What is a skeletal problem?
A skeletal problem is present when the jawbones do not match each other front-to-back, vertically or sideways. The most common types are:
- Class II: Retruded lower jaw or protruding upper jaw
- Class III: Protruding lower jaw or retruded upper jaw
- Vertical problems: Skeletal open bite and deep bite
- Transverse problems: Narrow upper jaw, crossbite
- Asymmetries: The jaw shifted to one side
How is it diagnosed?
Facial and profile examination, an intraoral examination, panoramic and cephalometric (lateral skull) X-rays and measurements are carried out. Three-dimensional imaging may also be used when needed. These records show which jaw the problem comes from and to what extent.
Treatment during growth
Because the jaws are still growing in children and teenagers, growth can be guided with orthopaedic appliances:
- Widening a narrow upper jaw with palatal expansion
- Supporting upper jaw development with a face mask
- Correcting a retruded lower jaw with functional appliances or mandibular advancement with clear aligners
Because the effect of these treatments is limited to the growth period, timing is important.
Treatment in adults
Orthodontic camouflage
In mild and moderate skeletal problems, the bite and appearance can be improved by adjusting the inclination of the teeth without changing the position of the jaws. This approach can be carried out with clear aligners or braces. However, camouflage has a limited effect on the facial profile.
Orthognathic surgery
In marked skeletal discrepancies, orthodontics and jaw surgery are planned together. The process usually has three stages:
- Pre-surgical orthodontics: Bringing the teeth into the correct position on the jawbones
- Surgery: Repositioning of the lower and/or upper jaw by the jaw surgeon
- Post-surgical orthodontics: Detailed finishing of the bite and retention
In suitable cases, the pre- and post-surgical orthodontic stages can also be carried out with clear aligners. The decision on surgery is made jointly by the orthodontist and the jaw surgeon, taking into account the patient's concerns, expectations and records.