When the Lower Jaw Sits Behind the Upper Jaw

The most common skeletal condition includes the patient whose lower jaw and teeth sit behind the upper jaw. It is crucial that these types of cases be diagnosed and treatment planned properly to preserve or enhance facial esthetics as well as to provide proper function of the teeth, the jaws and the jaw joints. Since growth is completed and therefore can not be manipulated, surgery is necessary in addition to orthodontic treatment.

From the beginning, the case is methodically planned by the orthodontist and a maxillofacial surgeon.

The ideal treatment in these cases typically involves braces to be applied to the upper and lower teeth, and the teeth are aligned relative to each jaw. Then, with the braces still in place, jaw surgery (orthognathic surgery) is performed by the maxillofacial surgeon. This typically involves the advancement of the lower jaw and sometimes requires simultaneous surgical modification of the upper jaw.

Most commonly, the patient is hospitalized for one or two days and the jaws are "fixated" or "wired" together for as few as two or as many as six weeks, to promote healing. Soon after the fixation is removed, Dr. Wintner can resume his treatment to provide final detailing of the bite. Dr. Wintner's goal is to complete as much tooth movement as possible prior to the surgery to maximize the surgical results. Usually the braces can be removed within three months post-surgery.

When Lower Jaws Protrudes Ahead of the Upper Jaw

While less common, this condition many times requires a surgical treatment plan that involves a surgical reduction of the lower jaw and/or the advancement of the upper jaw. As with other orthognathic surgery, the procedures are usually done within the mouth. Consequently, scarring is not a consequence. As with the opposite condition, the teeth need to be aligned with braces prior to the surgery.

Surgically Assisted Palatal
(Upper Jaw) Expansion

Frequently, the upper jaw is too narrow and needs to be widened (expanded). Expansion could allow for more space to align the teeth (thereby possibly eliminating extractions) and could provide for a better bite. Unlike a child, an overnight or outpatient surgical procedure might be necessary to enable a palatal expansion device to widen the upper jaw. The actual expansion device itself is exactly the same as the one used in child patients.

It includes a screw-like component which is turned by the patient once or twice daily (for approximately two weeks or less) to achieve the necessary expansion. When expansion is required, this procedure is typically done at the beginning of the orthodontic treatment.

Dr. Wintner published an article on this subject that was featured in The American Journal of Orthodontics and Dentofacial Orthopedics in January, 1991. The article includes a case study of a patient treated by Dr. Wintner which illustrates the importance of surgically assisted palatal expansion in the adult patient as a means to avoid multiple extractions, thereby preserving facial esthetics and lessening treatment time. The photos shown here were included in this article.

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