Some orthodontic problems may not be limited solely to the position of the teeth. Significant differences in the size, position, or relationship of the upper and lower jaws may affect dental occlusion, chewing function, and facial-jaw balance.
In complex orthodontic cases, treatment planning is based on a comprehensive assessment of the current position of the teeth, the skeletal relationship between the jaws, growth and development status, and the individual needs of the patient.
For individuals in Bursa who require assessment due to a complex orthodontic problem, Dr. Dt. Ebru Çetinkaya Tokmak performs a detailed orthodontic evaluation to determine whether orthodontic treatment alone may be sufficient or whether other specialties should be involved in the treatment process.
What Is Complex Orthodontic Treatment?
Complex orthodontic treatment refers to orthodontic approaches planned for conditions involving more extensive discrepancies between the positions of the teeth and jaws, beyond standard dental crowding.
In such cases, the problem may not be related solely to the alignment of the teeth. The relative positions of the upper and lower jaws, facial asymmetries, significant bite problems, and skeletal discrepancies may also form part of the assessment.
While some complex orthodontic problems can be managed using orthodontic methods alone, certain adult patients with significant skeletal discrepancies may require an orthognathic surgery assessment in combination with orthodontic treatment.
Which Orthodontic Problems May Be Considered Complex?
Not every orthodontic problem is treated within the same scope or using the same method.
Some of the following conditions may require a more detailed orthodontic assessment and complex treatment planning:
- Significant positional discrepancies between the upper and lower jaws
- The lower jaw being noticeably positioned forward or backward
- The upper jaw being developmentally positioned backward or forward
- Significant open bite problems
- Severe crossbites
- Facial and jaw asymmetry
- Cases in which the bite cannot be adequately corrected through orthodontic tooth movement alone
- The presence of multiple orthodontic problems simultaneously
The presence of these findings alone does not mean that surgical treatment is required. The treatment approach is determined individually following a detailed clinical and radiographic assessment.
Does Every Jaw Discrepancy Require Surgery?
No. Not all jaw and bite problems require surgical treatment.
Particularly in individuals who are still growing and developing, certain jaw development problems may be assessed and managed using different orthodontic or orthopaedic approaches.
In adults, orthodontic treatment alone may also be an option depending on the extent of the problem. Surgical assessment is generally considered when the skeletal discrepancy is significant and the desired correction cannot be achieved through tooth movement alone.
What Are Surgical Orthodontics and Orthognathic Surgery?
Surgical orthodontics refers to a treatment approach in which orthodontic treatment, where necessary, is planned together with surgical repositioning of the jaws.
Jaw surgery, known as orthognathic surgery, may involve surgically changing the position of the upper jaw, lower jaw, or both jaws where required. The aim is to create a comprehensive treatment plan designed to improve the skeletal relationship between the jaws and the way the teeth meet.
In this process, orthodontic and surgical treatment are not considered independently of one another. Planning the treatment and coordinating its different stages may require collaboration between the disciplines of orthodontics and oral and maxillofacial surgery.
Is Orthodontic Treatment Performed Before Surgery?
In the conventional surgical orthodontic approach, orthodontic treatment may be performed before surgery in many cases to prepare the teeth for the planned jaw positions.
Following surgery, orthodontic treatment may continue for a period of time to make the final adjustments to the bite relationships between the teeth. The sequence and duration of treatment are not the same for every individual and are determined according to the multidisciplinary treatment plan.
How Is Complex Orthodontic Treatment Planned?
Treatment planning for complex orthodontic problems requires a detailed assessment process.
Orthodontic Examination
At the initial stage, the alignment of the teeth, the relationship between the upper and lower jaws, and the existing bite problem are evaluated.
The individual’s concerns, expectations from treatment, and current oral and dental health are also included in the assessment process.
Assessment of Diagnostic Records
Where considered necessary, the following may be used in treatment planning:
- Clinical photographs
- Intraoral records
- Radiographic images
- Digital intraoral scans
- Measurements showing dental and jaw relationships
Distinguishing Between Skeletal and Dental Problems
One of the important aspects of complex cases is determining how much of the problem originates from the position of the teeth and how much results from the skeletal relationship between the jaws.
This distinction helps determine whether treatment can be planned using orthodontic methods alone or whether a multidisciplinary approach involving different specialties may be required.
