Braces and Jaw Advancement Surgery: Why Straight Teeth Are Only Part of the Plan

When people begin considering maxillomandibular advancement surgery, one of their first practical questions is often about braces. Some patients already have fairly straight teeth and wonder why orthodontic treatment would be necessary. Others are concerned that wearing braces could add another year or two to an already demanding surgical process.

The answer is not the same for everyone.

Most patients undergoing traditional corrective jaw surgery need orthodontic treatment before and after the operation. However, braces are not automatically required in every case. The decision depends on the position of the teeth, the way the upper and lower teeth fit together, the purpose of the surgery, and the surgical approach being used.

Maxillomandibular advancement performed primarily to treat obstructive sleep apnea may sometimes be planned differently from jaw surgery performed mainly to correct an underbite, overbite, facial asymmetry, or other major bite problem.

Understanding what braces actually do during the process makes it easier to see why apparently straight teeth may still need orthodontic preparation.

In a conventional surgical-orthodontic treatment plan, patients commonly wear fixed braces:

• Before surgery to position the teeth correctly within each jaw
• During surgery to help the surgeon guide and stabilize the bite
• After surgery to refine the final tooth positions
• Followed by retainers to help preserve the result

Orthodontic preparation commonly takes approximately 12 to 18 months before jaw surgery, although shorter and longer treatment periods are possible. After surgery, braces may remain in place for approximately six months or longer while the orthodontist fine-tunes the bite. Some hospital treatment programs estimate that the full orthodontic and surgical process may take two and a half to three years. ^[1]

These figures are averages rather than fixed rules. A patient with significant dental crowding, rotated teeth, missing teeth, a narrow upper arch, or pronounced dental compensation may require more preparation. Someone whose arches are already well aligned may need much less.

Selected patients may undergo a surgery-first approach, limited orthodontic treatment, clear-aligner treatment, or maxillomandibular advancement without conventional braces. These alternatives require careful planning and are not suitable for every bite pattern.

Braces before maxillomandibular advancement surgery are not simply intended to make the teeth look straight. Their more important purpose is to prepare the teeth so that the upper and lower jaws can be moved into their planned positions without creating an unstable or inaccurate bite.

Jaw position and tooth position are related, but they are not the same problem.

Braces can move teeth through the supporting bone, but they cannot reposition the entire upper or lower jaw in an adult. Surgery moves the jawbones, while orthodontic treatment positions the teeth within those bones. Successful treatment therefore depends on close coordination between the oral and maxillofacial surgeon and the orthodontist. ^[2]

Braces Align and Level the Teeth

Before surgery, crowded, tipped, rotated, or uneven teeth may need to be placed into a more orderly position.

The orthodontist may also level the biting surfaces of the teeth. This helps create upper and lower dental arches that can be fitted together more predictably when the surgeon advances and repositions the jaws.

A smile can look reasonably straight from the front while still containing tilted roots, uneven arch forms, or teeth that do not sit correctly over the supporting jawbone. These less visible problems can affect surgical planning and the quality of the final bite.

Braces Remove Dental Compensation

Dental compensation is one of the most important reasons braces may be required before maxillomandibular advancement surgery.

When the jaws grow in an imbalanced position, the teeth often tilt naturally in an attempt to maintain contact with the teeth in the opposite jaw. For example, the upper front teeth may lean forward or the lower front teeth may lean backward to camouflage an underlying skeletal discrepancy.

This adaptation may make the bite appear less severe than the jaw problem actually is.

Before corrective jaw surgery, the orthodontist may need to move these teeth back into a more natural position over their respective jawbones. This process is known as orthodontic decompensation.

Decompensation may temporarily make the bite look or feel worse. An overbite, underbite, gap, or facial imbalance may become more noticeable as the teeth are moved out of their compensating positions. This does not mean treatment is failing. It exposes the true skeletal discrepancy so the surgeon can correct it accurately.

After the jaws are moved, the decompensated teeth should fit together more appropriately.

Braces Coordinate the Upper and Lower Dental Arches

The upper and lower dental arches must be compatible in width, shape, and tooth position.

If one arch is much narrower than the other, moving both jaws forward may not automatically produce a stable bite. Orthodontic treatment may therefore be used to coordinate the arches before surgery.

In some patients, arch coordination may also involve expansion, tooth removal, restorative dental work, or additional surgical planning. The exact approach depends on the amount of crowding, the condition of the teeth, the width of the jaws, and the intended jaw movements.

