SURGICAL ORTHODONTICS

When Do You Need Surgery?

Surgical orthodontics is also known as jaw surgery or orthognathic surgery. It is typically needed when the teeth do not fit together because the upper and lower jaws do not match. There is a limit, or envelope of correction for how much we can accomplish with just orthodontics. Beyond that limit, we require collaboration with an oral-maxillofacial surgeon or plastic surgeon. These surgical corrections assist the orthodontist in achieving the patient’s goals for form and function in these situations:

• Improve facial profile
• Correct a severe overbite – the mandible is too short
• Correct a severe underbite – the upper jaw is setback or lower jaw is too big
• Correct an open bite where the front teeth do not touch vertically
• Widen a narrow upper jaw
• Correct facial asymmetry
• Correct facial malformations due to cleft or other congenital defects
• Replace degenerative joints (TMJ)
• Relieve sleep apnea by realigning the jaws and teeth to open up the airway

Often, a combination of factors will be addressed by orthognathic surgery. For example, bringing the lower jaw forward will correct a severe overbite, improve the profile and improve the airway. Dr. Bentele will be able to show you examples from his vast surgical experience that match your particular problem.

THE ORTHOGNATHIC SURGERY PROCESS

This seems like a lot of steps but time wise, an orthognathic case typically takes the same or even less time than an ordinary orthodontic case.

1. Not a requirement, but the journey may start with a referral from oral- maxillofacial surgery, sleep medicine, cleft palate clinic, military healthcare or otolaryngology (ENT).
2. Evaluation by Dr. Bentele to determine if you require orthognathic surgery for medical, aesthetic or dental functional issues.
3. Orthodontic diagnostic records – X-rays, photos, comprehensive exam, 3D optical scan or physical models of the teeth
4. Dr. Bentele will formulate the surgical plan. Considerations include:
   • Presenting malocclusion and profile
   • The desired goal for the occlusion (how the teeth will fit after the surgery)
   • Whether or not teeth must be extracted to alleviate crowded or protruding teeth
   • Medical and functional issues such as chewing, speaking and breathing
   • Whether or not profile changes should be accentuated or minimized
   • Secondary aesthetic considerations such as nose and chin appearance
   • Adjunctive plastic surgery measures such as nose jobs (rhinoplasty), ear reshaping (otoplasty) and recontouring of asymmetric facial contours
   • Are there any preparatory surgeries required such as an initial maxillary expansion, closure of oronasal fistula or periodontal grafting?
5. Dr. Bentele will consult with the surgeon. The choice of surgeon may vary depending on the type of case, military connection, patient’s prior relationship with a surgeon and insurance considerations.
6. Before the orthodontic setup begins, the patient will be referred to the surgeon for an initial consultation and to discuss insurance/fee issues.
7. Orthodontic treatment to align the teeth and to position them for the best surgical fit. Often during this phase the bite will actually appear to worsen as compensations are corrected. Braces will remain on for the entire process.
8. Progress orthodontic records to simulate the surgery and to make any needed midcourse corrections.
9. When Dr. Bentele has completed the presurgical preparation, the patient will be referred back to the surgeon. A key consideration is that insurance preapproval is complete for the surgery timeframe.
10. Orthodontic surgery prep: hooks are placed on the archwires and steel tied for security. Depending on the surgeon, either impressions are done then or the surgeon will scan the teeth.
11. Virtual Surgical Planning: Dr. Bentele, the surgeon and a remote technician will accomplish the surgery virtually. A surgical splint and possibly hardware will be fabricated from this setup.
12. The surgery is accomplished. This is typically at a hospital and may or may not involve an overnight stay depending on the type of surgery and postop recovery. Rarely is the patient wired closed these days due to rigid fixation.
13. 6-week healing period. Most patients return to a regular school/work schedule after the first week but the patient will be on a soft diet and have a healing splint in place.
14. Return to orthodontics. The surgical phase is the big move but it will take approximately 4 months to detail and finish the case orthodontically.
15. Orthodontic debond and retainers.

WHY CHOOSE DR. BENTELE FOR ORTHOGNATHIC SURGERY CASES

Education and Experience. Dr. Bentele accomplished his orthodontic residency at The Ohio State University. Ohio State had an active orthognathic program under the direction of Dr. Larry Peterson. He was one of the most prominent oral-maxillofacial surgeons of the time, literally writing the predominant surgery textbook. Afterwards, Dr. Bentele spent 7 years in England and at the US Air Force Academy treating 40 to 50 surgery cases a year.

A unique attribute of a military orthodontic practice is the opportunity to accomplish a steady flow of orthognathic surgery patients. Oral- maxillofacial surgeons need to operate these types of cases regularly to hone their battlefield medicine skills. A typical orthodontic practice only rarely treats surgery cases, but this practice is unique due to our institutional associations. Dr. Bentele maintains his military connections and provides orthognathic surgery care for our soldiers at Ft Carson. These cases include facial malformations, trauma, and sleep apnea.

Joint replacement cases are treated with Brooks Army Medical Center in San Antonio. Our second institutional tie-in is with Children’s Hospital Colorado. Dr. Bentele is on the cleft palate team and is a University of Colorado Medical School faculty member in the Department of Otolaryngology. Children with a cleft palate often develop a midface retrusion which requires either orthopedic correction or orthognathic surgery. The team also treats a variety of other congenital defects that may require orthognathic surgery, for example hemifacial microsomia.