Orthodontic surgery
Abnormal occlusion surgery / dysgnathia surgery
Orthodontic surgery, which is also known as dysgnathia surgery or abnormal occlusion surgery, is carried out to correct abnormal occlusions. They are usually caused by a congenital malformation. A broken jawbone that has healed in the wrong position or a remodelling process carried out in the mandibular joint area can also cause this problem. This includes impaired chewing function, premature teeth wear, damaged periodontal apparatus, speech impairments or chronic pain caused by the premature jawbone joint wear. In addition to these functional problems major jaw displacements also result in the occurrence of aesthetic affects, which lead directly to immense physiological stress during adolescence.
An orthodontic surgery procedure carried out during childhood is frequently sufficient to correct the problem. In the case of abnormal occlusions (dysgnathias), where the problem cannot be orthodontically stabilised or it can only be treated as a compromise from a functional or an aesthetic viewpoint, then combined orthodontic surgery should be undertaken in close co-operation between orthodontists, oral surgeons and dental surgeons, if required as well. The optimum time for treating this problem lies in the period from being a young adult to when growth has finished. Successful treatment later on in life is also possible and sensible.
It can affect both the upper jaw as well as the lower jaw. Abnormal occlusions come in three dimensions: The sagittal malposition (mandibular protrusion or overbite), vertical malposition (open bite & closed bite), transversal malposition (crossbite & scissor bite) or even asymmetrical alignment of the jaws to one another or to the rest of the craniofacial structure. Malpositions are frequently combined. If the jaw continues to grow wrongly over a long period, then unwanted teeth movement and tilting will compensate for this problem and this needs urgent orthodontic treatment. It might be necessary to correct jaw malpositioning with dentures or implants in exceptional cases.
The cost of the surgical treatment is normally paid by your social health care scheme. Additional private services might also be needed as part of the surgical planning, but these will be discussed with you before the treatment starts.
The course of treatment
The initial examination with us at the orthodontic surgery will take place after you have been referred to us by your own orthodontic surgeon and you will also be given your treatment documents such as x-ray films or a jaw model to give to us. After a clinical examination has been concluded, we will tell you about the possible course of treatment available to you together with all of the necessary treatment stages and this will also include any alternative treatment options. We will discuss the next stages with your orthodontist afterwards. The treatment plan that we have drawn up plan will be documented and we will send both you and your orthodontist a copy of the plan.
We will make sufficient time free for this initial examination. Please mention when you arrange the appointment over the phone, that this will be your initial consultation appointment for orthodontic surgery. You can make your appointment at any one of our three practices.
Your orthodontist will normally start the orthodontic treatment by fitting an orthodontic brace. Towards the end of this phase of the treatment (about three months before the planned date of the operation) you will be sent to us, with current jaw models whenever possible, for follow-up checks and for the date of the operation to be confirmed and we will also arrange other planning dates during this appointment.
Approximately two weeks before the date of the planned operation we will hold a detailed session (we call this the “Set-up”) in which we will make an impression of your jaw and make other diagnostic examinations such as taking conventional x-rays or conducting a three dimensional radiology examination (CBCT).
An individual treatment plan based on these examinations will be drawn up for you. We will simulate a model operation of the surgical procedures and define them afterwards.
Your operation will be carried out in the DIAKO hospital in Bremen. The surgery will be carried out under a general anaesthetic and small incisions will be made solely in the oral cavity. The model operation simulation will correspond to moving the upper jaw, the lower jaw or both jaws if necessary into the correct position(s) in a single operation and fitting small titanium plates to stabilise the jaw(s). In the case of an extreme abnormality, it might be necessary to fit special devices (distractors) to the jaw, which cannot be seen from the outside and they will slowly and gently elongate the jaw.
Jaws are no longer wired up after an operation these days and feeding or drainage tubes are no longer used, nevertheless, you will have to go on a soft food diet for the next six weeks. The length of time that you have to stay in the hospital will depend on your progress and it is normally between five to seven days.
After being released from the hospital the healing process will be monitored in outpatient post-surgery appointments at a practice of your choice.
The small metal plates that were fitted during the corrective operation will be removed about 12 months after the surgery.
A final examination will be made about two years after the jaw relocation operation and we will check the success of the long-term treatment and discuss the result that has been achieved with you.
Orthodontic surgery (dysgnathia surgery) has become the main focal point of our activities in our joint surgery practice with regard to hospitalise patients and our sphere of influence now extends far beyond the borders of Bremen. Our renowned O & M surgeon Henning Gropp, who has a wealth of experience gained over many years and has carried out more than 1,600 successful dysgnathia operations since completing his special training in the USA, bears overall responsibility for the operations. More than 150 patients have been fitted with upper and lower jaw distractors since the introduction of one of the first intraoral lower jaw distractors in 1994. He uses intraoral distractor devices that are fitted through the oral cavity and cannot be seen from the outside and they lie along the jawbones.
