This 14 year old boy had a significant underset jaw, with upper teeth becoming unprotected by the recessed lower lip, and leading to increased rates of knocks and potential chipping.

Knocked front teeth are very common with retruded jaws, as the recessed chin does not allow the lower lip to cover and naturally protect the upper teeth.

Knocking tooth crowns leads to significant risk of devitalising teeth, which in turns leads to expensive root canal and dental restorative care. Overall the health and longevity of these teeth is much reduced.   Close up of upper central incisors. Note the significant corner chip of the tooth at right.

By moving the lower jaw forward, the lower lip comes into a natural lip posture, with front teeth becoming naturally covered with the soft, impact absorbing lip.

Comparison photos showing improved lip protection of upper front teeth, achieved with forward growth of lower jaw, with associated improved lip competence and natural lip coverage. Note the improvement in lower jaw and facial height that comes with jaw advancement. Time difference between photos is 8 weeks.

Surgery to distract requires a 1.5 hour operation, and which may be either day-stay alone, or with a short period of hospital stay that follows.

Distraction usually starts 1-2 days after surgery, and is a home based procedure, although oversight and guidance is provided by the surgeon.

Distraction is usually 2 turns a day (or 1mm of growth), and proceeds as long as is necessary. Most cases of jaw distraction require 8-12 mm of jaw growth, with distraction turns occurring over 8-12 days.

Distraction appliances are left in place for a further 4-6 weeks, and if braces are required, they are usually placed in this period. The distractors are then removed in another 1/2 hour day-stay operation.

Before and after treatment photos showing changes to the bite. The lower teeth are biting heavily into the palate, making biting impossible. Correction with forward distraction allows for normalisation of the incisor bite, and the opportunity for teeth to erupt normally against their opposites, naturally improving interdigitation. Photo differences are 8 weeks.

Specialist orthodontics provided by Dr Peter Vaughan, Orthodontist, and distraction surgery provided by Dr Paul Coceancig, Specialist Oral & Maxillofacial Surgeon.

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