There are times especially in adults and "non growing" patients where the bones are not in alignment. Orthognathic surgery in combination with orthodontics can be used when the skeletal correction is beyond what can be achieved with orthodontics alone or where greatly enhanced facial balance can be achieved by putting the bones into alignment.

A combined orthodontic/orthognatic approach is frequently used when the lower jaw is too small or too far behind the upper jaw. Bringing the lower jaw forward can greatly enhance the patients profile while simultaneously correcting the bite dicrepancy.

Similarly the lower jaw can out grow the upper jaw causing an under bite and unfavorable facial balance. Surgery to advance the upper jaw or to set back the lower jaw or a combination of the above is frequently used to again put the bones of the face in balance.

Other times an open bite develops where there is a large gap between the front teeth when the patient is biting down. Again surgery can be done to impact the posterior of the upper jaw allowing the lower jaw to rotate forward and close down the bite.

There are only a few examples where orthognathic surgery can be used in combination with orthodontics. The facial changes are very favorable as can be seen by the following treated cases.

Dental and facial changes with Orthognathic Surgery
Before	After
Severe Class Skeletal (upper jaw ahead of lower) Treated with braces and surgical impaction of upper jaw and advancement of lower jaw.
Before	After
Severe Class II Division II Malocclusion (Upper jaw ahead of lower jaw) Treated with braces and surgical advancement of lower jaw.
Before
After
Severe Class II Malocclusion treated with braces and surgery to advance lower jaw forward.
Before	After
Severe Class III treated with braces and surgery to advance upper jaw.