Often I am surprised that people don’t realize that orthodontic treatment can in many cases prevent surgery. This is the start of a series of blogs that touch on topics discussed in my recently published book, “The Orthodontic Cure”. It was actually a best seller on Amazon the first week of its release! I will also be adding some new material to the content already found in the book.

One of the most amazing feats that orthodontics is able to accomplish is that it can change skeletal structure without surgery. And surprisingly, orthodontics can prevent orthognathic surgery.

A Personal Story

I needed surgery when I was in dental school to bring my profile and smile within normal limits for an esthetic appearance.  I had a gummy smile and no chin.  My teeth were almost perfect, but my skeletal structure was off.

When I was thirteen, my mother took me to a general dentist because she saw that my growth pattern was off.  The general dentist said that my bite was perfect and that nothing needed to be done about the growth pattern.

So years later, I ended up in dental school and needed orthognathic surgery to make my profile and smile more cosmetically appealing.  It was a brutal procedure.

How We Prevented Surgery for My Son

My oldest son Brandon was born in 1986.  I was watching his growth pattern very carefully because I did not want him to have to suffer through a surgery like mine.   As nature would have it, genetics played a big factor and Brandon ended up with a gummy smile and no chin just like me.

What could I do to prevent Brandon from having orthognathic surgery?   It was back in 1996, so we used an approach that was common at the time. We used braces and a high pull j-hook headgear.  The headgear attached to his upper anterior teeth.  He wore the headgear every night and the results were amazing.  We changed his skeletal structure through orthodontics.

How?  The headgear actually caused the upper anterior skeletal structure to intrude and the gummy smile was reduced.  When the upper anterior skeletal structure was intruded; the lower jaw rotated forward which provided a chin.

orthodontic treatment before

Brandon’s before facial photos


orthodontic treatment after

Brandon’s final facial photos

What would the alternative have been if he had had orthognathic surgery?  It would have resulted in a hospital procedure that required his upper palate to be broken.  The surgeon would have removed bone from the upper palate, intruded the palate, and then secured the palate back into place with screws and ligature.  The full recovery time for this procedure can be almost a year.  The patient is usually in ICU for a day or two.  Then the patient has their mouth wired shut for two to four weeks. This necessitates a liquid diet followed by a soft diet for many weeks.

Major Advances in Today’s Orthodontics Approach

The orthodontics approach today (even compared to 1996) would be so much easier.  We would not use headgear.  We would use small screws (temporary anchorage devices or TADs) in the anterior palate and place them so that they are not visible. This would replace headgear.   We would then tie in the upper teeth to the TAD’s to intrude the anterior palate and reduce the gummy smile.

The moral of our personal story?  Brandon never had surgery and he looks great!

In future blogs we will be discussing other cases where surgery was prevented. And if you have any questions or comments in the meantime, please email me at ­­­­­­­­[email protected].