Frequently asked questions

Orthognathic surgery is the surgical treatment of certain alterations in the position, size or relationship between the maxilla and the mandible. It is mainly indicated when there is a skeletal discrepancy that cannot be adequately corrected with orthodontics alone.

It may be part of the treatment of mandibular prognathism, retrognathia, maxillary excess or deficiency, skeletal open bite, facial asymmetries and other dentofacial deformities. These alterations can affect the bite and chewing, but also facial proportions and, in certain patients, other functions.

The diagnosis must establish which part of the problem corresponds to tooth position and which to the facial skeleton. From there, treatment is planned jointly with orthodontics when indicated.

The goal is not simply to change appearance: the aim is to establish an adequate anatomical and occlusal relationship, while also seeking a balanced facial result.

Orthodontics can move teeth within their bony bases, but it does not significantly change the position of an adult jaw. For this reason, a malocclusion of predominantly dental origin can often be resolved with orthodontics alone, while a significant skeletal discrepancy may require orthognathic surgery.

The decision is based on facial and occlusal examination, photographic records, dental study and imaging tests. Factors analyzed include, among others, the relationship between the maxilla and mandible, the magnitude of the discrepancy, facial symmetry and the real possibilities of orthodontic compensation.

In some patients it is technically possible to camouflage a skeletal discrepancy through dental movements alone. However, the fact that this is possible does not necessarily mean it is the most appropriate option. The biological limits of tooth movement, stability, and functional and facial goals must all be considered.

An altered bite may originate from tooth position, from the relationship between the jaw bones, or from a combination of both components. Distinguishing between them is essential because the treatment differs.

Diagnosis begins with clinical examination of the face and occlusion. Facial proportions, symmetry, the relationship between maxilla and mandible, incisor position and the way the dental arches contact each other are studied. Photographic records, dental models or scans, and radiographic tests complete the analysis.

In a mainly dental alteration, the bony bases may have a reasonably adequate relationship, with the teeth being responsible for the malocclusion. In a dentofacial deformity, the position or dimensions of the skeleton contribute significantly to the problem.

This distinction determines whether the treatment should be orthodontic, surgical-orthodontic, or require another approach.

In orthognathic surgery it may be necessary to operate on only the maxilla, only the mandible, or both jaws. The choice depends on where the deformity is located and which movements are needed to establish an appropriate facial and occlusal relationship.

Single-jaw surgery acts on one of the jaws. Bimaxillary surgery modifies both the upper jaw and the mandible during the same procedure. This allows three-dimensional control of the relationship between both structures and may be necessary in complex discrepancies, certain asymmetries, or situations in which moving only one jaw would not achieve the intended result.

Bimaxillary surgery is not automatically a "better" option, nor is single-jaw surgery a "minor" procedure from the standpoint of indication. The extent of the surgery should respond to the diagnosis and the specific goals of each patient.

Movements of the maxilla and mandible also change the position and support of the soft tissues that cover them. As a result, orthognathic surgery can produce changes in the profile, chin projection, lip support, the paranasal region, the jawline or facial symmetry, depending on the movements performed.

These changes should not be analyzed independently from functional correction. During planning, occlusion, the skeleton and soft tissues are studied together to anticipate how each movement may affect facial balance.

The magnitude and nature of the change differ for each patient. Virtual planning can help study the planned skeletal movements, but the response of the soft tissues shows biological variability, and no simulation should be interpreted as an exact guarantee of the final result.

In many orthognathic treatments, orthodontics and surgery are part of a single therapeutic strategy. Presurgical orthodontics prepares the dental arches so that, once the jaws are surgically repositioned, the teeth can establish an adequate relationship.

This may involve eliminating dental compensations that developed over years to adapt to a skeletal discrepancy. For this reason, during certain preparation phases the bite may temporarily appear more uncoordinated.

After surgery, orthodontics allows precision adjustments in tooth position and consolidates the planned occlusion.

Different protocols exist, including surgery with reduced orthodontic preparation in selected patients. The choice depends on the deformity, the initial position of the teeth, and coordination between the maxillofacial surgeon and the orthodontist.

