Braces Before & After Surgery

If you’ve been told you need jaw surgery alongside orthodontic treatment, the natural question is: what actually happens, in what order, and for how long? Understanding the full sequence — from the first set of braces to the final retainer — makes the process far less intimidating and helps you know what to expect at each stage.

Surgical orthodontics combines two disciplines: an orthodontist to align the teeth, and an oral and maxillofacial surgeon to reposition the jaw. Neither works in isolation. The timing and coordination between them is what determines the outcome.

Why Braces and Surgery Are Combined

Braces alone can correct how teeth sit within the jaw. They cannot correct the position of the jawbone itself. When someone has a skeletal discrepancy — a jaw that is too far forward, too far back, or asymmetrical — moving teeth alone cannot fix the underlying structure.

This is the difference between a dental problem and a skeletal one. Cases involving significant overbite, underbite, crossbite, or open bite at the jaw level typically require orthognathic surgery: surgical repositioning of the upper jaw (maxilla), lower jaw (mandible), or both.

Which Comes First? Why The Order Matters

A common misconception is that surgery happens first. In the traditional approach, braces come first.

Presurgical Orthodontics

Before surgery, braces spend several months — often 6 to 18 — aligning the teeth within each jaw independently. This step, called decompensation, may temporarily make the bite look worse. Teeth that shifted to compensate for the jaw’s position are being straightened back to where they truly belong, so the surgeon has an accurate structure to work with.

Surgery

Once teeth are properly positioned within each arch, the surgeon repositions the jawbone. Common procedures include Le Fort I osteotomy for the upper jaw, bilateral sagittal split osteotomy for the lower jaw, or bimaxillary surgery when both jaws are involved. Plates and screws hold the bone in its new position while it heals.

Postsurgical Orthodontics

After surgery, braces remain in place for several more months. Their role shifts to fine-tuning the bite — making small adjustments so the upper and lower teeth meet precisely now that the jaws are correctly aligned. Elastics are often used during this phase to guide the bite into its final position.

An Alternative Sequence: Surgery-First

Some cases use a surgery-first approach, where the jaw is repositioned before braces are placed. This can shorten overall treatment time, since decompensation happens after surgery rather than before. It requires precise digital planning up front and is not suitable for every case.

How Long the Full Process Takes

Combined treatment typically spans 12 to 24 months from the first orthodontic appointment to the removal of braces. This breaks down roughly as follows:

  • Presurgical orthodontics: 6–18 months
  • Surgery and initial healing: several weeks
  • Postsurgical orthodontics: 6–12 months
  • Retention: ongoing, indefinitely

What Recovery Involves

Recovery from jaw surgery differs from typical orthodontic adjustments. Swelling and bruising are expected in the first one to two weeks. A liquid or soft-food diet is usually required initially, progressing gradually as healing allows.

Temporary numbness in the lips, chin, or cheeks is common as nerves recover, and it typically resolves over weeks to months. Jaw movement is often restricted early on, with elastics helping guide the bite while soft tissue and bone heal.

Diagnosis: How the Plan Is Determined

Before any treatment begins, the orthodontist and surgeon evaluate the case together. This typically involves:

  • Cephalometric X-rays to measure jaw and facial relationships
  • 3D CBCT imaging for detailed bone structure
  • Digital scans or impressions of the teeth
  • Virtual surgical planning to map the exact repositioning needed

This diagnostic phase determines whether a traditional or surgery-first sequence is appropriate, and what specific procedures are needed.

What Happens After Braces Come Off

Once braces are removed, a retainer maintains the corrected position of the teeth. Because the jaw itself has been surgically repositioned, the skeletal correction is permanent — the retainer’s role is solely to prevent minor dental shifting over time, not to maintain the jaw’s position.

Who Actually Needs This Combined Approach

Not every bite issue requires surgery. Combined treatment is generally reserved for skeletal discrepancies significant enough that teeth movement alone cannot resolve the bite, facial balance, or functional issues involved — including difficulty chewing, speech complications, or airway restriction. An orthodontist and surgeon jointly assess whether a case falls into this category during the initial evaluation.