In medical terminology, dysgnathia signifies different kinds of congenital or acquired misalignments of the teeth, jaws and/or masticatory system. These abnormalities may involve the tooth position, the number of teeth, the position of the jaws relative to one another or how the jaws fit with the facial skeleton and can result in both esthetic and functional impairment. Our health and well-being can be greatly impaired by these changes and may have an adverse effect on the complex interaction of all parts of the head and neck. Physiological functions such as chewing, biting, swallowing and speaking can be impaired. Tooth and jaw misalignment can also cause pain symptoms such as headaches and temporomandibular joint problems. Correct jaw relationship also plays an important part in facial appearance. The teeth and jaws may be incorrectly positioned in all three spatial dimensions. These errors may also be present in combination creating a complex misalignment. Successful treatment aims to achieve a normal dental occlusion. Whether this can be achieved purely by orthodontic methods or requires the assistance of surgery depends on the severity of the dysgnathia. Each tooth can be moved and tilted in the jaw only to a limited degree. Apart from normal occlusion, the position of the jaws in all three dimensions plays a crucial part in esthetic appearance. The position of the upper incisor and canine teeth is critical: the facial esthetics factor is a decisive parameter when planning surgery. Following an initial consultation with the orthodontist, who will diagnose the dysgnathia and inform you about the different possible treatments, the next consultation in our practice clinic is with the interdisciplinary team. Plaster models and X-rays are required for precise counseling.
Operation planning (OGM Münster)
The most appropriate surgical treatment is determined during the consultation. With the aid of our consultant’s report, the orthodontist draws up a plan of treatment and costs, which is submitted to the health insurer for approval. To clarify whether the costs will be met by the statutory health insurance, the plan of treatment and costs must be submitted to the respective health insurance company. Private patients are advised to obtain a guarantee of payment from their insurance company before starting treatment. For special planning procedures, the costs must be partially borne by the patient. As a rule, treatment takes place in three stages: preoperative orthodontic treatment, model operation and operation, and postoperative orthodontic treatment.
When the dental arches have been corrected by the orthodontist, planning the operation can start. Simulation is performed two weeks before the operation. Using impressions, X-rays and photos, a computer-assisted model of the planned operation is made to establish the exact new position of your jaws. Precise operation planning is possible preoperatively with 3D digital volume tomography so that operative risks can be minimized and best outcomes achieved. You will find further information in OGM.
In the main operating theatre, the jaw defects are corrected in the sagittal and vertical plane. In the first six weeks after surgery, you will be reviewed weekly by us or the orthodontist. In this period an occlusal splint is usually worn with loose elastics. The operation is performed under general anesthesia and is therefore completely painless and stress-free for the patient. The necessary mucosal incisions are made in the soft tissues surrounding the teeth. They are therefore made inside the mouth so there will be no visible scars. The jaw bone (upper jaw, lower jaw, chin) is then divided according to a standard procedure and brought into the position previously decided by the 3D analysis and model operation. In this position the jaw(s) is fixed to the surrounding bony structures with small titanium plates. If the bone has to be moved through a very great distance, we perform what is known as distraction, or gradual movement. The patient is not wired after the operation but the lower jaw is guided to the upper jaw with elastics fixed to the brackets. Because of this patients can open their mouths a little immediately after the operation. Speaking is also possible immediately afterwards but eating may be impaired for a short time. Hospitalization in the Raphaelsklinik is for about 3-6 days depending on the type of operation and how you feel. Subsequent follow-up is in our practice clinic and with your orthodontist.
Postoperative orthodontic treatment
Postoperative orthodontic treatment is used for fine adjustment of the teeth to achieve perfect occlusion. The titanium plates are removed after 6 months at the earliest but they can be removed up to 2 years after the main operation. The metal is removed under general anesthesia as an ambulant procedure in our practice clinic.