Braces Help Create a Reliable Surgical Bite

During maxillomandibular advancement surgery, the surgeon must place the jaws in the exact position established during preoperative planning. A custom surgical splint may be placed between the upper and lower teeth to guide this position.

Fixed braces with strong surgical wires and hooks provide convenient attachment points for temporary wires or elastic bands. These attachments help the surgeon bring the teeth into the planned relationship while the jawbones are secured with plates and screws.

Patient guidance from surgical centres notes that braces commonly stay on during the operation and help the surgeon position the jaws correctly. ^[3] 

The braces themselves do not move the jawbones during the operation. They act as part of the positioning and stabilization system.

Many patients wear braces for approximately 12 to 18 months before surgery. Nevertheless, treatment time can vary considerably.

Preoperative orthodontics may be shorter when:

• The teeth are already well aligned
• There is little dental compensation
• The upper and lower arches have compatible shapes
• No major space closure is required
• The treatment is primarily intended to improve the airway
• A surgery-first or minimal-preparation protocol is appropriate

Treatment may take longer when there is severe crowding, considerable tooth tipping, major arch-width discrepancy, impacted teeth, missing teeth, periodontal disease, or a complicated bite.

The surgeon and orthodontist usually monitor progress together. Surgery is scheduled when the teeth and arches have reached a position that allows the planned jaw movement to be performed safely and predictably.

The operation should not normally be scheduled solely because a certain number of months has passed. Readiness depends more on tooth position and bite preparation than on the calendar.

In traditional treatment, the braces remain attached to the teeth throughout the operation.

Shortly before surgery, the orthodontist may place rigid surgical archwires and add small hooks. During the procedure, the surgeon uses the teeth, surgical splints, hooks, wires, or elastic bands to reproduce the planned bite.

Once the jaws are in the intended position, titanium plates and screws are generally used to stabilize the bone segments. The temporary connection between the upper and lower teeth may then be released or replaced with lighter guiding elastics.

Modern fixation does not necessarily mean the jaws will be tightly wired together for several weeks. Some patients wear elastic bands that guide the bite while still allowing a limited degree of jaw movement. The exact postoperative stabilization method depends on the operation, bone stability, surgeon preference, and individual healing requirements. Maxillomandibular fixation can be accomplished with either wires or guiding elastics when clinically necessary. ^[4]

The operation moves the jawbones into a new position, but it does not usually complete every small tooth movement needed for an ideal bite.

Postoperative orthodontic treatment is used to settle, refine, and stabilize the way the teeth meet.

Braces Fine-Tune the New Bite

Even with detailed three-dimensional planning and custom surgical splints, small bite discrepancies may remain after surgery.

These may include:

• Minor spaces between teeth
• Small rotations
• Uneven tooth contacts
• Slight differences in the way the back teeth meet
• A dental midline that needs refinement
• Areas where one tooth contacts too heavily
• Teeth that need to settle further into the new bite

Postoperative orthodontics allows these final corrections to be made gradually.

Elastic Bands Guide the Teeth Together

Patients are often instructed to wear elastic bands between the upper and lower braces after maxillomandibular advancement surgery.

These elastics are not necessarily intended to immobilize the jaws completely. They may instead guide the lower jaw into the desired position, encourage the teeth to settle, and help the patient relearn the new bite.

Elastic wear may initially be more intensive and then decrease as healing progresses. The configuration can be changed by the surgeon or orthodontist as the bite evolves. Patients should not rearrange, remove, or replace elastics differently from the prescribed pattern unless instructed to do so.

Braces Help Maintain Bite Stability While Healing Occurs

The jawbones are secured internally, but bone healing takes time. The muscles, tongue, lips, jaw joints, and chewing patterns must also adapt to the new skeletal position.

Postoperative orthodontics provides controlled guidance during this period. The objective is not to hold unstable surgery together with braces, but to prevent small tooth movements from interfering with the developing bite.

The postsurgical phase also allows the team to identify bite changes early and correct them before they become more difficult to manage.

Braces commonly remain in place for approximately six to nine months after surgery, although the duration may be shorter or longer.

Some patients need only a few months of finishing treatment. Others may require nine to twelve months or more, particularly when extensive tooth movements were deliberately postponed until after the operation.

