If the abnormality of the teeth of the upper and lower teeth is so severe that it cannot be solved by orthodontic treatment alone, or if orthodontic treatment does not improve the appearance of the face, surgery to correct the shape of the jawbone may be necessary. In growing children, surgery can be avoided by performing skeletal improvement through orthodontic treatment, but surgery is required when adults need skeletal correction. Orthognathic surgery is also called surgical correction. After the orthodontist has properly positioned the teeth through orthodontic treatment, the oral and maxillofacial surgeon will perform surgery to reposition one or the upper and lower jaw bones to the correct position through the surgery.
Surgery in the jaw area is closely related to the engagement of the teeth and has a great effect on the movement of the temporomandibular joint. That’s why it must be done in close cooperation with orthodontists and oral and maxillofacial surgeons. In other words, surgery in the jaw area is not just aesthetic cosmetic surgery, but a functional surgery that takes into account numerous factors.
If the upper and lower dentition is uneven or there is an abnormality in the size or position of the lower and upper jawbone, orthognathic surgery may be necessary. If the difference in the size of the lower and upper jaw is large, it may cause problems with chewing function or pronunciation, and it may not be aesthetically pleasing.
Of course, not all of the above cases require surgery. It is necessary to undergo various tests to determine whether surgery is absolutely necessary or whether it can be improved by corrective treatment without surgery.
Diagnoses
To determine the need for orthognathic surgery, orthodontists and oral and maxillofacial surgeons work together in the diagnostic process. If you are considering surgery, it is recommended that you first consult with an orthodontist. Before starting treatment, the orthodontist will have a consultation time to talk about your curiosity and talk about the treatment process. It is very important. Also, since it is a long-term treatment, you need to be prepared. In some cases, psychiatric counseling may be an important part of the treatment process. After the consultation, the physicians acquire the necessary data for the treatment plan for correction and surgery, and conduct tests. If you are taking medication or have a chronic illness, you must tell your orthodontist or oral and maxillofacial surgeon. Based on the results of all tests, it is determined whether surgery is absolutely necessary or can be improved with orthodontic treatment alone.
In summary, the overall surgical plan for orthognathic surgery is first determined by consulting an orthodontist who performs orthodontic treatment. After that, the oral and maxillofacial surgeon in charge of the surgery will confirm the detailed surgical plan and explain it.
Indications
The orthodontist plays the role of moving the teeth so that the upper and lower sides fit well after the jawbone is corrected, and the oral surgeon plays the role of positioning the jawbone in the correct position.
The orthodontic surgery procedure is accompanied by orthodontic treatment. In general, those who undergo jaw correction surgery have their teeth adapted to the abnormal jawbone, so if the jawbone is positioned normally through surgery, the teeth may not fit well. As a result, it is not only impossible to operate to a degree sufficient to improve the appearance, but also an unwanted recurrence may occur before the jaw bone heals after surgery.
Although it varies greatly depending on the condition, those who undergo surgery usually receive corrective treatment for surgery as short as 3 months or as long as 1 year before surgery. Surgery proceeds with the orthodontic device attached, and finish correction is performed approximately 3-4 weeks after discharge. Usually after 6 to 12 months of surgery, all treatments are completed after the correction.
1. Purpose of orthodontic treatment before surgery
Orthognathic surgery, which corrects the shape of the jaw, is a process in which the teeth planted in the jaw bone move together, so corrective treatment is necessary to correct the meshing of the upper and lower teeth. Preoperative orthodontic treatment has the following goals:
- Makes jagged teeth neat.
- Move the upper and lower teeth to the correct position for each jawbone.
- After surgery, align the upper and lower teeth.
In general, the goal is to achieve a perfect fit between teeth during surgery with orthodontic treatment for more than 6 months to 1 year before surgery. However, these days, due to the development of orthodontic treatment and surgical techniques, the period of orthodontic treatment before surgery has been greatly reduced, and in some cases, orthodontic treatment may be completed in 2-4 months. If the conditions are correct, surgery can be done first.
The question of how long orthodontic treatment is needed before surgery is based on how much you have to move your teeth in order to have the best appearance and stability after surgery. If you do not interfere with the operation even if you do not have a tooth position before surgery, and if it is determined that the improved appearance will be maintained after surgery, you can perform the surgery without correction before surgery and succeed with corrective treatment after surgery.
