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FAQ:  Underbite

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Underbite - Surgery instead of braces? I'm 19 years old and I have an underbite.

All of my friends say that I have a beautiful smile but I don't feel that way because of my underbite, which I think is pretty bad.

I went to my dentist and he said that I would have to have braces and then have surgery. Since I'm 19 I really don't want to get braces but I'm fine with having the surgery done to realign my jaw.

Is there anyway that I can just get the surgery done without the braces? I know my teeth aren't 100% straight but I really don't want to get braces. ...Visitor from OH

I know your main concern is to correct your underbite, and you understand that surgery is needed: you just would like to do it without having to wear braces. So lets talk about this situation and let me help you understand the importance of having braces along with surgery to correct your underbite.

As an orthodontist our main objective is to achieve a beautiful, healthy smile for you. This is achieved by perfectly aligning the teeth in each jaw bone and having each jaw bone perfectly aligned with the face.

You stated that you had an underbite, and without proper records to make a definitive diagnosis, it is hard to determine if the problem is in the upper or lower jaw or a combination of both.

Teeth have a mind of their own and no matter how the jaws are positioned in your face, teeth are always trying their best to fit together so we can eat. However, when the jaws are misaligned, as yours are, so are the positions of your teeth.

We as orthodontists refer to this as your teeth are "compensated" to your present jaw position. So it is imperative that a presurgical phase of orthodontics is performed to remove these compensation using braces prior to surgery.

We refer to this as decompensating the teeth prior to surgery or, for you, "your bite is going to look worse before it gets better".

The main reason for aligning the teeth prior to surgery is to help the surgeon perfectly align the jaws during surgery. How does he/she do that with your teeth?

Well.. let's think of your teeth as a car key. If the key is not made perfectly the car will not start. Likewise an oral surgeon will use your perfectly positioned teeth as a key to maximize the alignment of your jaws during surgery.

Without presurgical orthodontics the surgeon will never be able to properly align the jaws, which can adversely affect your facial esthetics. Would you build a home on a poor foundation? The foundation, in this example, is your teeth in each jaw bone.

To give you even a better understanding of how important it is to align your teeth with braces prior to surgery you need to understand that surgery is going to drastically improve your facial balance and profile.

The presurgical phase could range anywhere from 6 - 18 months depending on the severity of your present bite. The surgical phase today is done with rigid fixation, which means you are not wired together for ten weeks and your surgical movements are quite stable.

With proper diagnosis and excellent treatment mechanics during the presurgical phase your post-surgicial phase could be limited to about 4-6 months. There are many options for braces while you are going through treatment.

There are the metal traditional braces, ceramic, clear and the newer lingual braces which are invisible. I feel for surgical cases, InVisalign is a poor choice, unless the alignment of teeth are near ideal.

The most important aspect of this whole process is to find an experienced orthodontist and oral maxillofacial surgeon who are well trained in surgical orthodontics and enjoy what they do.

Editorial Staff

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