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Orthognathic Surgery (Jaw Surgery) in Bangkok

Orthognathic surgery (jaw surgery) is the procedure to reposition the maxilla, mandible, or chin is the mainstay treatment for patients who are too old for growth modification and for dentofacial conditions that are too severe for either surgical or orthodontic camouflage.

Today’s orthognathic surgical treatment for dentofacial deformity consists of standard orthognathic procedures to correct jaw deformity, as well as adjunctive procedures to improve hard and soft tissue contours. These adjunctive procedures include an osseous versus alloplastic genioplasty, and suction lipectomy of the neck (plastic).

Orthognathic Surgery Techniques with Orthodontics

Surgery First Approach for Jaw Correction

Surgery first is another treatment paradigm for the correction of dentomaxillofacial deformities. Introduction of the surgery-first (SF) approach to orthognathic surgical protocols has changed the treatment and management of patients with dentofacial skeletal deformities by eliminates the presurgical orthodontic treatment phase and thus allows for immediate skeletal and soft tissue imbalance resolution, followed by orthodontic tooth movement reduce the length of orthodontic treatment.

Surgery First mainly has 2 phases

1. Pre-surgical orthodontic phase
2. Surgery phase
3.  Post-surgical orthodontic phase (ortho)

Conventional Orthognathic Surgery Approach

Conventional Approach has 3 phases

1. Presurgical ortho (Orthodontic first) : The goal of this treatment is the removal of dental compensation to reveal the true extent of skeletal deformity by orthodontic treatment . Teeth will be moved into the new position that has the corrected relationship with jaw. Treatment time for this phase is around 16-24 months for alter the teeth position before sending patient to have orthognathic surgery.
2. Surgery phase (Jaw surgery)
3. Postsurgical orthodontic phase : After surgery, orthodontist will refine the teeth detail again around 6 months.

In this technique, there  are some limitations such as long duration  of the treatment and worsening of patients  profile during pre-surgical orthodontics which  decrease patient’s compliance.

Comparison: Surgery First vs. Conventional Approach

1. Surgery First reduce the total treatment time around 6-12 months. Moreover, teeth can be moved faster than the conventional approach.
2. Surgery First : Facial profile improve immediately after surgery
3. Patient can choose the surgery date anytime for surgery first while in conventional approach, patient has to wait orthodontist to move teeth in first phase.
4. The most difficulty in Surgery first approach is to predict the final teeth position after finishing treatment combing the facial profile. This difficult part need experience orthodontist. Otherwise, the case can’t be finished.

If you require Jaw surgery in Bangkok, Thailand, or have questions regarding Orthognathic Surgery, contact Global Dental Complex today.

Orthognathic Surgery (Surgery First): Jaw Surgery Before Orthodontic Treatment

Orthognathic surgery is a corrective jaw surgery used to improve the relationship between the upper jaw, lower jaw, teeth, and facial structure. Traditionally, patients usually wear braces for a period of time before jaw surgery. However, in selected cases, Orthognathic Surgery (Surgery First) may allow the jaw surgery to be performed before full orthodontic preparation.

Orthognathic Surgery (Surgery First), also known as the surgery-first approach, is a treatment concept where corrective jaw surgery is performed early in the treatment process, followed by orthodontic treatment to refine the bite and align the teeth afterward. This approach may shorten the overall treatment time for suitable patients and provide earlier improvement in facial profile and jaw position.

However, surgery-first treatment is not suitable for everyone. It requires careful diagnosis, precise planning, stable surgical positioning, and close coordination between the orthodontist and oral and maxillofacial surgeon. The decision must be based on jaw structure, bite condition, tooth alignment, facial balance, and long-term stability.

What Is Orthognathic Surgery (Surgery First)?

Orthognathic Surgery (Surgery First) is a corrective jaw surgery approach in which the jaw is surgically repositioned before completing orthodontic tooth alignment. After surgery, braces or clear aligners are used to fine-tune the bite and complete tooth movement.

In traditional orthognathic treatment, patients usually go through pre-surgical orthodontics first. This phase may take months or longer because the orthodontist prepares the teeth so the jaws can fit together after surgery. With the surgery-first approach, the jaw correction happens earlier, and orthodontic treatment continues after the jaw has been repositioned.

The main idea is to correct the skeletal problem first, then use orthodontics to refine the dental details afterward. This can be beneficial for patients who are suitable for this approach, especially when the tooth alignment does not require long pre-surgical preparation.

How Is Surgery-First Orthognathic Treatment Different from Traditional Jaw Surgery?

