Some bite problems begin in the bone rather than the teeth, and no amount of wire tension can move a jaw once it has finished growing. When the upper and lower jaws sit out of balance, you may struggle to chew, notice a front bite that never closes, or feel unhappy with your profile, even after years of careful orthodontic work.
At McCullum Orthodontics in Jeffersonville, Indiana, Dr. Heather McCullum provides a full range of orthodontic services for patients of all ages, including multidisciplinary care that brings surgery into the plan when braces cannot reach the cause of a bite problem. We take time to find what is driving your concerns, so you can choose a path with clear information.
When Braces Cannot Correct the Problem
Traditional braces and clear aligners are very good at straightening teeth and improving how they meet. They reach a limit when the cause of a bite problem is the size or position of the jaws, because teeth can only travel so far through the surrounding bone. That is why a bite can look straight and still feel wrong.
A 2024 review in PubMed Central explains that surgery and orthodontic treatment are combined for patients with severe dental and skeletal deformities. The same review describes surgery as an option once growth has stopped and growth modification or camouflage can no longer correct the bite.
Signs Your Jaws May Need More Than Braces
Only a full evaluation can confirm what is behind a bite problem, but a few patterns may point to a jaw discrepancy.
- Difficulty chewing: food may be hard to bite into or break down, even when teeth look straight.
- Open bite: the front teeth may not touch when the back teeth come together.
- Jaw asymmetry: the chin or jaw may sit off center, or one side of the face may look different from the other.
- Profile concerns: a recessed or prominent jaw may affect facial balance and how you feel about your smile.
Each of these signs deserves a closer look, and jaw position can also affect the airway, which is one reason airway-focused orthodontics shapes how we evaluate patients. Jaw joint discomfort has many causes, and surgery may not resolve it, so we assess jaw joint concerns separately as part of TMD diagnosis and treatment.
What Surgical Orthodontic Treatment May Look Like
Surgical orthodontics is a team effort between an orthodontist and an oral and maxillofacial surgeon, and it traditionally unfolds in three stages. Each stage has a clear purpose, and knowing the order may help the process feel less overwhelming.
Orthodontic Preparation Before Surgery
Braces come first. Their job is to line up the teeth within each jaw so the upper and lower teeth fit together properly once the jaws are repositioned. Your bite and smile may look different for a while during this stage, which is a temporary part of the plan.
The Surgical Phase
The surgeon repositions the upper jaw, the lower jaw, or both, depending on your diagnosis. Careful planning between your orthodontist and surgeon helps guide how far each jaw needs to move. Because this phase involves the jaws themselves, the plan is built around your diagnosis and your goals.
Finishing With Braces and Retainers
After surgery, a shorter period of orthodontic treatment fine-tunes your bite. Retainers then help protect the result. Total treatment can extend up to about 36 months in some cases, so we encourage you to ask about timing early.
Who May Be a Good Candidate
Surgery is often considered when a skeletal discrepancy is too severe for orthodontics alone, or when growth has ended, and growth modification is no longer possible. In some cases, orthodontic camouflage may be an alternative, which is why a complete evaluation matters before any decision is made.
Younger patients may have more options. Early evaluation lets us follow jaw growth over time, and dentofacial orthopedics, including growth modification with a facemask or Herbst appliance, is designed to guide growth in children and teens.
Contact McCullum Orthodontics About Surgical Orthodontics
You deserve a team that explains each step. Dr. McCullum graduated as Valedictorian from the University of Louisville School of Dentistry, earning her degree summa cum laude, and received the American Association of Orthodontists Award. She brings 15 years of orthodontic experience to our doctor-owned Jeffersonville practice, and our financing options may help make treatment more manageable.
If braces have not given you the bite or profile you hoped for, we are ready to look at your options with you. Reach out through our contact form to schedule a free consultation.