Planning can integrate clinical examination, photographs, radiographic studies, CBCT (cone beam computed tomography), intraoral scans and three-dimensional models. The information required depends on the procedure and the anatomical complexity of the case.

In certain surgeries it is possible to build a virtual representation of the facial skeleton and dentition. On this model, asymmetries can be studied, measurements taken, osteotomies simulated, and planned movements analyzed before entering the operating room.

In complex reconstructions, the position of bone segments, the design of certain surgical guides, or the relationship between the reconstruction and a future rehabilitation can also be planned.

These tools increase the amount and precision of available information, but they do not replace diagnosis or surgical experience. Digital planning is useful when it serves a correctly indicated clinical strategy.

Three-dimensional planning allows the anatomy to be studied in all three spatial planes and certain procedures to be simulated before they are performed. This is especially useful when there are asymmetries, combined jaw movements, bone defects or anatomically complex reconstructions.

From imaging studies and digital records, models can be generated to analyze osteotomies, displacements and relationships between different structures. In selected cases, the plan can be transferred to the operating room using splints, surgical guides or other specifically designed elements.

Its main value does not lie in turning surgery into an automatic process. It allows problems to be anticipated, alternatives to be compared, and a given plan to be transferred with greater precision.

The outcome still depends on factors such as the indication, surgical execution, individual anatomy, soft tissues, healing and the patient's biological response.

Cone beam computed tomography, known as CBCT, is an imaging technique that provides three-dimensional information about the bony structures of the maxillofacial region.

Unlike a conventional radiograph, which represents three-dimensional structures in a two-dimensional image, a CBCT allows analysis of slices and reconstructions in different planes. It can provide information on impacted teeth, available bone, anatomical relationships, the maxilla, mandible, joints and other structures, depending on the clinical indication.

It can also be used as part of certain virtual planning workflows.

Not every patient or procedure requires a CBCT. As with any radiological examination, there must be a valid indication justifying its use. The choice of imaging test depends on the diagnostic information needed and should balance clinical usefulness against radiation exposure.

Oral surgery comprises surgical procedures performed mainly on teeth, oral cavity tissues and dentoalveolar structures, such as certain complex extractions, impacted teeth, biopsies and other procedures.

Oral and maxillofacial surgery additionally covers conditions and treatments affecting the facial skeleton and structures. Its scope includes dentofacial deformities, facial trauma, maxillofacial reconstruction, jaw pathology and certain temporomandibular joint disorders, in addition to oral surgery procedures.

For the patient, the relevant distinction is essentially clinical. A complex tooth extraction, a deformity affecting the overall position of the jaws, and a mandibular reconstruction represent problems of very different nature and complexity.

The diagnosis determines what type of procedure and what level of planning are needed in each situation.

Preoperative assessment begins by determining whether there is an adequate indication for the procedure and whether the expected benefits justify its risks. The specific characteristics of the procedure and the patient are then studied.

The evaluation may include medical history, current medication, allergies, prior surgical history, physical examination, imaging tests and preoperative studies. Depending on the procedure and the patient's condition, additional assessments may be necessary.

Risks are not the same for all surgeries. Aspects that may be assessed include bleeding, infection, sensory disturbances, healing, bone stability, occlusal problems and anesthetic risks, in addition to complications specific to each procedure.

Adequate informed consent does not consist merely of signing a document: it requires understanding the indication, the reasonable alternatives, the limitations and the relevant risks of the proposed treatment.

There is no single recovery time that applies to all maxillofacial surgery. A dentoalveolar procedure, orthognathic surgery and extensive facial reconstruction have very different postoperative courses.

It is also worth distinguishing between several stages: initial recovery, reduction of swelling, tissue consolidation and a gradual return to usual activities. Patients may be functionally recovered well before the biological healing process has fully concluded.

The time required depends on the procedure performed, its extent, the patient's characteristics and postoperative progress. Diet, oral hygiene, physical activity and return to work may also require different recommendations.

