Surgical Orthodontics for Teens and Adults in Decatur, GA
Medically reviewed by Dr. Noam Green, DMD and Dr. Lauren Gordon, DMD | Last updated October 2026
Surgical orthodontics is one of the most consequential decisions in orthodontic care. It combines orthodontic tooth movement with surgical repositioning of the jaw bones, and it opens up what is possible when teeth and skeleton do not fit the way a patient wants them to. At Green Orthodontics in Decatur, GA, I spend as much time helping patients decide whether surgery is the right choice for them as I do planning the orthodontic work that goes with it. I do not want to tell people they need surgery simply because they have a skeletal discrepancy. I want them to understand what is possible with and without surgery, and I want the decision to be theirs.
What Is Surgical Orthodontics?
Surgical orthodontics combines orthodontic tooth movement with surgical repositioning of the upper jaw, lower jaw, or both, to correct bite and jaw relationships that cannot be fully addressed by moving teeth alone.
There are certain things we can accomplish by moving teeth, and there are other things that really require changing the position of the jaws themselves. When a patient wants to change something at that skeletal level, surgical orthodontics is how we open up that possibility. The orthodontic work prepares the teeth to fit the new jaw relationship we are planning for, the oral and maxillofacial surgeon repositions the jaws, and I finish the bite once the jaws are in their new position.
How Is Surgical Orthodontics Different from Traditional Orthodontic Treatment?
Traditional orthodontics changes the position of teeth. Surgical orthodontics changes the position of the jaws, with orthodontic treatment preparing the teeth before and finishing them after.
In a conventional orthodontic case, I can watch how the upper and lower teeth come together in the patient’s actual bite as treatment progresses. In a surgical case, the teeth need to be positioned for a jaw relationship that does not exist yet, which makes planning more abstract. One of the ways I handle that abstraction is by printing three dimensional models of the upper and lower dental arches and physically articulating them, so I can see how the arches will fit after the surgeon moves the jaws. I need to move the teeth so the top and bottom arches fit together like puzzle pieces once the jaws are in their new position. That takes time, and it is the single most important part of the orthodontic preparation.
What Problems Does Jaw Surgery Correct?
Jaw surgery is used for bite and jaw problems that are driven by the position of the jaws themselves, not just the position of the teeth. The situations we most often consider surgery for include:
- Significant skeletal overbites, where the upper jaw sits well ahead of the lower
- Skeletal underbites, where the lower jaw sits ahead of the upper
- Anterior open bites that will not close with orthodontics alone
- Posterior crossbites tied to a narrow upper jaw in adults past the age when the palate can be widened without surgery
- Facial asymmetries where one side of the jaw is positioned or sized differently from the other
- Jaw relationships that affect facial proportions in a way the patient wants to change
Not every bite problem has a skeletal cause, and not every skeletal problem needs surgery to improve. Which brings us to the next question, which I think is the most important one on this page.
Can Orthodontics Alone Correct a Jaw Problem Without Surgery?
Sometimes yes, sometimes no, and the answer deserves a real conversation rather than a one size fits all rule.
Part of what I have learned about the limits of orthodontic treatment, I have learned from patients who told me very clearly that they did not want surgery. Patients have come in and said absolutely no, I do not want surgery, please doc just do whatever you can. I have taken a number of those cases on with the patient fully understanding the tradeoffs, and I have been surprised sometimes by how far we have been able to go. I have treated patients with significant anterior open bites who had been told elsewhere that surgery was their only option, and in a number of those cases we achieved substantial correction with Invisalign. I have treated skeletal underbites and overbites where we made the bite work beautifully without changing the underlying jaw relationship.
Those conversations have shaped how I think about this. I do not treat a patient’s reluctance to have surgery as an obstacle. I treat it as meaningful information about what they are trying to accomplish, and I ask myself what is actually possible without changing the position of the jaws.
The published evidence supports this kind of individualized thinking. In carefully selected patients with mild to moderate skeletal discrepancies, orthodontic treatment alone can achieve meaningful correction of the bite without changing the position of the jaws themselves. This is nonsurgical correction, called orthodontic camouflage in clinical terms. A 2022 systematic review of nonsurgical treatment of borderline skeletal Class III cases found nonsurgical correction appropriate for milder discrepancies and in some borderline cases produced a facial profile at least as attractive as surgery. For anterior open bites specifically, a 2024 study in the American Journal of Orthodontics and Dentofacial Orthopedics reported successful closure in all cases treated with clear aligners in appropriately selected adult patients, though the correction is primarily dentoalveolar rather than skeletal.
There are honest tradeoffs with the nonsurgical approach, and I say them out loud with every patient. We are not changing the position of the chin or the lower face. If the patient’s main concern is facial profile or jaw position, orthodontics alone will not deliver that. There are also limits to how far teeth can be moved before the bone supporting them becomes a problem. If I would need to push teeth beyond the alveolar envelope, nonsurgical correction is not safe and I will say so.