Multidisciplinary Assessment
If the orthodontic assessment indicates that a surgical opinion or evaluation by another specialty is required, the treatment process may be planned in collaboration with the relevant specialists.
Where surgery may be required, the scope and suitability of the surgical procedure are assessed separately by the relevant surgical specialty.
How Are Orthodontics and Jaw Surgery Planned Together?
Surgical orthodontic treatment does not consist of a single procedure. The treatment process may involve several different stages.
Depending on the individual’s condition, the process may generally include:
- Detailed orthodontic assessment
- Development of the orthodontic and surgical treatment plan
- Pre-surgical orthodontic preparation where required
- Surgical treatment performed by the relevant surgical team
- Post-surgical orthodontic adjustments
- Post-treatment retention and follow-up
The sequence of treatment and the procedures performed are not the same for every individual. Orthognathic treatment requires close coordination between the orthodontist and the maxillofacial surgeon throughout the treatment process.
Does the Orthodontist Decide on Surgery Alone?
A skeletal problem that may require surgery can be identified during an orthodontic assessment; however, the decision regarding surgical treatment and the scope of the surgical procedure are determined through multidisciplinary evaluation.
Dr. Dt. Ebru Çetinkaya Tokmak evaluates the relationship between the teeth and jaws from an orthodontic perspective and develops the orthodontic treatment plan. Where surgical assessment is required, evaluation by the relevant oral and maxillofacial surgeon is also incorporated into the treatment planning process.
What Is the Role of Digital Planning in Complex Orthodontic Treatment?
Digital technologies may be used during the record-taking and treatment planning processes for complex orthodontic cases.
Digital intraoral scans and three-dimensional records can assist in evaluating the current positions of the teeth and reviewing planned orthodontic movements.
In surgical orthodontic treatment, different types of digital data may also support the treatment team during the planning process. However, digital simulations should not be considered a definitive prediction or guarantee of treatment results.
The course of treatment may vary according to clinical findings, biological response, and multidisciplinary assessment.
Surgical and Complex Orthodontic Treatments in Bursa
For individuals in Bursa who require assessment due to a significant jaw discrepancy, severe bite problem, facial-jaw asymmetry, or another complex orthodontic condition, the first stage is a detailed evaluation of the dental and skeletal components of the problem.
During the orthodontic assessment performed by Dr. Dt. Ebru Çetinkaya Tokmak, the current positions of the teeth, bite relationships, and the relationship between the jaws are evaluated.
Where the existing problem can be managed with orthodontic treatment alone, appropriate treatment options are planned. Where surgical assessment or evaluation by other specialties is required, a multidisciplinary approach may be followed.
The treatment plan is developed individually according to each patient’s existing orthodontic and skeletal condition.
Frequently Asked Questions
Does every advanced orthodontic problem require jaw surgery?
No. The fact that an orthodontic problem is advanced or complex does not, by itself, mean that surgery is required. The dental and skeletal characteristics of the problem are assessed to determine the appropriate treatment approach.
What is orthognathic surgery?
Orthognathic surgery is a treatment approach involving surgical repositioning of the jaws to correct significant skeletal jaw discrepancies. In many surgical orthodontic cases, the process is planned in combination with orthodontic treatment.
Does the orthodontist perform jaw surgery?
No. The orthodontist manages the orthodontic assessment and treatment process. Where jaw surgery is required, the surgical procedure is performed by an appropriately qualified surgical specialist.
Are braces required before jaw surgery?
Pre-surgical orthodontic preparation may be required in many conventional orthognathic treatment plans. However, the treatment protocol is determined according to the individual patient’s condition.
Can clear aligners be used in surgical orthodontic treatment?
In selected cases, clear aligner systems may be considered at different stages of orthodontic treatment. However, the treatment method should be determined according to the requirements of the complex case and the multidisciplinary treatment plan.
Can surgery be avoided if a jaw discrepancy is identified during childhood?
During growth and development, certain jaw development problems may be assessed and managed using orthodontic and orthopaedic approaches. However, it would not be accurate to state that every skeletal problem can be completely corrected during the growth period or that the future need for surgery can always be prevented.
Content Last Updated: 18 July 2026
This content has been prepared for general informational purposes. Individual diagnosis and treatment planning are determined following clinical assessment and, where necessary, multidisciplinary evaluation.