a size mismatch between the upper and lower jaws, leading to protruding upper front teeth or underbites. Crossbites, especially those occurring on both sides of the jaw may have a skeletal component.

2) Correction of skeletal canting (slanting)

Canted jaws cannot be completely fixed with braces alone. Especially those in the lower jaw that also cause slanting of the jawline and chin.

3) Vertical maxillary excess

Excessive vertical growth of the upper jawbone (maxilla) can cause the appearance of a gummy smile or maxillary protrusion. Camouflage is normally done with gum surgery (gingivectomy or crown lengthening) but if the bony excess is severe, camouflage results are usually unsatisfactory.

Braces alone with the usage of additional appliances like temporary anchorage devices (TADs) can be used to help the braces to mask certain issues like canting.

If the jaw size proportion is not surgically corrected, then other camouflaging methods such as extractions may be required. These methods cannot completely fix issues such as a weak/receding chin.