The decision is individualized, it depends on what the patient wants to accomplish, and the goal is for the patient to understand exactly what is being corrected, what is not being corrected, and what they are signing up for either way.
Does Surgical Orthodontics Help with Sleep Apnea?
Jaw surgery (also called orthognathic surgery) can play a role in treating obstructive sleep apnea in carefully selected patients, but obstructive sleep apnea is a medical diagnosis. I do not recommend jaw surgery solely for airway improvement without appropriate evaluation and involvement of a qualified sleep physician.
A procedure called maxillomandibular advancement, which moves both jaws forward, has been shown in a 2025 meta analysis in Otolaryngology Head and Neck Surgery to produce the highest success rate of any surgical treatment for obstructive sleep apnea, with an average reduction of about 42 events per hour in the breathing event score sleep physicians use (the apnea hypopnea index). The current American Academy of Sleep Medicine practice parameters, however, place maxillomandibular advancement after CPAP and oral appliance therapy in the treatment sequence, as a specific indication option rather than a first line treatment.
What that means in practice at my office: if a patient comes in asking about jaw surgery for sleep apnea, I want to see a formal sleep study interpreted by a sleep physician before we talk about surgical planning. I also want the sleep physician, and often an ENT, involved in the decision. Part of the airway improvement that patients experience after jaw surgery is a real anatomical change, and part of it may reflect weight loss, growth, or other factors that are hard to separate out. I would rather be honest about that than oversell what surgery can do on its own.
Who Is a Good Candidate for Surgical Orthodontics, and at What Age?
A good candidate is someone whose goals cannot be adequately achieved by moving teeth alone, and who understands the benefits, limitations, and risks well enough to make an informed decision.
Skeletal maturity matters, but I do not make this decision based on a birthday alone. I am looking at the patient’s age, their growth pattern, their imaging over time, the growth stage markers we see on a side view x-ray (cervical vertebral maturation), and the clinical picture as a whole. In most patients we wait until active facial growth is substantially complete before performing conventional jaw surgery, and I generally think of age 18 as a reference point for conventional cases, not a universal cutoff.
Mandibular growth tends to continue longer than maxillary growth, which is particularly relevant for patients with skeletal underbites, where continued lower jaw growth after surgery can affect long term stability. Operating too early in a growing underbite patient is a known cause of relapse, so for that patient population we tend to wait a little longer and watch the growth curve more carefully. Some specific dentofacial surgical procedures, including a procedure that gradually lengthens the lower jaw (mandibular distraction osteogenesis) for airway obstruction in infants with micrognathia, have an established evidence base in much younger patients, and those are performed in collaboration with pediatric craniofacial teams.
How Do You Coordinate with the Oral and Maxillofacial Surgeon?
Once a patient and I have discussed their goals and identified a potential role for surgery, I refer them to an oral and maxillofacial surgeon for a consultation. After that consultation, I speak directly with the surgeon about the proposed skeletal movements and how we will coordinate our treatment. Once we have agreed on the overall approach, I meet with the patient again to go through the plan.
I work with surgeons I have longstanding relationships with, and I also work with surgeons who are new to me on a particular case. In both situations, what I bring is careful communication, real effort to arrive at a plan the surgeon and I are aligned on before we start, and ongoing coordination through the orthodontic preparation and after surgery so the whole treatment stays coherent.
Surgical orthodontics is a partnership. The surgeon leads the surgical plan, the operation, and the detailed risk, complication, and recovery conversation with the patient. I lead the orthodontic preparation and the finishing. We work together on everything in between, from early planning through how the bite settles after surgery. I do not have full control of the surgical outcome, and I would not pretend to. What I take seriously is the orthodontic side, the coordination with the surgeon, and making sure the patient understands every piece of the treatment, not just the piece I personally perform.
Starting surgical consultation early in orthodontic planning, rather than deferring it until later, has been associated with shorter total treatment time, by roughly 15 months in a 2026 cohort study of surgical orthodontic cases in a university program. That is one reason I prefer to involve the surgeon from the beginning when surgery is a real possibility.
Common Questions
Expect roughly two years of orthodontic treatment before surgery, and roughly six to twelve months of orthodontic treatment after surgery, for a total of about two and a half to three years.
Those are ranges, not promises, and the amount of time varies with the complexity of the case and the amount of dental decompensation that needs to be undone before the jaws can be moved.
Before surgery. The preparation phase typically runs around two years, often eighteen to twenty four months, longer in cases that require extractions or significant decompensation of the incisors. During this phase I move the teeth so that they will fit together properly in the planned post surgical jaw relationship, which, again, is a jaw relationship that does not exist yet in the patient’s actual mouth. This is where the three dimensional printed models and the puzzle piece work matter most.
- Around surgery. The actual surgery is a one or two night hospital stay in most cases. The surgeon handles the surgical plan and the operative course.
