Surgical Orthodontics and Jaw Surgery in San Ramon, CA
Surgical orthodontics combines braces with an operation by an oral and maxillofacial surgeon to reposition one or both jaws. It is for adults whose bite problem is skeletal and large enough that moving teeth alone would only disguise it. Most patients who ask about it do not need it.
Dr. Jenée Kaplan, DDS
Orthodontic residency and a Master’s degree at Loma Linda University. Member of the American Association of Orthodontists, the American Dental Association, and the California Dental Association.
What is surgical orthodontics?
Orthodontics moves teeth within the jaws. It cannot move the jaws. When the bite problem is the position or length of a jaw rather than the position of teeth, there are two honest options: move the teeth to disguise the difference, or reposition the jaw and then align the teeth to it.
Surgical orthodontics is the second. Braces align each arch first so the teeth will fit together once the jaws are in their new relationship, an oral and maxillofacial surgeon repositions the jaw, and braces then finish the detail. It is one plan run by two clinicians, agreed before the first bracket is placed.
To be direct about the scale: this is real surgery, under general anesthetic, usually with a night or two in hospital and several weeks of soft diet and restricted activity. It is also, for the cases that need it, the only approach that produces a bite that works rather than a compromise that looks acceptable.
It is a small minority of cases. This page exists because patients deserve to know the option is real and to hear plainly whether their case is anywhere near needing it — and for most people reading this, the answer will be that it is not.
- Records come first, and they are more extensive than for routine treatment: a scan, photographs, cephalometric radiographs and usually three-dimensional imaging, because the surgical plan is measured in millimeters from them.
- Braces go on and the arches are aligned and levelled over roughly twelve to eighteen months. The teeth are deliberately positioned for where the jaws will be, which can make the bite look worse before surgery. That is expected and it is worth being warned about.
- The surgeon repositions the upper jaw, the lower jaw, or both, and fixes them with small plates and screws that stay in place. Jaws are not usually wired shut in modern practice.
- Braces stay on for roughly six to twelve months afterwards to finish the fit precisely, then come off, then retainers — indefinitely, as with any orthodontic treatment.
Who actually needs jaw surgery?
A good fit for
- An adult with a severe skeletal underbite, where the lower jaw sits well ahead of the upper or the upper jaw is markedly deficient.
- A large skeletal open bite, where the front teeth cannot be brought together because of the way the jaw grew rather than because of habit.
- A severe overjet driven by jaw position, where camouflaging it would require pushing teeth beyond what the bone can support.
- Marked facial asymmetry from unequal jaw growth, where function as well as appearance is affected.
- A patient who has been shown the measurements and understands what camouflage would and would not achieve for their specific face, and prefers the correction to the compromise.
- Some cases of sleep-disordered breathing where the jaws are the identified cause — always jointly with a sleep physician, never on an orthodontic assumption.
Not the right answer if
- Almost everyone. Most bite problems are matters of tooth position, and most skeletal differences are mild enough that braces or aligners produce a result the patient is genuinely happy with. If you are reading this because you are worried, the likeliest outcome of an examination is that surgery is not on the table.
- A growing patient. Operating before growth finishes risks the result changing afterwards, which is why these plans wait — and why an underbite found at eight is a growth-guidance case rather than this one.
- Anyone whose motivation is appearance alone and whose bite functions. That is a conversation worth having honestly, and it is not one this practice will push someone into.
- A patient who has not been shown what camouflage would achieve. Nobody should consent to jaw surgery without seeing the alternative properly presented, including its limits.
- Anyone who cannot commit to two to three years of treatment. Surgery is one day in the middle of a long process, and stopping partway leaves a bite deliberately arranged for an operation that did not happen.
What does surgical orthodontic treatment cost?
Orthodontic fees are quoted per case rather than per condition, because two people with the same diagnosis can need very different treatment. These are the factors that move the number up or down, so you know what you are being quoted on:
- The orthodontic fee covers braces before and after surgery, which is a longer course than routine treatment.
- The surgeon, anesthesia and hospital are billed separately by those providers, and they are the larger part of the total.
- Three-dimensional imaging and surgical planning.
- Medical rather than dental insurance often applies, because correcting a functional skeletal problem is frequently a medical benefit. This is worth establishing early — it changes the arithmetic substantially.
- Time away from work or school for recovery, which is a real cost even though nobody invoices for it.
Ask for the fee, the payment schedule, and your insurance benefit in writing at the consultation, before you decide anything. Any orthodontic practice should give you all three without being pressed.
How long does the whole process take?
Two to three years end to end: roughly twelve to eighteen months in braces before surgery, the operation, then six to twelve months of finishing. Retainers afterwards, indefinitely.
What moves that estimate
- How far the teeth have to be moved before the jaws can be repositioned.
- Whether one jaw or both are operated on.
