Jaw Surgery & Orthodontics in Austin

Combined orthodontic-surgical treatment at Limestone Hills coordinates with board-certified Austin oral and maxillofacial surgeons for cases where teeth-only movement cannot achieve a stable bite or facial balance. Pre-surgical orthodontics positions the teeth so the surgeon can move the jaws into the planned position; post-surgical orthodontics finishes the bite once the bones have healed. Most combined cases run 24 to 36 months end-to-end. Free 3D CBCT scan + treatment-planning consultation included; the surgical consult with the partnering oral surgeon is scheduled separately and billed by the surgical practice.

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Comprehensive guide to jaw surgery for improved function and facial appearance at Limestone Hills Orthodontics in Austin, TX.
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When Is Jaw Surgery Needed?

Orthodontics moves teeth through bone.

When the bones themselves are in the wrong position relative to one another (a lower jaw too far forward of the upper, an upper jaw too narrow to support the tongue, an asymmetric face from one-sided growth, or a vertical excess that keeps the lips from closing comfortably), the only way to produce a stable result is to reposition the bones surgically and then align the teeth into the new bite.

Combined orthodontic-surgical treatment is the standard of care for these cases. Dr. Viecilli completed his orthodontic specialty residency at NYU College of Dentistry and his PhD in orthodontic biomechanics at Loma Linda University, where surgical-orthognathic case management was a core part of the residency curriculum.

Conditions That May Require Jaw Surgery

Class III (Underbite)

Lower jaw sitting forward of the upper jaw. Surgical correction repositions the lower jaw posteriorly or advances the upper jaw, depending on which jaw is the source of the discrepancy. Combined with 6 to 12 months of pre-surgical braces.

Severe Class II Skeletal

Lower jaw positioned far behind the upper jaw, often with chin retrusion and lip incompetence. Mandibular advancement surgery moves the lower jaw forward; orthodontics aligns the teeth into the new bite.

Anterior Open Bite

Upper and lower front teeth that do not meet when the back teeth are touching. Surgical impaction of the upper jaw closes the open bite by rotating the mandible forward and up. Combined with orthodontics to detail the final bite.

Asymmetric Jaw Growth

One side of the face longer than the other from differential growth or a previous trauma. Surgical correction repositions the affected jaw to restore facial symmetry, with orthodontics coordinating tooth positions through the asymmetry correction.

Maxillary Transverse Deficiency (SARPE)

Upper jaw too narrow for the tongue posture and tooth alignment, in adults beyond the age where MARPE works. Surgically-assisted rapid palatal expansion (SARPE) cuts the bone and re-expands it; orthodontics coordinates the new arch shape.

Vertical Maxillary Excess

Long-face syndrome with excessive gum display and a tendency for lip incompetence. Surgical impaction of the upper jaw and rotational repositioning of the mandible restores facial proportion. Orthodontics coordinates the bite through the vertical change.

Types of Jaw Surgery Limestone Hills Coordinates

Le Fort I Osteotomy

A Le Fort I osteotomy repositions the upper jaw (maxilla) as a single segment, addressing a maxilla that is too far forward, too far back, or set at a vertical height that causes excessive gum display. The oral and maxillofacial surgeon performs the procedure; Dr. Viecilli aligns the upper teeth beforehand so the new bite is stable the moment the jaws are wired or banded together in the operating room. Post-surgical detailing at Limestone Hills settles the teeth into the corrected jaw position.

Le Fort II Osteotomy

A Le Fort II osteotomy advances the midface as a larger pyramidal segment that includes the nasal bones and the central portions of the orbit, correcting deficiencies that a standard Le Fort I cannot address. The surgical cut is higher and the movement more complex, making precise pre-surgical dental positioning critical. Dr. Viecilli coordinates the orthodontic preparation and post-surgical detailing so the final occlusion matches the surgical plan.

Bilateral Sagittal Split Osteotomy (BSSO)

A bilateral sagittal split osteotomy moves the lower jaw (mandible) forward or backward by splitting the posterior ramus on each side and repositioning the tooth-bearing segment. BSSO is the most common procedure for correcting severe Class III underbites and Class II overbites where skeletal camouflage with braces or aligners alone would compromise the facial profile or long-term stability. Limestone Hills handles the pre-surgical alignment and post-surgical bite finishing; the partnering oral surgeon performs and bills the surgical procedure separately.

2-Piece and 3-Piece Maxillary Osteotomies

When the upper jaw needs to be widened, leveled, or differentially repositioned in ways a single-piece Le Fort I cannot achieve, the surgeon divides the maxilla into two or three independent segments and moves each to a planned position. These segmental cuts allow correction of arch width discrepancies, arch-form asymmetries, and leveling of the curve of Spee directly at the skeletal level. Dr. Viecilli plans the pre-surgical tooth positions for each segment so the pieces fit together precisely after fixation.