- After surgery. The finishing orthodontic phase typically runs six to twelve months. The teeth need to settle into the new jaw relationship, and I refine the bite as healing progresses. Open bite cases and more complex corrections tend to take longer in this phase.
Recovery is hardest in the first few weeks, with most patients on a liquid diet for two to four weeks and back to normal foods over about three months.
I do not believe it is my responsibility to downplay the experience of surgery. Jaw surgery is a significant procedure, and recovery can be challenging in the first weeks even when everything goes well.
Your surgeon leads the detailed recovery conversation with you, because the specific picture depends on the exact operation and the surgeon is best positioned to walk you through what to expect, what to watch for, and what to call about. I want my patients going into that conversation already understanding the general shape of recovery, so we talk about it together ahead of time as part of the whole treatment decision. Here is the general picture from the published literature.
Peak swelling and limited mouth opening are usually in the first forty eight to seventy two hours. Most patients are on a liquid diet for roughly two to four weeks, transitioning to a soft diet for several weeks after that, before gradually returning to normal foods over roughly three months. Normal mouth opening and swelling continue to improve across those three months. Numbness or altered sensation of the lower lip and chin is common in the early weeks after surgery of the lower jaw. In a 2025 meta analysis of nearly 5,400 patients, altered sensation persisted at one year in about one in five patients, more often with larger mandibular advancements and in older patients.
In the longer run, the published evidence on quality of life after jaw surgery is encouraging. A 2022 summary of systematic reviews in the European Journal of Orthodontics found that jaw surgery produces large improvements in oral health related quality of life and self image, with a transient dip during the pre surgical orthodontic phase and clear improvement by three to six months after surgery that is sustained at two years and beyond. Long term satisfaction studies, including a 10 to 15 year follow up of patients treated with mandibular surgery, report satisfaction in roughly 96 percent of patients with dissatisfaction and regret in the single digits. In my practice, patients who have proceeded with surgery have generally been highly motivated, have taken time to understand the tradeoffs, and have been happy with the decision. That is my clinical experience with selected patients, not a claim about universal satisfaction.
Some altered sensation in the lower lip and chin is common in the first weeks after surgery that involves the lower jaw. Most of that sensation returns, but a meaningful minority of patients, about one in five at one year in the best current meta analysis, continue to notice some altered feeling long term. The risk is higher with larger mandibular advancements and in older patients.
Your surgeon leads the detailed risk conversation with you, including the specifics of this and the other possible complications. I want my patients walking into that conversation already understanding the general picture, able to ask the right questions, and ready to make an informed decision about whether to proceed.
Fees for surgical orthodontic treatment are case specific, and there are two separate sets of fees to understand. The orthodontic fees, which my practice charges, cover the pre surgical and post surgical orthodontic treatment and planning. The surgical and facility fees, which the surgeon’s office and the surgical facility or hospital charge, cover the operation itself, anesthesia, and the stay.
For current orthodontic fee ranges and for how we handle insurance coordination, please contact our office and ask for Tracie. For surgical and facility estimates, those come directly from the surgeon’s office you are referred to. Insurance coverage of orthognathic procedures varies, is often reviewed on a case by case basis under medical rather than dental benefits, and depends on documentation of functional need. We are happy to help you understand that process.
Why Choose Green Orthodontics for Surgical Orthodontic Treatment?
Successful surgical orthodontics is a team effort. It is not just me that patients have to trust. They have to trust a team.
Here is what I bring to that team.
I spend considerable time on the preparation. I print the upper and lower dental arches, physically articulate them to see how they will fit after the jaws are moved, and refine the orthodontic positioning until the puzzle pieces fit the way the surgeon and I planned.
I communicate directly with the surgeon from the early planning conversation, and I stay in that communication through the preparation, the surgery, and the finishing. The surgeon and I plan the case together, not in parallel.
I help my patients understand the full treatment, not just my piece. I want them walking into the surgical consultation already understanding the general shape of what surgery involves and the recovery that follows, so they can ask the right questions and make an informed decision with the surgeon.
I am honest about what orthodontics can and cannot accomplish on its own, and I am honest about the limits of my role once we are inside the operating room.
The surgeon leads the surgical plan, the operation, and the detailed surgical risk conversation with the patient. I lead the orthodontic preparation and the finishing. We work together on everything in between. I take all of that seriously.
Dr. Noam Green, DMD. Board certified by the American Board of Orthodontics (ABO) and the Royal College of Dentists of Canada (RCDC). Past Assistant Program Director and Professor at the Georgia School of Orthodontics. Currently mentors orthodontists, dentists, and students who shadow at the practice. Owner of Green Orthodontics since November 2015.
Book Your Consultation
If you have been told you may need jaw surgery, or if you have been thinking about it on your own, the right next step is a conversation. Not every skeletal discrepancy needs surgery, and not every patient who is a candidate for surgery decides to proceed. Our job is to help you understand what is possible with and without it, so the decision is yours and it is informed.
Book a complimentary consultation at our Decatur, GA office, or call or text us.