Orthodontics Before and After Jaw Surgery – Book Chapter at Springer

Dr. Julia Steinmaier (née Funke), together with Dr. Werner Schupp and Dr. Julia Haubrich, has written the chapter “Orthodontic Therapy in the Context of Orthognathic Surgery” — in German, roughly “Kieferorthopädische Behandlung im Zusammenhang mit einer Kieferoperation.” It was published in 2023 in the second volume of the textbook “Fundamentals of Craniofacial Malformations” (Springer, editor: Ulrich Meyer). The book addresses malformations and misalignments of the jaw and face; the second volume is dedicated to treatment principles. Complete citation: Schupp W, Funke J, Haubrich J. Orthodontic Therapy in the Context of Orthognathic Surgery. In: Meyer U (Hrsg.), Fundamentals of Craniofacial Malformations: Vol. 2, Treatment Principles. Springer International Publishing 2023, S. 155–183, DOI 10.1007/978-3-031-28069-6_13. The book and chapter are aimed at professionals. For patients, we have summarized below how orthodontic treatment works in connection with jaw surgery. To the book at the publisher: Chapter at Springer (DOI 10.1007/978-3-031-28069-6_13)

What the chapter is about

The chapter describes the combined treatment of orthodontics and jaw surgery for jaw misalignments that cannot be corrected by tooth movement alone. The foundation is careful diagnostics: functional and esthetic analysis, model analysis, and skull measurements from lateral cephalometric radiographs or three-dimensional imaging. At the beginning of planning, a decision is made whether to perform orthodontic preparation first (“orthodontics first”) or whether surgery can be performed directly (“surgery first”); the second approach requires that the dental arches already fit together and can shorten treatment time. During preparation, the teeth are aligned so that the misalignment becomes initially more pronounced before surgery, and the dental arches fit together harmoniously afterward. Treatment and surgery are now planned digitally; the chapter shows a case that was planned using planning software (OnyxCeph3).

When orthodontics and jaw surgery come together

If the cause of a misalignment lies not only with the teeth but in the position of the jaws relative to each other — for example, a severely protruding or receding lower jaw — this often cannot be corrected in adults by tooth movement alone. Growth is complete; the jaws can no longer be guided. In such cases, a combination of orthodontic treatment and surgery can be appropriate.

Which misalignments are treated in combination

• Severely receding lower jaw: orthodontics aligns the dental arches so that they fit together after surgery; jaw surgery moves the lower jaw forward.
• Severely protruding lower jaw: orthodontics aligns the teeth within each jaw as they would stand without the misalignment; jaw surgery moves the lower jaw back, the upper jaw forward, or both jaws.
• Skeletal open bite, in which the front teeth do not meet because of the shape of the jaws: orthodontics arranges the dental arches; jaw surgery changes the inclination of the jaws, often the upper jaw, so that the bite closes.
• Facial asymmetry, for example a chin shifted to one side: orthodontics aligns the dental arches and the midlines; jaw surgery positions the jaws symmetrically. Such asymmetry can also develop after the temporomandibular joints have been involved in juvenile idiopathic arthritis; in a long-term study, the position of the lower jaw and facial symmetry improved after surgery, without temporomandibular joint function deteriorating (Krarup et al. 2025)1.

The steps at a glance

• Joint planning: orthodontics and jaw surgery use radiographs, models, or scans to determine where the teeth and jaws belong. According to one systematic review, three-dimensional planning tends to match the planned result more accurately than two-dimensional planning, although the studies are not consistent (Starch-Jensen et al. 2023)2. For pronounced jaw misalignments, we work together with a practice for oral and maxillofacial surgery.
• Orthodontics before surgery: the teeth are aligned within each jaw so that they fit together after the operation. During this phase, the bite may temporarily look less favorable than before.
• Surgery: this is carried out by the practice for oral and maxillofacial surgery, not by our practice.
• Orthodontics after surgery: fine adjustment of the bite, followed by stabilizing the result with retainers.

How long the individual phases last depends on the initial situation, as well as whether preparation is performed or surgery can be done directly. That the direct approach shortens treatment is reported by all studies in one systematic review; however, due to their quality, this is not yet considered definitively proven (Monaghan and Ward 2021)3. We will discuss a timeline for your case after joint planning.

Questions for the conversation with oral surgery

• Which procedure is planned for me: on the upper jaw, the lower jaw, or both?
• Will the operation take place in a hospital, and how long will I stay there?
• What can I eat after the operation, and when can I return to work or school?
• What risks exist with my procedure, for example numbness of the lip or chin, and how are they managed?
• What follow-up appointments are scheduled, and how do oral surgery and orthodontics coordinate?

Does insurance cover it?

For adults, statutory health insurance covers orthodontic treatment only in cases of severe jaw misalignments that require combined orthodontic and surgical treatment. We will tell you during the initial consultation whether your case qualifies. Retainers are typically a private expense. Whether you have statutory or private insurance: diagnostics, consultation, and care are the same for all patients at our practice. More under Costs & Insurance and Orthodontics for Adults.