Braces / Jaw Surgery

When people have crooked or crowded teeth, or when their bite does not align properly, braces can usually fix the problem, and the orthodontist can align the teeth and bite without any surgery. There are more difficult cases, though, that cannot be properly corrected with braces alone. When these more difficult cases are treated with braces exclusively and no surgery is done, the final bite and appearance is not only significantly less than ideal, but also is prone to relapse towards the original appearance, and is at high risk for a variety of dental problems in later years.

Clearly, then, a certain number of orthodontic cases require surgical assistance. The most common of these surgeries is removal of wisdom teeth. Frequently, orthodontists need the wisdom teeth removed before placing the braces, so that the wisdom teeth do not hinder the movement of the other teeth. In other cases, the orthodontist desires removal of the wisdom teeth as soon as possible, after the braces come off. Lastly, there are cases in which the wisdom teeth slowly begin to hinder the orthodontic progress. In these cases, the wisdom teeth are removed while the braces are still on.

The second most common surgery that is performed, in conjunction with orthodontic treatment, is for impacted “eye teeth”, or canines. These cases are referred to, in lay terms, as “eye teeth being stuck in the roof of the mouth”. Although the teeth that are “stuck” are not always “eye teeth”, and are not always in the “roof of the mouth”, or even in the upper jaw, the lay term does describe the most frequent situation. It is fairly common for teeth that are very important to the bite and smile to be stalled in their progress of coming into the mouth. When this happens, the tooth is termed to be impacted, and it then needs surgical and orthodontic assistance to be brought properly into the bite. The surgery involves opening the gums and affixing a gold chain to the impacted tooth. After a brief period of healing, the orthodontist then applies forces to the chain, so as to drag the tooth into the proper location in the bite and smile.

A newer surgical procedure, that is combined with braces, is offering solutions to previously difficult orthodontic problems. It is possible to place small metal implants into strategic areas of the jaw bone. These implants are called T.A.D.’s (temporary anchorage devices). After a brief healing period, the T.A.D.’s are used as anchors, off of which orthodontic forces are applied. These forces can now move teeth in directions that we previously impossible. This is very effective for previously difficult cases, such as the orthodontic adult.

All the surgeons at Associates in Oral Surgery and Dental Implants work closely with many orthodontists in the area. The surgeons are well aware that close communication between the doctors involved in treating the patient is essential for an optimal, final result. Whether the surgery is a minor tooth removal or a more major realignment case, it is our mission to ensure that every aspect of the patient’s case is thoroughly understood between the two specialists prior to the actual surgery.

In addition to straightening the teeth and establishing a stable, proper bite, surgically-assisted repositioning of the teeth and jawbones creates positive changes to the appearance of the face and profile. The common types of bite problems that are treated by this combination of braces and surgery are called, in lay terms, “severe under bite, severe overbite, receded jaw, gummy smile, proud chin, and open bite”.

T.A.D.’s are very effective for certain cases that were previously difficult to treat, such as the adult who wants braces to align the front teeth, but has already lost all of his or her molars. With no molars, the orthodontist is missing the strongest, natural anchors available for leverage. In the past, missing molars frequently meant that the other teeth could not be straightened. With these T.A.D.’s, placed in the missing molar locations, the orthodontist regains the major anchors needed to align the front teeth. Additionally, there are a host of other orthodontic tooth movements that were previously considered nearly impossible to perform and which are now being performed with relative ease, thanks to T.A.D.’s.

In other cases, that cannot, or should not, be treated with braces alone, surgery is necessary. Sometimes the desired tooth movements can be obtained when assisted by surgery performed in the office. This office-based surgery is intended to avoid major, jaw-repositioning surgery, and its required hospitalization. The surgery consists of placing multiple and / or large metal T.A.D.’s, consisting of orthodontic wires and elastics, into the jawbone(s).

In some adults, or otherwise more difficult cases, the teeth and jawbones are too solid to be moved, with just braces and T.A.D.’s alone. In these cases, the jawbone is reconfigured around the teeth into single tooth segments. Those segments are moved, as noted above. In addition to obtaining the proper positions, avoiding major jaw surgery, and avoiding hospitalization, this technique drastically reduces the length of time the patient must wear braces. Sometimes this technique is used exclusively to decrease the length of time in braces.

In the most sever and difficult cases, major jaw-repositioning surgery is the only reasonable treatment plan. The specialties of orthodontics and oral and maxillofacial surgery are trying to decrease the number of extreme personal and financial burden on patients needing to undertake these procedures through early diagnosis, advanced technology, and emerging surgical techniques.

Our Office

Our office is conveniently located one block west of Rangeline on 29th Street. We are on the second floor of the Wells Fargo Building next to Oasis Day Spa.
  • Address:   2819 E. 29th St. Suite 2 Joplin, MO
  • Phone:      (417) 623-2000
  • Fax:          (417) 623-7948
  • Hours:      Open Monday-Friday 8am to 5pm