The relationship between the upper and lower jaws determines, more than almost any other anatomical factor, how a face looks and how it functions. When that relationship is correct, chewing is effortless, speech is clear, the teeth meet in a stable and even contact, and the facial profile is harmonious. When it is significantly off due to skeletal discrepancies between the size and position of the two jaws no amount of orthodontic treatment can fully resolve it. Braces move teeth. Corrective jaw surgery moves jaws.
Orthognathic surgery the technical term for corrective jaw surgery is one of the most transformative interventions in dentistry and maxillofacial surgery. It addresses problems that are skeletal in origin: underbites, overbites, open bites, crossbites, and facial asymmetries that result from the jaws growing unevenly. The results are functional patients chew, breathe, and speak more effectively and aesthetic, often dramatically and permanently improving facial profile and balance.
Novo Care’s oral and maxillofacial surgery team provides orthognathic surgery consultation and treatment in Addis Ababa, serving patients from Bole, Haya Hulet, and across Ethiopia.
Understanding jaw discrepancies what causes them
Skeletal jaw discrepancies develop during the growth years. The upper jaw (maxilla) and lower jaw (mandible) are independent structures that grow at different rates and times. When their growth is uncoordinated — due to genetics, childhood habits, previous trauma, or developmental conditions the result is a jaw relationship that teeth alone cannot compensate for.
Class III jaw relationship (underbite): The lower jaw is proportionally larger or more forward than the upper. In profile, the chin projects prominently. The lower front teeth sit in front of the upper front teeth. Chewing is inefficient. This is the most common indication for lower jaw setback surgery (mandibular setback) or upper jaw advancement (maxillary advancement).
Class II jaw relationship (overbite/retrognathia): The lower jaw is proportionally smaller or further back than the upper. The profile shows a receding chin. The upper teeth significantly overlap the lower. This typically indicates lower jaw advancement surgery (bilateral sagittal split osteotomy BSSO).
Open bite: The front teeth do not meet at all when the back teeth are in contact. Often associated with tongue positioning habits or vertical jaw growth patterns. Surgical correction involves repositioning the upper jaw (Le Fort I osteotomy) to close the vertical gap.
Facial asymmetry: One side of the face is visibly different in height or projection from the other, due to uneven jaw growth. Surgical correction requires asymmetric repositioning of one or both jaws.
The treatment pathway: orthodontics first, surgery second
Orthognathic surgery does not replace orthodontic treatment it works together with it. The treatment sequence is always:
Phase 1: Pre-surgical orthodontics (typically 12–18 months) Before jaw surgery, braces or clear aligners are used to align the teeth within each jaw independently, removing any dental compensations that have developed to mask the skeletal discrepancy. At this stage, the bite may temporarily look worse — this is expected and is part of the preparation.
Phase 2: Surgical correction The jaw is repositioned to the planned position and fixed with titanium plates and screws. Surgery is performed under general anaesthesia and typically requires a hospital stay of 1–3 nights. The titanium fixation is permanent and does not require removal in most cases.
Phase 3: Post-surgical orthodontics (typically 6–9 months) After the jaw has healed in its new position, final orthodontic refinement achieves the detailed tooth position and bite relationship that completes the treatment.
The total treatment duration from the beginning of pre-surgical orthodontics to the end of post-surgical orthodontics is typically 2 to 2.5 years for most cases.
The surgical procedures what happens in the operating theatre
Le Fort I osteotomy repositions the upper jaw by cutting across the maxilla above the level of the tooth roots, separating it from the facial skeleton, moving it to the planned position (forward, backward, up, down, or rotated), and fixing it with titanium plates. This addresses maxillary retrusion, open bites, and vertical maxillary excess.
Bilateral sagittal split osteotomy (BSSO) repositions the lower jaw by splitting the mandible on both sides through the back section of the jawbone, allowing the tooth-bearing portion to move independently while remaining attached to the muscles and soft tissue that supply it. This addresses mandibular prognathism (underbite), retrognathia (overbite), and asymmetry.
Genioplasty repositions the chin bone independently of the main jaw movement. It is frequently performed alongside BSSO or Le Fort I to achieve the final facial profile balance. The chin is cut free, moved to the planned position, and fixed.
For complex cases, all three procedures may be performed simultaneously in a single surgical session.
The planning process where NovoCare’s technology matters
The surgical outcome is determined entirely by the quality of the planning. NovoCare uses digital planning tools incorporating 3D imaging, digital cephalometric analysis, and virtual surgical planning (VSP) to design the exact repositioning of each jaw before surgery begins. The surgical plan is translated into custom surgical guides that are used in the operating theatre to achieve the planned jaw positions with precision.
The alternative free-hand surgical positioning based on the surgeon’s clinical judgement produces variable results and is not the standard of care for contemporary orthognathic surgery.
Novo Care provides orthognathic surgery consultations in Addis Ababa. If you have been told that your bite cannot be fixed with braces alone, contact us to discuss whether jaw surgery is appropriate for your case.