Traditional orthognathic treatment usually follows this sequence: braces first, jaw surgery second, and finishing orthodontics afterward. The pre-surgical orthodontic phase helps align the teeth relative to each jaw before the surgeon moves the jawbones into the planned position.

In Orthognathic Surgery (Surgery First), the sequence is different. The surgery is performed at the beginning of treatment or after only minimal orthodontic preparation. After surgery, orthodontic treatment is used to adjust the bite, align the teeth, and finalize the occlusion.

The surgery-first approach may offer earlier facial improvement and may reduce the period where the bite looks worse during pre-surgical orthodontics. However, it also requires more precise planning because the surgeon and orthodontist must predict how the teeth will move after surgery.

Who May Be Suitable for Orthognathic Surgery (Surgery First)?

Orthognathic Surgery (Surgery First) may be suitable for selected patients with jaw discrepancies who do not need extensive dental decompensation before surgery. Suitability depends on the relationship between teeth, jaws, and facial structure.

You may be a potential candidate if you have:

• Jaw imbalance that affects facial profile or bite
• Lower jaw protrusion or underbite
• Upper jaw deficiency or retrusion
• Facial asymmetry related to jaw position
• Open bite or bite disharmony in selected cases
• Relatively mild to moderate dental crowding
• Tooth alignment that allows stable surgical positioning
• Good periodontal health
• Realistic expectations about surgery and orthodontic finishing

Patients with severe crowding, complex tooth compensation, unstable bite, untreated gum disease, poor oral hygiene, or complicated orthodontic needs may not be ideal candidates for surgery-first treatment. In those cases, traditional orthodontics-before-surgery may provide a safer and more predictable result.

Problems That Orthognathic Surgery Can Address

Orthognathic surgery is used to correct skeletal jaw problems that cannot be fully corrected with orthodontics alone. The surgery-first method may be considered for some of these problems when the case is suitable.

Underbite

An underbite may occur when the lower jaw sits too far forward, the upper jaw is too far back, or both. This can affect chewing, speech, tooth wear, and facial balance. Orthognathic Surgery (Surgery First) may help correct the jaw relationship earlier in selected underbite cases.

Overbite or Lower Jaw Deficiency

Some patients have a lower jaw that is positioned too far back. This can affect the facial profile, chin position, lip support, and bite. Jaw surgery may reposition the lower jaw to improve function and facial harmony.

Facial Asymmetry

Facial asymmetry may occur when one side of the jaw grows differently from the other. Orthognathic surgery can help reposition the jaws to improve symmetry, although complete facial symmetry is not always possible.

Open Bite

An open bite occurs when the front teeth do not meet when biting. This may affect chewing, speech, and tooth wear. Surgery may be needed when the open bite is caused mainly by jaw structure rather than tooth position alone.

Jaw Relationship Problems

Some patients have a mismatch between the upper and lower jaws that affects both bite and facial appearance. Orthognathic surgery can help create a more balanced jaw relationship when orthodontics alone is not enough.

Benefits of Orthognathic Surgery (Surgery First)

1. Earlier Facial Improvement

One of the main benefits of Orthognathic Surgery (Surgery First) is that facial profile and jaw position may improve earlier in the treatment process. This can be meaningful for patients whose main concern is facial imbalance or jaw appearance.

2. May Reduce Overall Treatment Time

In selected cases, the surgery-first approach may reduce the total time needed for treatment because the long pre-surgical orthodontic phase is shortened or avoided. However, treatment time still depends on orthodontic complexity and healing response.

3. Avoids Long Pre-Surgical Bite Worsening

In traditional treatment, pre-surgical orthodontics may temporarily make the bite look or feel worse as the teeth are decompensated before surgery. Surgery-first treatment may reduce this period for suitable patients.

4. Improved Motivation During Orthodontic Finishing

Because patients see facial improvement earlier, some feel more motivated to continue post-surgical orthodontic treatment and complete the process properly.

5. Functional and Aesthetic Correction

The goal of orthognathic surgery is not only to improve appearance. It also aims to improve jaw relationship, bite function, chewing, speech, and long-term oral stability where possible.

Limitations of the Surgery-First Approach

Although Orthognathic Surgery (Surgery First) can be beneficial, it has important limitations. The approach is technique-sensitive and requires careful case selection.

