Case Study: Surgery Is Sometimes Required To Align Adult Teeth

Timing is often the reason for a visit to the orthodontist. In this case, Jacob was planning for the future, hoping for positive results before his wedding.

Patient. Jacob was referred to Baltimore Orthodontic Group by his general dentist, who had noted a clinical asymmetry in his lower jaw.

Problem. Jacob presented with a posterior crossbite on his right side, and an open bite at the front of his smile. Crowding was noted on both the top and bottom arches, and the upper and lower midlines were not aligned due to the pre-existing asymmetry. Jacob shared with our doctors his goals of achieving ideal symmetry and esthetics, with the hopes of seeing noticeable improvements before his wedding in the spring of 2024. 

Solution. Posterior crossbites are best addressed in young children, as they do not self-correct with time and in actuality become harder to treat with age. Once we grow past an "ideal age window", crossbites become more stubborn as our bones begin to mature and sutures begin to fuse. Posterior crossbites in adults often cannot be treated with an expander alone. Instead, surgical intervention is often needed in order to achieve true correction, protect the integrity of the hard and soft tissues, and maximize stability in retention. In Jacob's case, surgery would have the additional benefits of correcting the asymmetry in his lower jaw to perfectly align his bite, while simultaneously ensuring contact on the anterior teeth to facilitate daily speech and mastication. After reviewing the benefits of this approach, Jacob was committed and ready to get started!

Process. The decision was made to begin Jacob's case with a palatal expander in conjunction with surgery. The palatal expander would create additional transverse room to either side of the jaw to address the malocclusion and assist the surgeon in the procedure to correct the crossbite. The expander was delivered shortly after the new year of 2022, immediately preceding the surgery, and retained for approximately six months. Subsequently, Jacob's teeth were straightened with Invisalign before a second procedure to perfect the symmetry of his arches.

Result. Typically, surgical cases are carried out with traditional braces to assist in stabilization and healing. However, the doctors at Baltimore Orthodontic Group were able to achieve ideal results utilizing Invisalign following Jacob's request. Jacob was even able to take a short break from his Invisalign attachments and trays to get married, before picking up treatment again seamlessly!

Finishing touches were placed with additional aligners before the conclusion of treatment in December of 2024 - just in time for the holiday season! Treatment spanned less than three years and yielded some fantastic results in the occlusion and profile, thanks to Jacob's commitment and dedication throughout the process. At the end of treatment, Jacob was prescribed retainers to wear at night to preserve the positive improvements in his smile. What an amazing difference!