- Whether growth has finished, which is confirmed rather than assumed in younger patients.
- Scheduling with the surgeon and the hospital.
- Recovery, which varies between people and is not usefully predicted in advance.
What happens, from consultation to retainer
Consultation
An examination and an honest assessment of whether this is even a question for your case. You should leave knowing which side of the line you are on.
Records and joint planning
Full records, then a plan agreed with the oral and maxillofacial surgeon before treatment starts. You meet the surgeon at this stage rather than at the end.
Braces, before surgery
Twelve to eighteen months aligning each arch for the jaws’ future position. The bite can look worse during this phase, which is expected.
Surgery
Performed by the surgeon under general anesthetic, usually with a night or two in hospital. Jaws are fixed with plates and screws and are not normally wired shut.
Early recovery
Soft diet for several weeks, restricted activity, and close review by both the surgeon and this practice. Most people are back at work or school in two to four weeks.
Braces, after surgery
Six to twelve months finishing the fit precisely, now that the jaws are in position.
Retention
Retainers, indefinitely, exactly as with any orthodontic treatment.
Surgery, or camouflage with braces?
This is the real decision, and both options are legitimate. The job of a consultation is to say honestly what each achieves for your specific face and bite, and then let you choose.
| Surgical orthodontics | Camouflage with braces | |
|---|---|---|
| What it corrects | The jaw relationship itself | Tooth position, disguising the jaw difference |
| Bite function | A normal bite | Improved; a compromise in large discrepancies |
| Facial profile | Changes, which is often the point | Largely unchanged |
| Stability | Good once healed | Risk of relapse where teeth were pushed near their limits |
| Gum risk | Low — teeth stay within their bone | Recession where teeth are moved beyond their bone |
| Total time | Two to three years | Eighteen to thirty months |
| What it involves | An operation, hospital, and weeks of recovery | Braces or aligners only |
| Suitable for | Large skeletal discrepancies in a finished skeleton | Mild to moderate discrepancies, and anyone who declines surgery |
What is recovery actually like?
- Swelling peaks in the first two or three days and is at its most dramatic when it is least dangerous. It improves steadily over two to three weeks, and the last of it takes a few months.
- Numbness of the lip and chin is expected after lower jaw surgery as the nerve recovers. It resolves over weeks to months for most people, and a small proportion keep some permanent altered sensation — that is a real risk and the surgeon will quantify it for you.
- Diet is liquid then soft for several weeks. Planning that in advance makes the first fortnight considerably easier.
- Most people are back at work or school in two to four weeks, and back to contact sport considerably later — the surgeon sets that timeline, not us.
- The emotional side is underdiscussed. Seeing your own face change, even for the better, takes adjustment, and the weeks when swelling makes it unrecognisable are hard. Knowing that in advance helps.
- You have two clinical teams and they coordinate. Anything about the surgery goes to the surgeon; anything about the teeth and the bite comes here.
Why have it done here?
- The plan is agreed jointly with the oral and maxillofacial surgeon before the first bracket goes on, rather than assembled around a referral halfway through.
- You are shown the measurements behind the recommendation, and what camouflage would achieve instead. Nobody should consent to jaw surgery without seeing the alternative properly presented.
- Most patients who ask about this are told they do not need it. That is the useful thing about being told you do.
Questions patients ask about jaw surgery
How do I know if I need jaw surgery?
From measurements, not from how your teeth look. Cephalometric and three-dimensional imaging show whether the problem is jaw position or tooth position, and how large the difference is. Most people who worry about it turn out not to need it, and you are entitled to see the numbers either way.
Can I avoid surgery and just have braces?
Often yes — camouflage is a legitimate option and many patients choose it after hearing what each approach achieves. Where the discrepancy is large, braces alone produce a straighter photograph on an uncorrected bite, sometimes with gum recession from pushing teeth past their bone. You should be shown that trade-off explicitly.
Is jaw surgery painful?
Less than most patients expect. Swelling and numbness dominate the early weeks rather than pain, which is managed and generally described as manageable. The harder parts are the liquid diet, the swelling, and the adjustment to seeing your face change.
Will my jaw be wired shut?
Not usually. Modern practice fixes the repositioned jaws with small plates and screws that stay in place, so the jaws move normally afterwards. Elastics may be used to guide the bite, but wiring the jaws shut is now uncommon.
Does insurance cover jaw surgery?
Medical insurance frequently contributes where the surgery corrects a functional problem rather than appearance alone, which is a different benefit from your orthodontic cover. Establish this early — it changes the total substantially, and pre-authorisation takes time.
How long before I look normal again?
Most swelling settles within two to three weeks and you will look like yourself within about six. The last subtle swelling takes a few months to go. Planning around a specific date months out is reasonable; planning around one three weeks out is not.
What does it correct?
Comparing options? metal braces, clear aligners.