What Is Orthognathic Surgery?
Orthognathic surgery — often called “jaw surgery” — is a surgical procedure that repositions the upper jaw (maxilla), lower jaw (mandible), or both, to correct significant discrepancies in how the jaws fit together. The word comes from the Greek “orthos” (straight) and “gnathos” (jaw).
Braces and orthodontic treatment alone can move teeth, but they cannot move the jawbones themselves. When the upper and lower jaws are misaligned enough, or grown to significantly different sizes, teeth cannot be positioned into a correct, stable, and functional bite using orthodontics alone. Orthognathic surgery corrects the underlying skeletal problem so the jaws — and the bite — can be brought into proper alignment.
The result is a combination of functional improvement (a bite that works properly for chewing, speaking, and breathing) and a more balanced, proportional facial appearance.
What Cases Are Ideal for Orthognathic Surgery?
Orthognathic surgery is reserved for cases where the problem is skeletal, not just dental — meaning the jawbones themselves, not just the teeth, are out of proportion or out of position. Common examples include:
Skeletal Class II (overbite/retrognathia)
The lower jaw is significantly smaller or set back relative to the upper jaw.
Skeletal Class III (underbite/prognathism)
The lower jaw is significantly larger or positioned forward relative to the upper jaw, or the upper jaw is underdeveloped.
Open bite
The upper and lower front teeth don't touch when the back teeth are closed together, often due to vertical jaw growth discrepancies.
Facial asymmetry
One side of the jaw has grown differently than the other, creating a noticeable shift in the chin or bite.
Severe crossbite
The upper jaw is too narrow relative to the lower jaw across multiple teeth.
Obstructive sleep apnea
In select cases, jaw position contributes to airway obstruction, and moving the jaws forward can meaningfully improve breathing.
Jaw problems from trauma, birth defects, or prior surgery
Including cleft lip and palate or other conditions affecting jaw growth.
Who Is a Candidate?
Good candidates for orthognathic surgery generally share the following characteristics:
Jaw growth is complete
Surgery is typically performed after facial growth has finished — usually around age 15–16 for females and 17–18 for males, though this varies by individual and is confirmed with growth records or imaging.
Commitment to the process
Because treatment involves both orthodontics and surgery, the patient needs to be prepared for a multi-step, multi-year process, including consistent orthodontic appointments.
Good general health
The patient is healthy enough to safely undergo surgery and general anesthesia.
Realistic expectations
The patient understands the process, timeline, and outcomes.
The problem is skeletal, not purely dental
The discrepancy is significant enough that moving teeth alone cannot resolve it.
Patients are typically referred for a jaw surgery evaluation by their orthodontist or dentist after a thorough exam, photographs, X-rays (including a panoramic and cephalometric radiograph), and often a 3D CT scan to evaluate the jaws precisely.
How Many Specialties Are Involved?
Orthognathic treatment is a team effort. Depending on the complexity of the case, the following specialists may be involved:
Orthodontist
Aligns the teeth before and after surgery so they fit together properly once the jaws are repositioned. This is the specialist patients typically work with most often.
Speech-language pathologist
Involved when jaw position affects speech, particularly in cleft or airway-related cases.
General/restorative dentist
Monitors overall dental health throughout treatment and manages any restorative needs.
Psychologist or counselor (occasionally)
May be involved for patients needing additional support adjusting to facial changes or the demands of a long treatment process.
Oral and maxillofacial surgeon
Performs the jaw surgery itself.
Oral and maxillofacial radiologist
May assist in interpreting advanced imaging for surgical planning.
Sleep medicine physician
Involved when surgery is being considered to treat obstructive sleep apnea.
Anesthesiologist
Manages anesthesia during the surgical procedure, typically performed in a hospital or surgical center.
In most routine cases, the core team is the orthodontist and the oral and maxillofacial surgeon, working closely together from the initial consultation through the final result.
How Long Does Treatment Take?
Orthognathic treatment is a marathon, not a sprint. While every case is different, a typical timeline looks like this:
Pre-Surgical Orthodontics (about 12–18 months)
Braces are placed first to align and level the teeth within each jaw and remove the natural compensations the teeth have made for the underlying skeletal problem. This can temporarily make the bite look worse, which is expected — it means the teeth are being unmasked from their compensations in preparation for the jaws to be corrected surgically.
Surgery (the procedure itself and initial recovery)
The surgery is typically performed in a hospital or outpatient surgical center under general anesthesia. Depending on which jaw(s) are involved, the operation itself generally takes 2–5 hours. Patients usually stay in the hospital for 1–2 nights and take about 2–4 weeks off work or school for initial healing, though full bone healing takes closer to 6–12 weeks, and complete recovery and adaptation can continue for several months.
Post-Surgical Orthodontics (about 6–12 months)
After the jaws have healed sufficiently, braces are used to fine-tune the bite, close any remaining spaces, and settle the teeth into their final, precise position.
Total Treatment Time
From the first day of braces to the final removal, most patients are in active treatment for approximately 18 months to 3 years. Retainers are worn afterward, as with any orthodontic treatment, to maintain the result long-term.
What Happens If a Patient Declines Orthognathic Surgery?
Surgery is always the patient's choice, and there are viable paths forward for patients who decide not to proceed with it. Declining surgery generally means one of the following:
Accepting a compromised bite
Orthodontic treatment can align the teeth as well as possible within the limits of the existing jaw relationship, but the bite, chewing function, and facial profile will not be fully corrected. This is sometimes called “orthodontic camouflage.”
Choosing to stop or forgo orthodontic treatment altogether
Some patients decide to leave the bite as-is, particularly if the discrepancy is not causing significant functional problems.
Ongoing risk of relapse or strain
Without correcting the underlying skeletal discrepancy, camouflaged results can be less stable over time and may place extra stress on the teeth, jaw joints (TMJ), and supporting gum and bone tissue.
It's important for patients to understand that camouflage treatment is a real, valid, and commonly chosen option — it is simply a different set of trade-offs than surgery, and the right choice depends on the severity of the discrepancy, the patient's goals, and their overall health and life circumstances.
Alternative Treatment Options
For patients who decline jaw surgery, orthodontic camouflage aims to create the best possible bite and appearance by moving teeth alone to compensate for the jaw discrepancy, rather than correcting the jaws themselves. Depending on the severity of the case, this can include:
Extraction of permanent (adult) teeth
Removing one or more adult teeth — commonly premolars — creates space to retract or reposition the remaining teeth, helping to compensate for a jaw discrepancy and improve how the front teeth meet.
Interproximal reduction (IPR)
Small amounts of enamel are removed between teeth to create space for alignment without extraction.
Strategic tooth movement (dental compensation)
Teeth are tipped or moved beyond their “normal” position within the bone to disguise the jaw discrepancy as much as possible.
Restorative or cosmetic dentistry
Bonding, veneers, or crowns can sometimes be used afterward to refine tooth shape and improve appearance further.
Temporary anchorage devices (TADs)
Small temporary bone screws can help move teeth more precisely, expanding what's possible without surgery in select cases.