For this reason, recovery times published online should be understood only as general references. A useful estimate can only be given once the specific intervention being considered and the individual clinical circumstances are known.

Reconstruction may be necessary when there is a significant loss or alteration of bone and tissue that compromises the anatomy or function of the maxilla or mandible.

The causes are varied. They may include resection of lesions or tumors, trauma, infections, severe atrophy, sequelae of previous treatments, or certain congenital defects.

The reconstructive goal depends on the problem. In some cases it is to restore bone continuity and stability; in others, to re-establish facial contour, separate cavities, provide support to the soft tissues, or create conditions for future dental rehabilitation.

Reconstructing therefore does not simply mean "filling" a defect. It is necessary to understand which structures have been lost and which functions must be restored. The more complex the defect, the more important it becomes to plan, from the outset, the final functional result to be achieved.

The reconstructive strategy depends on the location, size and three-dimensional characteristics of the defect, the soft tissue available, its cause, and the subsequent functional goals.

Smaller defects can be treated with different bone regeneration techniques or bone grafts. When the loss is extensive, more complex reconstructions may be necessary, including larger-volume grafts or transfer of vascularized tissue.

In certain segmental reconstructions, microvascular free flaps are used, capable of providing bone and tissue with their own blood supply. Virtual planning can help determine the geometry of the reconstruction and the position of the segments.

There is no universally superior technique. An appropriate reconstruction is one that responds to the specific characteristics of the defect and considers, from the beginning, the function that the reconstructed structure will need to fulfill afterward.

A bone graft is material used to augment, reconstruct or promote bone formation in an area where the available volume is insufficient for the therapeutic goal.

Depending on the situation, the patient's own bone, materials of different origin, or bone substitutes may be used, alone or in combination. Each option has different properties, indications and limitations.

In maxillofacial surgery and implantology, a graft may be necessary when bone loss prevents an implant from being placed in an adequate position, or when a particular anatomy needs to be reconstructed. However, not every bone deficiency requires the same procedure.

The decision depends on the volume that needs to be restored, the shape of the defect, the soft tissues, the stability required, and the future rehabilitation. A graft is a reconstructive tool, not an identical treatment for every bone loss.

A microvascular free flap is a portion of tissue — which may include bone, muscle, skin or other components — transferred from another region of the body to the area requiring reconstruction, while preserving its blood vessels. These vessels are connected using microsurgical techniques to recipient vessels in the reconstructed region.

This ability to provide tissue with its own blood supply is especially valuable in certain complex or large defects.

In mandibular reconstruction, for example, flaps containing bone can be used to restore lost segments of the mandible. The choice of donor tissue depends on the characteristics of the defect and the reconstructive needs.

These are highly complex procedures that require specific planning. Their indication is reserved for situations in which their reconstructive advantages justify the magnitude of the intervention.

In many cases it is possible to reconstruct the mandible after resection, although the strategy depends on the extent and location of the defect, the diagnosis, the affected tissues, and the overall oncological treatment.

When the resection results in loss of mandibular continuity, one of the goals is to re-establish a stable structure that helps restore facial contour and functions such as chewing. In extensive defects, vascularized bone from another region may be required.

Planning can begin before the resection. Virtual techniques allow, in certain cases, the anatomy to be removed to be studied and the subsequent reconstruction of the segment to be designed in advance.

The priority remains appropriate treatment of the disease. Reconstruction must be integrated into that plan and must consider, from the outset, the functional needs, the soft tissues and the possibilities for subsequent rehabilitation.

In certain patients, dental rehabilitation can indeed be considered after a maxillary or mandibular reconstruction, but the possibilities depend on the reconstructed anatomy, the type and quality of the bone, the soft tissues, previous treatments and the patient's general condition.

Rehabilitation may include conventional prostheses, implant-supported solutions, or other alternatives. When implants are considered, their ideal position should, whenever possible, be taken into account from the earliest stages of reconstructive planning.

This concept is important because restoring bone continuity and restoring it in a position adequate to later support teeth are not exactly the same objective.

