Surgical Orthodontics and Jaw Surgery in Shelby Township
Surgical orthodontics pairs braces or aligners with jaw surgery (orthognathic surgery). Fredal Orthodontics works on these cases with oral surgeons. The surgeon does the surgery. Dr. Thomas Fredal Jr. is an orthodontic specialist. He plans and runs your braces or aligner care before and after it.
*For new patients only. Patients transferring from another orthodontist: $250 consultation fee, credited toward treatment if they start here.
When Is Orthognathic Surgery Considered?
The choice between orthodontic treatment alone and orthognathic surgery depends on the case. Dr. Fredal looks at how severe the skeletal discrepancy is, meaning how far the jaw bones are out of line with each other.
He also weighs facial balance and profile, the bite, tooth position, function and your goals for treatment. When moving the teeth alone cannot properly correct the jaw problem, he may discuss surgical orthodontic treatment with you.
Class III (Underbite)
In a Class III bite, or underbite, the lower jaw sits forward of the upper jaw.
Severe Class II Skeletal
In a severe skeletal Class II bite, the lower jaw sits far behind the upper jaw.
Anterior Open Bite
In an anterior open bite, the upper and lower front teeth do not meet when the back teeth touch. Open-bite treatment depends on the cause and how severe it is. For a more significant skeletal open bite, Dr. Fredal’s approach may include an evaluation for orthognathic surgery when appropriate.
Asymmetric Jaw Growth
With asymmetric jaw growth, one side of the jaw has grown more than the other, so the jaws are uneven.
Maxillary Transverse Deficiency
Maxillary transverse deficiency means the upper jaw is too narrow from side to side.
Vertical Maxillary Excess
Vertical maxillary excess means the upper jaw is too long from top to bottom.
Types of Orthognathic Surgery Fredal Orthodontics Coordinates
Le Fort I Osteotomy
An osteotomy is a planned cut in a bone. A Le Fort I osteotomy is a planned cut in the upper jaw (maxilla). Fredal Orthodontics coordinates this surgery. It also coordinates the Le Fort II osteotomy, a cut that also takes in the nose area.
Bilateral Sagittal Split Osteotomy (BSSO)
A bilateral sagittal split osteotomy (BSSO) is a planned split on both sides of the lower jaw (mandible). Fredal Orthodontics coordinates BSSO with the surgeon.
Two-Piece and Three-Piece Maxillary Osteotomies
These are cuts that divide the upper jaw into two or three parts. Fredal Orthodontics coordinates both. It also coordinates segmental osteotomies (cuts around a small section of bone) for ankylosis. Ankylosis means a tooth has fused to the bone.
Surgically Assisted Rapid Palatal Expansion (SARPE)
SARPE stands for surgically assisted rapid palatal expansion. It pairs a palatal expander, an appliance for the roof of the mouth, with upper-jaw surgery. Dr. Fredal coordinates SARPE with an oral surgeon. Fredal Orthodontics manages the orthodontic treatment before and after the surgery. The practice also coordinates DOME, which stands for distraction osteogenesis maxillary expansion.
The Surgical Orthodontic Timeline
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1
Pre-Surgical Orthodontics
6 to 12 monthsThis is the orthodontic phase before the jaw surgery. In this phase, Dr. Fredal uses braces or Invisalign, when appropriate.
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2
Surgical Procedure
By the oral surgeonThe surgeon performs the jaw surgery at a hospital or surgery center. Every surgical case is planned with Virtual Surgical Planning (VSP), a 3D computer plan of the surgery, and Dr. Fredal coordinates that plan with the surgeon.
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3
Post-Surgical Detailing
3 to 9 monthsThis is the orthodontic phase after the jaw surgery. Dr. Fredal uses it for detailing, which means fine-tuning how the teeth fit together.
Surgery-First Approach
Fredal Orthodontics does not offer a surgery-first approach, in which the jaw surgery comes before any orthodontic treatment. Every surgical case starts with the orthodontic phase before surgery.
Coordinated Surgical Team
A Partner Oral Surgery Practice
An oral surgeon does the jaw surgery, outside the practice. Fredal Orthodontics has a partner oral surgery practice for these cases. Dr. Fredal works out each plan with the surgeon.
