Surgical Orthodontics — Orthognathic Treatment for Adults

Surgical orthodontics — often referred to as orthognathic treatment — combines specialist orthodontic care with jaw surgery to correct skeletal discrepancies that cannot be resolved by orthodontics alone. It is indicated when the relationship between the upper and lower jaws, or between the jaws and the rest of the facial skeleton, falls outside the range that tooth movement alone can address.

This practice has extensive experience in the orthodontic component of surgical cases — both as the treating orthodontist coordinating with surgical colleagues, and as a specialist consulted on complex multidisciplinary cases.

When Is Surgical Orthodontics Indicated?

Orthognathic treatment is considered when:

• There is a significant mismatch in the size or position of the upper and lower jaws (skeletal discrepancy)
• The bite cannot be corrected by moving teeth alone without creating an unstable or compromised result
• Significant facial asymmetry is present
• The patient has sleep-disordered breathing — including obstructive sleep apnoea — that may benefit from skeletal jaw advancement
• Orthodontic treatment is required to support, prepare for, or complete a surgical correction planned by an oral and maxillofacial surgeon

Surgical orthodontic cases are always planned and delivered collaboratively with an oral and maxillofacial (OMFS) or craniofacial surgical team.

Procedures Undertaken

Mandibular Advancement Surgery

Mandibular advancement involves surgically repositioning the lower jaw (mandible) forward. This is achieved via a bilateral sagittal split osteotomy (BSSO) — a well-established procedure in which the mandible is divided on each side and moved to the planned position, then stabilised with titanium plates and screws.

Indications include:

• Skeletal class II malocclusion (recessed lower jaw, prominent overbite)
• Lower jaw deficiency affecting facial profile and aesthetics
• Obstructive sleep apnoea, where advancement of the lower jaw significantly increases the oropharyngeal airway and reduces collapsibility of the upper airway

Mandibular advancement surgery — particularly as a component of maxillomandibular advancement (MMA) — is a highly effective intervention for sleep-disordered breathing and is increasingly used in collaboration with sleep medicine physicians for patients who cannot tolerate CPAP or where a skeletal contribution to airway compromise has been identified.

Bimaxillary Advancement Surgery

Bimaxillary advancement involves the simultaneous surgical repositioning of both the upper jaw (maxilla) and the lower jaw (mandible). This is carried out via a Le Fort I osteotomy of the upper jaw combined with a bilateral sagittal split osteotomy of the lower jaw.

Indications include:

• Significant skeletal discrepancy involving both jaws
• Cases where the aesthetic and functional goals require coordinated movement of both the upper and lower jaw
• Severe obstructive sleep apnoea where maxillomandibular advancement (MMA) is indicated — simultaneously advancing both jaws to achieve the maximum improvement in airway volume and function
• Facial skeletal asymmetry requiring movement in multiple planes of space

Bimaxillary surgery allows a high degree of three-dimensional control over the position of both jaws and the overall facial aesthetic outcome. Treatment planning — including the sequence and degree of jaw movements — is agreed collaboratively between the orthodontist, surgeon, and patient using detailed imaging, digital planning tools, and surgical simulation.

Upper Jaw Advancement or Impaction (Isolated Le Fort I Osteotomy)

Not all orthognathic cases require movement of both jaws. Where the skeletal discrepancy is confined to the upper jaw, a Le Fort I osteotomy of the maxilla alone may be performed to advance, impact, or reposition the upper jaw without altering the lower jaw surgically.

Upper jaw advancement is indicated where the maxilla is deficient in its forward position, resulting in a flat mid-face, a compromised upper lip position, or a skeletal class III appearance driven by maxillary rather than mandibular factors.