Limitations may include:

• Not suitable for every jaw or bite problem
• Requires highly coordinated orthodontic and surgical planning
• Post-surgical orthodontics is still necessary
• Bite may feel unstable immediately after surgery
• More difficult if teeth are severely crowded or compensated
• May not be ideal for patients with poor oral hygiene or gum disease
• Requires good patient cooperation after surgery
• Facial and bite results still depend on healing and orthodontic finishing

The fastest approach is not always the best approach. The priority should be a stable, functional, and natural-looking result.

The Treatment Process for Orthognathic Surgery (Surgery First)

1. Comprehensive Consultation

The first step is a detailed evaluation by an orthodontist and oral and maxillofacial surgeon. The team will review your bite, jaw relationship, facial proportions, tooth alignment, medical history, and treatment goals.

2. Digital Records and Imaging

Records may include facial photographs, intraoral photos, dental scans, X-rays, cephalometric analysis, and 3D imaging. These records help the team understand the jaw structure and plan the surgical movements accurately.

3. Case Selection

The team determines whether a surgery-first approach is suitable or whether traditional orthodontics-before-surgery would be more predictable. This decision is based on the severity of tooth compensation, crowding, bite stability, and skeletal discrepancy.

4. Virtual Surgical Planning

Digital planning may be used to simulate jaw movement and guide surgical positioning. This helps the team plan how the jaws should be moved and how the bite will be managed after surgery.

5. Minimal Orthodontic Preparation, If Needed

Some surgery-first cases may still need short orthodontic preparation before surgery. This may include placing braces, removing interfering teeth, or preparing the dental arches enough to support surgical planning.

6. Jaw Surgery

The surgeon repositions the upper jaw, lower jaw, chin, or a combination of these depending on the treatment plan. The jawbones are stabilized using plates and screws. The exact procedure depends on the patient’s diagnosis.

7. Recovery and Healing

After surgery, the patient enters a healing period. Swelling, bruising, limited mouth opening, numbness, and dietary restrictions are common during recovery. The dental team will provide detailed aftercare instructions.

8. Post-Surgical Orthodontic Treatment

After surgery, orthodontic treatment continues to align the teeth and refine the bite. This stage is essential for achieving a stable final result. Skipping or delaying post-surgical orthodontics can compromise the outcome.

9. Retention and Long-Term Follow-Up

After orthodontic finishing, retainers are used to help maintain tooth position. Follow-up visits are important to monitor bite stability, jaw healing, and long-term function.

Is Orthodontic Treatment Still Needed After Surgery?

Yes. Even with Orthognathic Surgery (Surgery First), orthodontic treatment is still needed after surgery. The surgery corrects the jaw position, but the teeth must still be aligned and adjusted so the bite fits properly.

Post-surgical orthodontics is a key part of treatment. It helps refine tooth contacts, improve bite function, close spaces, coordinate the dental arches, and stabilize the final result.

How Long Does Surgery-First Treatment Take?

The total treatment time varies depending on the severity of the jaw problem, tooth alignment, healing response, and orthodontic finishing needs. Surgery-first treatment may shorten overall treatment time in selected cases, but it does not eliminate the need for orthodontics.

Some patients may complete treatment faster than with the traditional approach, while others may still require a long finishing phase. Your orthodontist and surgeon can give a more realistic timeline after diagnosis and planning.

Is Orthognathic Surgery Painful?

Orthognathic surgery is performed under general anesthesia, so patients do not feel pain during surgery. After the procedure, swelling, soreness, bruising, tightness, numbness, and limited jaw movement are common.

Pain is usually managed with medication and aftercare instructions. Recovery varies depending on the type of surgery, number of jaws involved, individual healing, and patient health.

Recovery After Orthognathic Surgery

Recovery after jaw surgery requires patience and careful care. Patients usually need a soft or liquid diet during the early healing period. Swelling often peaks in the first few days and gradually improves over time.

General recovery instructions may include:

• Follow a soft or liquid diet as instructed
• Take medication exactly as prescribed
• Maintain oral hygiene carefully
• Avoid heavy exercise during early recovery
• Use cold or warm compresses as recommended
• Avoid smoking and alcohol during healing
• Attend all surgical and orthodontic follow-up visits
• Report fever, severe pain, breathing difficulty, or unusual symptoms promptly

Complete recovery and final facial refinement can take months as swelling resolves and the bite is adjusted.

Orthognathic Surgery (Surgery First) vs. Conventional Orthognathic Surgery

Conventional orthognathic treatment usually starts with months of orthodontics before surgery. This is ideal for many patients because the teeth can be positioned properly before the jaws are moved.

Orthognathic Surgery (Surgery First) performs the jaw surgery earlier, followed by orthodontic finishing. It may be helpful in selected cases where the dental alignment allows stable surgical movement without long preparation.