Some cases need other experts too. He then works with general dentists, gum specialists (periodontists), ear, nose and throat (ENT) doctors and others. Fredal Orthodontics also coordinates TMJ surgery, which is surgery on the jaw joint.
How Dr. Fredal Plans Surgical Cases
Fredal Orthodontics is a private practice with one doctor. Dr. Fredal plans and oversees each patient’s treatment himself. You see the same orthodontist from start to finish.
He diagnoses every case in 3D. He uses an i-CAT CBCT scan (a 3D X-ray) along with an iTero digital scan. When he plans treatment, he looks at the roots, the bone around them, how the jaws relate, the airway and the face, not just the tops of the teeth.
In his view, these details can change big decisions. One is whether to widen the jaw, remove teeth or guide growth. Another is whether to combine braces and Invisalign. A third is whether to suggest surgery or care shared with other experts (interdisciplinary treatment).
Cost & Insurance
Your orthodontic care and your corrective jaw surgery are billed separately.
The Fredal Orthodontics fee covers the orthodontic part of treatment. It covers diagnosis and treatment planning. Braces or Invisalign are included when appropriate. It also covers working with your surgeon, Virtual Surgical Planning (VSP) and all orthodontic visits before and after surgery. The orthodontic fee does not change with how long treatment takes.
The surgeon and the hospital or surgery center bill on their own. Their bills cover the surgery, facility fees, anesthesia and any related medical services. The practice’s team helps plan care with your surgeon. Before treatment begins, the team explains what each provider bills. That way, you know what to expect.
Frequently Asked Questions
How do I know if I need jaw surgery?
The first step is a consultation with Dr. Fredal. He reviews your 3D records with you and gives his treatment recommendation, which may include a talk about jaw surgery. You also get the exact cost of the orthodontic treatment in writing. The surgeon bills for the surgery separately.
The consultation is free for new patients. Patients transferring from another orthodontist pay a $250 consultation fee, credited toward treatment if they start here.
How long does combined orthodontic-surgical treatment take?
It depends on the case. The orthodontic phase before surgery typically lasts 6 to 12 months. After the jaw surgery, the detailing phase that fine-tunes the bite typically lasts 3 to 9 months. The time for each phase varies from case to case. Dr. Fredal gives you a treatment-time estimate for your own case after his diagnostic evaluation.
Does insurance cover the surgery?
In many cases, medical insurance may provide benefits for the surgical part of treatment, if specific medical criteria are met. Orthodontic treatment is typically covered under any orthodontic dental benefits you have. Fredal Orthodontics is in network with Delta Dental. With an out-of-network plan, the practice files the claim for you. You also get your benefits verification in writing.
Are there options other than jaw surgery?
For some problems, yes. For an open bite, Dr. Fredal may use Invisalign, braces, posterior intrusion (moving back teeth deeper into the bone) or TADs (small temporary mini-screws), depending on the cause and severity. For adults, he treats some skeletal cases with MARPE, an expander held by mini-screws in the roof of the mouth. A specialist outside the practice places the mini-screws.
Can I have Invisalign instead of braces before surgery?
Yes, when it is appropriate for your case. Dr. Fredal uses braces or Invisalign before surgery, and the orthodontic fee covers either one. For selected cases, he also offers hybrid sequencing: Invisalign first, then braces. He recommends the option that fits your teeth and your surgical plan.
Does treatment ever start with the jaw surgery?
No. Fredal Orthodontics does not offer a surgery-first approach, which means jaw surgery before any orthodontic treatment. Every surgical case starts with the orthodontic phase, using braces or Invisalign when appropriate. The oral and maxillofacial surgeon operates after that phase. Dr. Fredal then finishes the orthodontic care.
Talk With Dr. Fredal About Surgical Orthodontics
The consultation is free for new patients. It takes 50 minutes. Dr. Fredal runs every consultation himself and spends 20 of those minutes with you.
*For new patients only. Patients transferring from another orthodontist: $250 consultation fee, credited toward treatment if they start here.