Drs. Engen & Pizzini
Call: (509) 326-4445

Surgical Orthodontics

After your orthodontic evaluation with Dr. Engen, he may have told you that you may need orthognathic surgery (jaw surgery). Jaw surgery is employed when your orthodontic problem is more skeletal and less dental in nature. The only solution to a skeletal problem is with a skeletal solution.

What do you mean by jaw surgery?
The nature of your jaw surgery will depend on the nature of your skeletal problem. Different surgical procedures exist like surgical palatal expansion, maxillary advancement, maxillary impaction, mandibular advancement and mandibular set-back.

Who does the surgery?
If a surgical option has been offered to you by Dr. Engen, he will have you evaluated by an oral surgeon. Dr. Engen and the oral surgeon will discuss your case to develop and coordinate the ideal treatment plan.

When is the surgery done?
Depending on the nature of your presenting condition, there is usually a pre-surgical phase of orthodontics, followed by the surgical phase, and the case is completed with a post-surgical phase of orthodontics to detail and finish the case.

What age is the surgery done? 
Jaw surgery is usually done once patients are skeletally mature. In females this is between 17-18 years of age. In males this is between 18-19 years of age. There are exceptions, and the specifics will be decided between you, Dr. Engen and the oral surgeon.

How does the bone heal after surgery? 
When you break a bone, such as an arm, finger, or leg, the body responds by forming a callous which is the first stage of the healing process. Most people think bone is like cement or like a rock. It is not. Bone is a living tissue which is constantly tearing itself down and building itself back up. The callous then remodels and heals into this new skeletal position making the change permanent.

This sounds extreme! 
Ten to twenty years ago this was radical treatment. Patients used to have to be hospitalized for a month, have their jaws wired shut, and the cost was $20,000-30,000. With new advances in technology patients can usually go home the same day as surgery, jaws no longer need to be wired shut, and the cost is considerably less. Today jaw surgery is no longer a radical treatment, but rather a predictable, affordable treatment modality that can be offered to more patients who need it.

Examples of Jaw Surgery

Surgical Palatal Expansion — When an upper jaw is too narrow, and the patient is skeletally mature, simply expanding the jaw with an expander will not work. The oral surgeon will make cuts in the upper jaw so that the bones can be freely moved. After the bones have been moved to their new position they will heal, making the changes permanent.

Maxillary Advancement — When an upper jaw is back relative to the lower jaw or the face, as is often seen in Class III patients, an upper jaw advancement is performed. Like surgical palatal expansion, the oral surgeon will make cuts in the upper jaw so the upper jaw can be moved bodily in a forward direction. The jaw is then fixated into this new position with bone plates and heals making the changes permanent. Maxillary advancement will also have the effect of fuller lips and fuller cheek bones.

Maxillary Impaction — When a patient has an excessive gummy smile, the only way to correct it is with a maxillary impaction, or moving the upper jaw up, thereby reducing the gummy appearance.

Mandibular Advancement — When the lower jaw is too far back, as is often seen in Class II patients, and the bones are skeletally mature, a lower jaw advancement is performed. Not only does this correct the skeletal discrepancy, it also results in a stronger soft tissue chin.

Mandibular Set-Back — When the lower jaw is too far forward, as is often seen Class III patients, and the bones are skeletally mature, a lower jaw set-back is performed. This will put the lower jaw in a more normal position and make the chin less prominent.



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  • Spokane
  • 9911 N. Nevada #110
  • Spokane, WA
  • 99218
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  • Call: (509) 326-4445