The choice between the two approaches depends on diagnosis, tooth compensation, jaw discrepancy, bite stability, and treatment goals. A careful comparison should be made before choosing the treatment sequence.

Can Surgery-First Treatment Improve the Face Quickly?

In many suitable cases, facial profile improvement is visible earlier because the jaw position is corrected at the beginning of treatment. However, swelling after surgery can temporarily affect facial appearance, and the final result takes time to settle.

It is also important to remember that facial improvement must be balanced with bite stability. A good surgical result should support both appearance and function.

Risks and Possible Complications

Like any surgery, Orthognathic Surgery (Surgery First) has risks. These may include swelling, bleeding, infection, numbness, relapse, bite instability, jaw joint discomfort, unfavorable healing, need for additional orthodontic treatment, or need for revision surgery in rare cases.

Specific risks depend on the type of jaw surgery, patient anatomy, medical history, surgical complexity, and post-operative care. Your surgeon should explain the risks that apply to your case before treatment.

Who May Not Be Suitable for Surgery-First Orthognathic Surgery?

Some patients may be better suited for traditional orthodontic preparation before surgery. Surgery-first treatment may not be recommended if there is severe dental crowding, significant tooth compensation, unstable bite, untreated gum disease, poor oral hygiene, or complex orthodontic movements that must be completed before surgery.

It may also be unsuitable for patients who cannot commit to post-surgical orthodontics and follow-up care. The surgery-first approach requires cooperation throughout the entire treatment process.

Questions to Ask Before Surgery-First Orthognathic Treatment

Before choosing Orthognathic Surgery (Surgery First), useful questions include:

• Am I a suitable candidate for surgery-first treatment?
• Would traditional orthodontics-before-surgery be more predictable?
• Which jaw needs surgery?
• Do I need upper jaw, lower jaw, chin, or two-jaw surgery?
• How long will post-surgical orthodontics take?
• What are the risks in my case?
• How will my bite be stabilized after surgery?
• Will my facial appearance change significantly?
• What is the expected recovery time?
• What happens if my bite does not settle as planned?

Conclusion: Surgery-First Jaw Correction Requires Careful Case Selection

Orthognathic Surgery (Surgery First) is an advanced treatment approach that corrects jaw position before completing orthodontic tooth alignment. For suitable patients, it may provide earlier facial improvement, reduce the period of pre-surgical orthodontics, and potentially shorten the overall treatment timeline.

However, this approach is not appropriate for every case. The best results depend on accurate diagnosis, digital planning, precise surgery, orthodontic coordination, and patient commitment to post-surgical treatment. A careful consultation with an orthodontist and oral and maxillofacial surgeon is essential before deciding whether surgery-first treatment is the right option.

If you have an underbite, jaw imbalance, facial asymmetry, open bite, or jaw relationship problem, a professional evaluation can help determine whether Orthognathic Surgery (Surgery First) or a conventional jaw surgery approach is more suitable for your needs.

Frequently Asked Questions About Orthognathic Surgery (Surgery First)

What is Orthognathic Surgery (Surgery First)?

Orthognathic Surgery (Surgery First) is a jaw surgery approach where corrective jaw surgery is performed before completing orthodontic treatment. Braces or aligners are then used after surgery to refine the bite.

Is surgery-first orthognathic treatment suitable for everyone?

No. It is suitable only for selected patients. Case selection depends on jaw structure, tooth alignment, bite stability, crowding, gum health, and the complexity of orthodontic movements needed.

Will I still need braces after surgery?

Yes. Post-surgical orthodontic treatment is still needed to align the teeth, refine the bite, and stabilize the final result.

Is surgery-first treatment faster than traditional jaw surgery?

It may reduce overall treatment time in suitable cases, but not always. The total timeline depends on the complexity of the bite, healing, and post-surgical orthodontic finishing.

What are the benefits of surgery-first jaw surgery?

Potential benefits include earlier facial improvement, shorter or no pre-surgical orthodontic phase, reduced time with a temporarily worsened bite, and improved patient motivation during finishing treatment.

What are the risks of Orthognathic Surgery (Surgery First)?

Risks may include swelling, infection, numbness, bite instability, relapse, jaw joint discomfort, healing problems, or the need for additional treatment. Your surgeon will explain case-specific risks.

How do I know if I am a candidate?

You need a detailed evaluation by an orthodontist and oral and maxillofacial surgeon. Records such as photos, scans, X-rays, and bite analysis are used to determine whether surgery-first treatment is suitable.