Most bites can be corrected with braces or aligners alone. But for a smaller number of people, the issue isn’t just where the teeth sit — it’s the size and position of the jaws themselves. In those cases, the best, most stable result sometimes comes from combining orthodontics with jaw surgery. As a consultant orthodontist who plans these cases regularly, let me explain what’s involved, calmly and clearly, because it’s far less daunting than it first sounds.
What is orthognathic surgery?
Orthognathic surgery is a procedure to reposition the jaws. The medical term for the underlying issue is dentofacial deformity — which sounds alarming, but simply means the upper and lower jaw sizes don’t match up as they should. When the mismatch is significant, no amount of moving the teeth alone will fully resolve how they meet, because the foundations they sit on are out of proportion. Surgery brings the jaws into the right relationship, and orthodontics positions the teeth perfectly within them.
Who might need it
Jaw surgery is only considered for specific situations, such as:
- A noticeable difference in the size or position of the upper and lower jaws.
- Very deep bites or other discrepancies that braces alone can’t fully correct, particularly once growth is complete.
- Cases where a stable, healthy, long-lasting bite simply can’t be achieved by moving teeth on their own.
For many of these patients — especially if they’re caught young — growth can be guided to reduce or avoid the need for surgery later. But where growth has finished and the discrepancy is significant, surgery may be the route to the best result.
How braces and surgery work together
People are often surprised by the division of labour. The surgeon’s part — the operation itself — might take a few hours. My part, as the orthodontist, often spans around two years of careful work around it: positioning the teeth precisely before surgery so they’ll fit together correctly afterwards, and then finishing the bite once the jaws are in their new position. It’s very much a planned, staged journey, with regular appointments to set everything up. You’re guided through it the whole way.
The consultant difference
This kind of treatment sits firmly in consultant territory. There are only a small number of consultant orthodontists in the country, and we’re trained specifically to manage the most complex cases — and to work hand-in-hand with the maxillofacial surgeons who perform the operation. I plan these cases jointly with the surgeon I work alongside, both within the NHS hospital service and privately in practice. That close teamwork is what gives patients a safe, coordinated, well-planned result.
A bonus benefit: airway, snoring and sleep
There’s an aspect of jaw surgery that surprises many people: its effect on breathing. Bringing the upper and lower jaws forward can open up the airway — which is why jaw surgery is sometimes part of the treatment for <strong>obstructive sleep apnoea</strong>, the condition where people repeatedly stop breathing and wake through the night because their airway closes.
This is an area I have a particular interest in; my own Master’s research was in obstructive sleep apnoea. Depending on the case, it can be managed with splints or, where appropriate, with jaw surgery to advance the jaws and improve the airway. It means that for some patients, correcting the bite and improving their sleep and breathing can go hand in hand.
Private and NHS pathways
Because my colleagues and I work in both the hospital service and private practice, we can advise on the right pathway for you. Complex cases are very much our day-to-day work in the hospital, so we understand exactly which problems can be treated with braces, which can be camouflaged, and which genuinely need surgery — and we can guide you to the most appropriate route, whether that’s NHS or private.
Frequently asked questions
Is jaw surgery painful? The procedure is done under general anaesthetic, and any discomfort afterwards is managed with pain relief and settles as you heal. The bigger commitment is usually the orthodontic journey around it, which we guide you through step by step.
Can I avoid surgery if I’m treated young? Often, yes. For some bite problems, guiding growth in childhood can reduce or remove the need for surgery later — which is exactly why early assessment matters so much. (See our article on early interceptive treatment.)
How long does the whole process take? The surgery itself is a matter of hours, but the orthodontic treatment around it commonly spans around two years from start to finish.
Book a consultation
If you’ve been told your bite may need more than braces, a consultant-led assessment will give you clear, honest answers about your options. Book a consultation with our team at No 1 Orthodontics in Derby.
