BM7
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Many people in the lookmaxing community assume that braces before a bimaxillary orthognathic surgery are only for cosmetic tooth alignment. In reality, their main purpose is to decompensate the teeth so the surgeon can correctly reposition the jaws.
When someone has a skeletal discrepancy (such as mandibular retrusion, maxillary protrusion, or an asymmetry), the teeth naturally compensate over the years. The upper incisors may lean backward, the lower incisors may lean forward, and other teeth may tip to create the best bite possible despite the underlying jaw problem. This compensation can make the face appear functional even though the jaws themselves are in the wrong position.
Before orthognathic surgery, the orthodontist intentionally removes these dental compensations. At first, this often makes the bite look worse and can even make the facial profile appear less attractive temporarily. However, this is a necessary step because it exposes the true skeletal relationship between the maxilla and the mandible.
Once the teeth are properly decompensated and aligned over their respective jaw bones, the surgeon can move both jaws into their ideal skeletal positions. This allows for a stable Class I occlusion, better facial balance, improved airway function, healthier temporomandibular joint mechanics, and greater long-term stability.
Skipping the decompensation phase forces the surgeon to compromise. The jaws may not be advanced or repositioned as much as needed because the compensated teeth would no longer fit together after surgery. In other words, compensated teeth limit the amount of skeletal correction that can be achieved.
Think of it this way: orthognathic surgery moves the bones, while orthodontics prepares the teeth so they match the new bone positions. If the teeth are not prepared first, the surgeon cannot fully correct the skeletal deformity.
This is why experienced orthognathic teams almost always recommend presurgical orthodontic decompensation. Although it may temporarily worsen the bite or facial appearance, it maximizes both the aesthetic and functional outcome of bimaxillary surgery and provides the most stable long-term result.
Large bimaxillary movements may look impressive from the outside, but without proper presurgical orthodontic planning and dental decompensation, they often result in a posterior open bite. We've seen a recent example of this.
This is one of the most fundamental principles of orthognathic surgery. Orthodontics is not just about straightening the teeth, it decompensates them so the jaws can be repositioned correctly while maintaining a stable, functional occlusion. Without this step, even an aesthetically pleasing skeletal movement can end up with an unstable bite and compromised long-term results.
When someone has a skeletal discrepancy (such as mandibular retrusion, maxillary protrusion, or an asymmetry), the teeth naturally compensate over the years. The upper incisors may lean backward, the lower incisors may lean forward, and other teeth may tip to create the best bite possible despite the underlying jaw problem. This compensation can make the face appear functional even though the jaws themselves are in the wrong position.
Before orthognathic surgery, the orthodontist intentionally removes these dental compensations. At first, this often makes the bite look worse and can even make the facial profile appear less attractive temporarily. However, this is a necessary step because it exposes the true skeletal relationship between the maxilla and the mandible.
Once the teeth are properly decompensated and aligned over their respective jaw bones, the surgeon can move both jaws into their ideal skeletal positions. This allows for a stable Class I occlusion, better facial balance, improved airway function, healthier temporomandibular joint mechanics, and greater long-term stability.
Skipping the decompensation phase forces the surgeon to compromise. The jaws may not be advanced or repositioned as much as needed because the compensated teeth would no longer fit together after surgery. In other words, compensated teeth limit the amount of skeletal correction that can be achieved.
Think of it this way: orthognathic surgery moves the bones, while orthodontics prepares the teeth so they match the new bone positions. If the teeth are not prepared first, the surgeon cannot fully correct the skeletal deformity.
This is why experienced orthognathic teams almost always recommend presurgical orthodontic decompensation. Although it may temporarily worsen the bite or facial appearance, it maximizes both the aesthetic and functional outcome of bimaxillary surgery and provides the most stable long-term result.
Large bimaxillary movements may look impressive from the outside, but without proper presurgical orthodontic planning and dental decompensation, they often result in a posterior open bite. We've seen a recent example of this.
This is one of the most fundamental principles of orthognathic surgery. Orthodontics is not just about straightening the teeth, it decompensates them so the jaws can be repositioned correctly while maintaining a stable, functional occlusion. Without this step, even an aesthetically pleasing skeletal movement can end up with an unstable bite and compromised long-term results.
