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Misalignment of your teeth with misalignment of the underlying bones may have a significant impact on your current or future jaw/facial function. Furthermore, discrepancies in the alignment of your teeth and jaws can affect your appearance and facial balance in a negative way. Naturally, every individual has a different perception on what may be acceptable from an aesthetic point of view; however, when jaw and teeth alignment are improved, improved dental and facial aesthetics generally follow.

An orthodontist (specialist in orthodontics) is able to successfully treat dental crowding and other misalignments of the teeth. However sometimes it is necessary to consider surgery to change the underlying skeletal or bony structure to provide an acceptable dental function (the ability to chew efficiently) and facial appearance. This type of surgery is termed "orthognathic surgery”. Dr. Stefanuto is a Dalhousie trained maxillofacial surgeon and is able to diagnose and treat abnormalities of the facial bones and soft tissues.

Warning Signs


Signs of a combined orthodontic and jaw alignment problem may include:

  • difficulty chewing or digesting food
  • inability to get front teeth to bite together
  • speech difficulties
  • excessive wear or loosening of teeth
  • accidental cheek biting
  • inability to get your lips together comfortably
  • a chin that appears too prominent or not prominent enough
  • excessive showing of gums above your upper teeth
  • an upper lip that appears too long or too thin
  • an asymmetric appearance to top or bottom teeth, jaws or chin
  • TMJ (jaw joint) problems

When a problem is suspected, it is appropriate for your dentist to refer you to an orthodontist and/or the maxillofacial surgeon at APEX Surgical – Centre for Oral and Facial for analysis and planning.

The Process


A thorough history and examination is always required. Photographs, radiographs ("x-rays"), sometimes CT scanning and molds of the teeth will typically be obtained to allow detailed analysis. This analysis, coordinated between the orthodontist and surgeon, will determine the treatment plan options presented to you.

If a combined orthodontic/surgical solution is right for you, the treatment sequence usually consists of orthodontic preparation ("braces") for a period of time (12-18 months), followed by the surgical procedures, and then a shorter period of orthodontic work to refine the final result.

Surgically, the lower jaw can be moved forward or backwards, and the upper jaw can be widened, moved up or down, and forward or back as needed to provide a proper relationship between the upper and lower teeth, the upper and lower jaws, and the face as a whole. The chin can also be moved forward and back, and also lengthened or shortened vertically if needed. The movements are all carefully planned out and executed with precision.

Procedures are all done from inside the mouth to avoid any visible scarring and minimize the recovery. Depending on the exact procedures done, the surgical portion may just be a short outpatient procedure (go home right afterwards), or it may require a short stay in the hospital in the more complex cases or if other medical conditions warrant.

In almost all cases some movement and function of the jaw is allowed to occur immediately following surgery, very rarely are tight elastics placed to help with the surgery. Wires are not used as they were in the past.

Recovery is variable and dependent on the procedure you have done. In all cases, appropriate medications and instructions will be provided to optimize your comfort and healing and reduce the chance of complications. Of course all surgical procedures carry with them some risks, but the rate of any serious complications for these somewhat routine procedures are extremely low.

Your surgeon will discuss any relevant risks with you, and all opportunity given for any concerns to be addressed.