Orthodontic adjustments may be limited during the earliest healing period. Once the surgeon confirms that healing is progressing appropriately, active orthodontic refinement can gradually resume.

The braces are removed when the bite is stable, the tooth contacts are satisfactory, and the orthodontist believes the result can be maintained with retainers.

Yes. Most patients will need retainers after completing orthodontic treatment.

Teeth naturally have a tendency to shift after braces, especially during the months immediately following removal. Retainers help hold the teeth in their corrected positions while the surrounding bone and gum tissues reorganize.

The orthodontist may recommend:

• A removable clear retainer
• A removable wire-and-acrylic retainer
• A fixed wire bonded behind the front teeth
• A combination of fixed and removable retainers

Retainer wear is often more frequent at first and may later be reduced to nighttime use. Long-term nighttime retention may be recommended because teeth can continue to move with age, regardless of whether a person has undergone jaw surgery.

Retainers maintain tooth position. They do not physically hold the surgically repositioned jawbones in place.

Maxillomandibular advancement surgery can sometimes be performed without conventional braces, but this is not the standard choice for every patient.

A braces-free or limited-orthodontic approach may be considered when:

• The patient’s existing bite is stable and functional
• The teeth are reasonably well aligned
• There is minimal dental compensation
• Both jaws can be moved together while preserving the bite
• The surgery is being performed primarily for obstructive sleep apnea
• The planned jaw movement does not require major dental correction
• The surgical team has an established protocol for operating without fixed orthodontic appliances

In these situations, temporary arch bars, bone-supported fixation devices, intermaxillary fixation screws, buttons, or other attachments may be used to help position the jaws during surgery. Fixed orthodontic archwires are convenient for intraoperative stabilization, but alternative fixation methods are available when braces are not present. ^[5]

Avoiding braces should not be treated as the main objective if orthodontic preparation is necessary for a stable result. Preserving an imperfect bite simply to shorten treatment could limit the planned jaw advancement or create postoperative bite problems.

It can.

Maxillomandibular advancement surgery for obstructive sleep apnea moves the upper and lower jaws forward to enlarge the airway and place tension on attached soft tissues. This can reduce upper-airway collapsibility during sleep. ^[6]

Some patients seeking this operation have a major jaw discrepancy and an abnormal bite. They may need the same comprehensive orthodontic preparation used in other forms of corrective jaw surgery.

Other patients have obstructive sleep apnea but an acceptable existing bite. Their surgeon may be able to advance the upper and lower jaws together while largely preserving the relationship between the teeth. Such patients may need limited orthodontics, temporary surgical appliances, or no conventional preoperative braces.

The airway goal does not make the bite unimportant. A large advancement that improves breathing but leaves the teeth unable to meet comfortably would not represent a satisfactory overall result.

Planning should therefore consider airway enlargement, facial balance, jaw-joint position, dental function, and long-term bite stability together. Orthodontists can play an important role in the multidisciplinary management of obstructive sleep apnea when maxillomandibular advancement is being considered. ^[7]

The surgery-first approach means the jaw operation is performed before lengthy preoperative orthodontic treatment.

Instead of fully aligning and decompensating the teeth before surgery, much of the orthodontic correction is carried out afterward.

Potential advantages include:

• Earlier correction of the jaw and facial imbalance
• Earlier improvement in the airway when treating obstructive sleep apnea
• Avoidance of the temporary worsening that can occur during dental decompensation
• A shorter period wearing braces before surgery
• Earlier improvement in appearance and quality of life

Recent reviews suggest that the surgery-first approach may allow patients to experience some quality-of-life benefits sooner. However, it requires careful patient selection, accurate digital planning, and tightly coordinated postoperative orthodontic care. ^[8]

Surgery first may not be appropriate when there is severe crowding, major transverse discrepancy, markedly compensated front teeth, unstable tooth contacts, or insufficient dental surfaces to guide the surgical bite.

The approach does not necessarily eliminate braces. It usually shifts a larger portion of orthodontic treatment to the period after surgery.

Clear aligners may be an option for selected patients undergoing maxillomandibular advancement surgery.

They can potentially be used for:

• Presurgical tooth alignment
• Dental decompensation
• Space management
• Postsurgical bite refinement
• Final detailing and retention

Clear aligners may be less visible and easier to remove for eating and cleaning. However, jaw surgery creates additional challenges that are not present in routine aligner treatment.