Upper jaw impaction is particularly relevant in cases with a significant anterior open bite. In these cases, the back of the upper jaw is surgically impacted (moved upward), which causes the mandible to autorotate upward and forward in a counterclockwise direction. This autorotation of the mandible is a powerful and predictable mechanism for closing an open bite and improving the facial profile — achieving correction not by moving the lower jaw surgically, but by allowing it to rotate into a more favourable position as a consequence of the upper jaw movement. This approach is often more stable than attempting to close an open bite through lower jaw surgery alone.

The direction and magnitude of upper jaw movement is planned precisely using 3D imaging and surgical simulation, and the orthodontic preparation is designed to allow the jaws to meet in their planned relationship at the time of surgery.

Surgical Facilitation for Maxillary Expansion

In adult patients with a narrow upper jaw, palatal expansion often requires a surgical component to release the resistance of the fused midpalatal suture. Surgical facilitation in this context refers to procedures that allow orthodontically or device-driven expansion of the upper jaw to proceed more predictably.

This includes surgically assisted rapid maxillary expansion — where corticotomy cuts are made around the maxilla to reduce skeletal resistance — as well as more complex procedures where expansion is combined with simultaneous Le Fort I repositioning of the maxilla.

Where expansion is part of a broader surgical orthodontic plan, it is sequenced and planned alongside other jaw movements to achieve the best overall result.

For a more detailed overview of expansion techniques used in adults, see the Palatal Expansion page.

The Surgical Orthodontic Journey

Orthognathic treatment follows a well-defined sequence, typically spanning 18 to 30 months from the start of pre-surgical orthodontics to the completion of post-surgical finishing.

Surgery-First Approach

In selected cases, a surgery-first protocol may be appropriate — where jaw surgery is performed at the outset, before any orthodontic preparation. This approach can significantly shorten the overall treatment timeline and allows patients to see the skeletal and aesthetic correction much earlier in the process. It is not suitable for all cases, as it requires careful patient selection and a high degree of precision in surgical planning. Where it is indicated, it is discussed as an option at the planning stage.

Standard Sequence

Stage 1 — Pre-surgical orthodontics
Before surgery, orthodontic treatment is carried out to align the teeth within each jaw individually and to decompress the bite. Counterintuitively, this phase may temporarily make the bite appear worse — this is intentional, as it positions the teeth to allow the jaws to be placed in their ideal skeletal relationship at surgery. This phase typically takes 12 to 18 months.

Stage 2 — Surgery
Surgery is carried out by the oral and maxillofacial surgical team under general anaesthesia. The jaws are moved to the planned positions and stabilised with plates and screws. Hospital stay is typically one to three days.

Stage 3 — Post-surgical recovery
Swelling and some dietary restriction are expected in the weeks following surgery. Most patients return to normal activity within two to four weeks, though full resolution of swelling takes several months.

Stage 4 — Post-surgical orthodontics
Once healing allows, orthodontic treatment resumes to refine the bite and achieve the final planned tooth positions. This phase typically takes three to six months.

Stage 5 — Retention
Retainers are provided on completion of treatment to maintain the result.

Multidisciplinary Collaboration

Surgical orthodontic cases are managed in close collaboration with oral and maxillofacial surgical colleagues. Where sleep-disordered breathing is a factor, sleep physicians may also be involved in treatment planning and in evaluating outcomes. Regular communication between all members of the treating team ensures the orthodontic and surgical phases are carefully coordinated.

Fees

The orthodontic component of surgical orthodontic treatment at Lusk Orthodontics starts from €7,000. This covers all orthodontic care throughout the treatment process — pre-surgical preparation, post-surgical finishing, and retention. Surgical fees, anaesthetist fees, and hospital costs are separate and are determined by the treating surgical team and the relevant hospital or clinic; these will be outlined in full at the joint planning stage. A detailed fee breakdown for the orthodontic component is provided at your consultation. Payment plan options are available.

Book a Surgical Orthodontics Consultation

If you have been referred for surgical orthodontics, or if you believe you may benefit from a combined orthodontic and surgical approach, book a consultation to discuss your case in detail.