Complex cases require coordination between reconstructive surgery and oral rehabilitation. The final result should be assessed not only in terms of anatomical restoration, but also in terms of the function that can reasonably be recovered.

A lack of bone does not automatically rule out implant-based rehabilitation, but it requires precise study of the available anatomy and the cause of the bone loss.

Knowing the height or width of the bone is not enough. Bone quality, soft tissues, nearby anatomical structures, the three-dimensional position required by the future prosthesis, and the loads it will need to bear must also be considered.

Depending on the defect, techniques such as bone regeneration, grafts, maxillary sinus lift or other reconstructive procedures may be considered. In severe atrophy, the problem may require a more complex approach.

The goal should not be to place an implant simply wherever bone still remains. Planning starts from the rehabilitation the patient needs and determines which anatomical conditions are required to achieve it predictably.

A graft may be considered when the volume or configuration of the existing bone does not allow an implant to be placed in a position adequate for future rehabilitation, or does not provide the conditions necessary for its stability.

The need depends on the defect. A narrow horizontal loss, a vertical deficiency, posterior resorption of the maxilla, or a localized defect around a missing tooth pose different problems and may require different techniques.

In some cases, bone reconstruction and implant placement can be performed simultaneously. In others, it is preferable to reconstruct first and allow healing before placing the implants.

For this reason, the relevant question is not only how much bone exists, but where it is located, what anatomy needs to be restored, and in what final position the dental rehabilitation needs to be placed.

Guided bone regeneration is a technique used to promote bone formation in certain defects. It is usually based on creating and protecting a space using a membrane, combined with graft materials depending on the characteristics of the case.

The membrane helps maintain favorable conditions for the regeneration process to occur, preventing early invasion of certain tissues into the area intended for reconstruction.

Different materials, membranes and surgical designs exist. The choice depends on the size and shape of the defect, the stability of the regenerated area, soft tissue closure, and the subsequent goal.

Not all bone defects can be predictably treated with the same technique. As the complexity or extent of the bone loss increases, other reconstructive procedures may become necessary.

The maxillary sinus is a cavity located in the upper jaw, close to the premolar and molar region. After losing posterior teeth, the bone available between the oral cavity and the sinus can decrease, both due to resorption of the ridge and due to the anatomical characteristics of this region.

Sinus lift is a technique intended to create conditions for increasing bone volume in certain posterior sectors of the maxilla. Different approaches exist, and the choice depends, among other factors, on the residual bone and the amount of augmentation needed.

In some cases the implants can be placed simultaneously; in others, reconstruction is performed first and implant placement follows later.

Its indication must be established after studying the anatomy through appropriate tests. Not every loss of posterior teeth requires a sinus lift, and alternative treatments may exist depending on the case.

There is no single waiting period applicable to all reconstructions. The timing depends on the technique used, the size of the defect, the graft material, the stability achieved, the anatomical region and the progression of healing.

In certain situations implants can be placed simultaneously with the reconstruction. In others, a staged protocol is used to allow the reconstructed area to mature before implant placement.

In addition, elapsed time is not the only criterion for deciding when to proceed. Clinical progress must be assessed and, when indicated, the condition of the area must be verified through imaging studies.

For this reason, timelines should be considered part of an individual therapeutic sequence. Attempting to shorten them without considering the biology of the reconstruction may compromise the very objective being pursued.

Implantology can range from the relatively simple replacement of a single tooth to rehabilitations in patients with severe bone loss, anatomical alterations, trauma, or sequelae of previous surgeries. In these latter cases, the problem is no longer simply where to place an implant.

It may be necessary to reconstruct bone, modify soft tissues, assess anatomical structures, and establish a surgical sequence that eventually leads to a functional rehabilitation.

Three-dimensional planning can help relate the desired position of the future teeth to the existing bone and determine what reconstruction would be needed to achieve it.

This approach reverses the usual reasoning: instead of starting from the residual bone to decide where implants can fit, it starts from the prosthetic and functional result to be achieved and plans backward to determine the surgical needs.