However, in some cases, it is difficult to adjust the jaw bone to the desired position when surgery is performed without correcting the position of the teeth with corrective treatment before surgery. There is also. In this case, months of orthodontic treatment are essential before surgery.
As such, the period of orthodontic treatment differs greatly depending on the dentition and skeletal condition of each patient, so it is recommended to follow the opinion of the orthodontist who will be in charge of surgical correction to determine whether surgery is possible first or how much of the preparatory period before surgery.
The main reason for jaw surgery is improvement of appearance. The more important value of “good looks and stable results” should not be given up just for “fast” surgery.
Before and after courses of orthognathic surgery
1. Pre-operative preparation
During the period of orthodontic treatment before surgery, the orthodontist will sample the lower and upper teeth and work together to determine the progress of the treatment. Through these models, the orthodontist will soon determine that the time for surgery is near. In addition, the date of the surgery will be scheduled in consultation with the oral and maxillofacial surgeon who will be in charge of the surgery. Before surgery, the upper and lower corrective wires are replaced with very hard ones. Usually, thick straight wire made of stainless steel is used. And the patient enters the procedure to prepare for surgery. In preparation for surgery, samples are taken, photographed, and X-rays are taken as in the first treatment. Based on the data obtained in this way, the final surgical plan to obtain the best surgical results is determined. In addition, on the final model, a surgical wafer is manufactured that allows the upper and lower teeth to mesh well after surgery and provides a standard for the amount and direction of surgery.
2. Immediately after surgery
Immediately after surgery, the lips and cheeks swell a lot, but the swelling is normal and will settle down soon, so there is no need to worry. You will probably hear from an oral and maxillofacial surgeon before surgery. In the first few days, the device you used for general anesthesia can clog your nose and hurt your throat, but this is also normal and will be okay soon. The discomfort after surgery is not severe and is controlled by medicine, so you do not have to worry too much, and in most cases, it is fixed so that the upper and lower jaws do not move for quick healing. These days, the surgical jaw bone is fixed securely from the inside with a small screw, so the patient’s discomfort is greatly reduced because the upper and lower jaws are not tied for a long period of time. In this state, the lower and upper jaws are fixed so that they do not move.
3. Corrective treatment after surgery
If you feel like it, you can go to work or go to school right after you leave the hospital. The swelling will be removed in about 2 weeks, so the face will change. You will meet orthodontists and oral and maxillofacial surgeons on a regular basis, and the promise at this time is very important, so be sure to keep them. In addition, you need to pay attention to oral hygiene. Postoperative orthodontic treatment usually begins 4 to 6 weeks after surgery and takes approximately 6 months to 1 year. During this period, some pre-orthodontic treatments and surgery are used to move some teeth that cannot be completely resolved, and rubber bands are used to better engage the teeth.
Frequently Asked Questions
1. Is orthognathic surgery dangerous?
It is not dangerous if you have a formal training and an experienced oral and maxillofacial surgeon. Of course, orthognathic surgery is a general anesthesia operation, so there is no possibility of other side effects to anesthesia, but it reduces the possibility of side effects through examination in advance. Therefore, it is not enough to give up the necessary surgery because of the danger.
2. Are there any traces or scars left after orthognathic surgery?
Since it is an incision in the mouth, no scar is left on the outside of the face.
3. How can I eat food right after orthognathic surgery?
After orthognathic surgery, you can drink only the liquid type, because the upper and lower teeth are fixed with a rubber band for 2 weeks on the first day. From 2 weeks after surgery, you can usually wear rubber bands on your own, so you can eat soft foods such as steamed eggs and tofu. However, you need to rinse your mouth often to keep the food from becoming inflamed.
4. How long does it take to adjust to daily life after orthognathic surgery?
Depending on the content of orthognathic surgery, there is a lot of difference among people, so it is difficult to talk uniformly. , To eat comfortably, it takes about 4-6 weeks.
5. Is orthognathic surgery painful?
Orthognathic surgery itself is performed under general anesthesia, so no pain is felt at all. However, by the time an anesthesia awakens, there may be long-term pain and discomfort after surgery, but anyone can withstand the prescribed medicine well and follow the doctor’s instructions.
6. Is orthognathic surgery necessary? Is correction insufficient?
If it is determined that orthognathic surgery is necessary due to a problem with the size or shape of the jaw, if you attempt to solve the problem with excessive orthodontic treatment, you cannot expect to improve the shape of the jaw bones as well as undesired results.
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