Traditional braces offer built-in hooks and rigid wires that can be used for surgical positioning and elastic bands. When a patient uses clear aligners, the surgical team may need temporary buttons, bonded attachments, arch bars, fixation screws, or specially designed surgical splints.

A 2025 systematic review concluded that clear aligners may produce results comparable to fixed appliances in some orthognathic surgery patients, but the available evidence remains limited. Clear aligners should therefore be considered a possible alternative rather than a universally interchangeable replacement for braces. ^[9]

The suitability of aligners depends on the complexity of the required tooth movements, the planned surgery, the patient’s ability to wear the aligners consistently, and the experience of the treating team.

Straight-looking teeth do not automatically mean braces are unnecessary.

The orthodontist must evaluate:

• The angle of the front teeth
• The position of the tooth roots
• The shape and width of each dental arch
• The relationship between the upper and lower dental midlines
• The amount of overbite and horizontal overlap
• The way the back teeth contact
• Whether the teeth are compensating for the jaw position
• Whether the proposed advancement will preserve or disrupt the bite

A person may have an attractive smile but still have front teeth that are tilted to conceal a recessed jaw. Correcting that tilt before surgery may be important even though the teeth do not appear crooked.

Conversely, a patient whose teeth and roots are well positioned and whose bite can be preserved during advancement may not need lengthy orthodontic preparation.

Braces can add inconvenience during the early recovery period, but they usually serve a useful purpose.

Swelling, limited mouth opening, cheek irritation, and elastic bands can make brushing more difficult. Food may collect around brackets and wires, particularly while the patient is following a liquid or soft-food diet.

Helpful measures may include:

• Using a small, soft toothbrush
• Brushing gently after meals
• Using prescribed mouth rinses
• Cleaning around hooks and wires carefully
• Applying orthodontic wax to irritating areas when permitted
• Following the surgeon’s instructions regarding water flossers
• Attending scheduled orthodontic and surgical follow-ups

Oral hygiene is particularly important because inflamed gums, plaque accumulation, broken brackets, and dental decay can complicate treatment.

Patients should contact the orthodontist or surgeon if a wire becomes displaced, a bracket breaks, an elastic hook causes injury, or the bite suddenly changes.

The decision should be made jointly by the surgeon and orthodontist after reviewing the patient’s bite, airway, teeth, jaw structure, facial proportions, and treatment priorities.

Assessment may include:

• Clinical examination of the teeth and jaws
• Dental photographs
• Digital dental scans or impressions
• Panoramic and cephalometric imaging
• Three-dimensional imaging when indicated
• Computerized surgical planning
• Evaluation of gum and dental health
• Sleep testing and airway assessment when treating obstructive sleep apnea

The team should be able to explain not only whether braces are recommended, but what specific orthodontic problem they are intended to correct.

Patients may wish to ask:

• Are my teeth compensating for my current jaw position?
• How much orthodontic treatment is expected before surgery?
• Could my current bite be preserved during the advancement?
• Am I a candidate for a surgery-first approach?
• Can clear aligners be used in my case?
• What will be used for surgical stabilization if I do not have braces?
• How long are braces likely to remain after surgery?
• Will my bite temporarily worsen before the operation?
• What type of retainer will I need afterward?
• Who will coordinate changes if the surgical and orthodontic plans need to be revised?

A clear answer to these questions can help patients distinguish necessary orthodontic preparation from treatment that may be optional.

Most people undergoing traditional maxillomandibular advancement surgery need braces both before and after the operation.

Before surgery, orthodontic treatment aligns the teeth, removes dental compensation, coordinates the upper and lower arches, and creates a bite that allows the jaws to be repositioned accurately. The braces usually remain in place during surgery and may provide attachment points for surgical wires or elastic bands.

After surgery, braces refine the bite, close small spaces, improve tooth contacts, and help the teeth settle into their new relationship. Retainers are normally used after the braces are removed.

However, braces are not unavoidable in every case. Patients with an already stable bite—particularly some people undergoing maxillomandibular advancement primarily for obstructive sleep apnea—may qualify for limited orthodontics, clear aligners, a surgery-first protocol, or surgery using temporary fixation appliances instead of conventional braces.

The important question is not simply, “Can the surgery be done without braces?” It is whether avoiding braces will still allow the surgeon and orthodontist to achieve a stable bite, adequate airway improvement, balanced facial proportions, and a predictable long-term result.