Why Do Patients Seek Custom Jaw Implants After Orthognathic Surgery?

Understanding Orthognathic Surgery: The Basics

To appreciate the link, you first need to understand what orthognathic surgery does. The mandible, or lower jaw, is essentially a three-dimensional structure. While it appears U-shaped, it behaves more like a continuous ring. For example, a fracture in one part of the mandible often leads to secondary fractures elsewhere because of its interconnected nature.

Orthognathic surgery aims to reshape the mandible, but the adjustments are often limited to two dimensions. A common example is the bilateral sagittal split osteotomy (BSSO), a procedure where cuts are made on both sides of the jaw to advance the lower teeth and chin forward or set it back. This dissociates the teeth-bearing segment from the vertical ramus of the mandible (the back portion of the jaw) while keeping the nerves intact—a critical aspect of the procedure.

After the bone is repositioned, screws are used to stabilize it. The result is a more aesthetically pleasing profile, improved occlusion, and sometimes better airway function. However, this two-dimensional augmentation leaves other areas unchanged, particularly the gonial angle (the prominent angle at the back of the jaw). This static feature often creates a desire for further enhancement, leading patients to explore custom implants.

Why Custom Jaw Angle Implants?

Patients seek custom jaw implants for several reasons after orthognathic surgery. Common concerns include:

• Irregularities at the osteotomy site: Some patients feel a palpable "step-off" where the bone was cut and repositioned.
• Gonial angle aesthetics: The jaw angle may appear too obtuse, too high, or insufficiently wide.
• Residual asymmetry: While the occlusal plane (the alignment of the teeth) is improved, the jawline may still have visible asymmetry or cant.

Orthognathic surgery reshapes the jaw in two dimensions, which can enhance the profile and alignment but often leaves the gonial angles underdeveloped. Custom implants address these issues by providing three-dimensional augmentation, improving height, width, and projection.

Advanced Cases and Custom Solutions

Let me share a recent case to illustrate the transformative potential of custom jaw implants. The patient had undergone a BSSO and mid-face surgery to advance a small mandible for better airway function. While the surgery achieved its primary goals, it left the patient with residual asymmetry, a narrow mandible, and a chin cant.

Using a CT scan, we designed custom implants tailored to their unique anatomy. For the jaw angles, we added height and width to create a stronger gonial angle and better lateral projection. We also corrected the chin’s cant with a customized implant, achieving a more symmetrical and natural-looking result.

Why PEEK Implants?

I often recommend PEEK (polyether ether ketone) implants for these cases. PEEK is durable, biocompatible, and feels remarkably similar to natural bone. It doesn’t fragment like some materials and can be removed with relative ease if necessary. Additionally, custom PEEK implants are precisely designed to fit the patient’s anatomy, making them far superior to off-the-shelf silicone implants in complex cases.

Final Thoughts

The relationship between orthognathic surgery and custom jaw implants highlights the evolving nature of facial aesthetics. While orthognathic surgery provides significant functional and aesthetic benefits, it often leaves room for refinement, especially in terms of three-dimensional jawline enhancement.

Custom jaw angle implants fill this gap, offering a tailored solution to address residual concerns and improve overall facial harmony. If you’ve had orthognathic surgery and feel there’s still something missing in your jawline, custom implants might be the next step in achieving your aesthetic goals.

Thank you for taking the time to read this. If you’d like to learn more about jaw augmentation or other facial procedures, visit our practice or schedule a consultation. I look forward to helping you feel confident in your unique facial structure.

– Dr. Jonathan Zelken, MD