Distraction Osteogenesis Maxillary Expansion (DOME)

DOME uses a surgically placed distraction device to gradually separate a surgically cut midpalatal suture, generating new bone through incremental expansion over several weeks rather than a single-stage surgical movement. The approach is used for adults who need substantial maxillary width gains that exceed what a MARPE (mini-implant-assisted rapid palatal expander) can reliably achieve. Dr. Viecilli places the orthodontic appliance, activates the distraction protocol, and monitors consolidation; the oral surgeon performs the initial osteotomy procedure, which is billed separately from the Limestone Hills orthodontic coordination fee.

Segmental Osteotomies for Ankylosis

When a tooth is ankylosed (fused to the surrounding bone) and cannot be moved orthodontically, the oral surgeon can perform a segmental osteotomy to mobilize the ankylosed dentoalveolar segment and reposition the entire block of bone and tooth together. This approach is used when conventional forced eruption or surgical exposure and traction have failed or are contraindicated. Dr. Viecilli coordinates the pre-surgical orthodontic setup and the post-surgical finishing to integrate the repositioned segment into the corrected arch.

TMJ Surgery

Temporomandibular joint surgery ranges from minimally invasive arthroscopic procedures to total joint replacement and is performed by an oral and maxillofacial surgeon when conservative management has not resolved the underlying structural problem. Orthodontic treatment at Limestone Hills is coordinated around the surgical plan: teeth are positioned to support the new joint posture before or after the procedure, depending on the case. Dr. Viecilli works directly with the treating surgeon to define the occlusal targets that the orthodontic phase will establish.
For other surgical procedures, please schedule a free consultation. Dr. Viecilli will review the case and confirm whether the planned surgery is one Limestone Hills can coordinate.

The Surgical Orthodontic Timeline

1

Pre-Surgical Orthodontics

6–18 months

Braces align the teeth into the position the surgeon needs to establish a stable bite at the moment the jaws are repositioned. For selected cases where the tooth movements are well-suited to clear aligner mechanics, the pre-surgical phase may begin with aligners and transition to braces for the final detailing and surgical stabilization. Dr. Viecilli determines the sequencing at the consultation.

2

Surgical Procedure

Single-day procedure

The oral and maxillofacial surgeon performs the jaw repositioning at a partner surgical facility while the orthodontic appliances are in place. Braces or surgical hooks allow the surgeon to apply inter-maxillary fixation precisely, holding the new jaw position while initial healing begins. The surgical and anesthesia fees are billed separately by the surgical practice.

3

Post-Surgical Detailing

3–9 months

Once the surgeon clears the patient for full orthodontic forces, braces are used to detail the bite, settle individual teeth into the corrected jaw position, and close any minor gaps that opened during healing. The post-surgical phase tends to move quickly because the jaw foundation is now in the correct position and teeth can express their final movements without skeletal resistance.

For selected cases, Dr. Viecilli and the surgical team may recommend a surgery-first approach where the surgical procedure happens before the orthodontic phase. The total treatment timeline varies by case complexity, the type of surgery, and the bite goal. Dr. Viecilli reviews the timeline at the consultation and updates it at every phase transition.

Surgery-First Approach

Surgery-first orthognathic treatment reverses the traditional sequence: the surgical jaw repositioning happens before the majority of orthodontic tooth movement. The advantage is that the patient sees the facial-balance improvement immediately at month 1 instead of waiting 12 to 18 months through pre-surgical orthodontics. The trade-off is more complex digital planning, a less stable initial bite for the first 6 weeks, and a slightly longer post-surgical orthodontic phase. Limestone Hills offers surgery-first cases when the patient and partnering surgeon both agree the trade-offs are appropriate.

Coordinated Surgical Team

Oral & Maxillofacial Surgeon

Dr. Jonathon Jundt, DDS, MD

Limestone Hills normally coordinates orthognathic surgical cases with Dr. Jonathon Jundt, who is dual-credentialed as both a Doctor of Dental Surgery (DDS) and a Doctor of Medicine (MD). Dr. Viecilli works directly with Dr. Jundt’s office on the surgical plan, the operating-room timing, and the post-surgical orthodontic detailing so the patient experiences a single coordinated treatment plan rather than two unrelated providers.

For cases where a different surgeon is preferred, Limestone Hills coordinates the orthodontic phase with the patient’s chosen oral and maxillofacial surgeon. The orthodontic plan is built around the surgical plan in either case.

Why Limestone Hills Handles Surgical Coordination

Orthodontics is necessary for nearly 100% of orthognathic surgical cases. Pre-surgical alignment establishes the tooth position the surgeon needs to lock the new bite at the moment the jaws are repositioned, and post-surgical detailing settles the teeth into the corrected jaw position once initial healing is complete. Without coordinated orthodontic phases on either side of the procedure, the surgical correction cannot be stabilized.

Many cases referred for surgical evaluation can be addressed without surgery when diagnosed by the orthodontist first. A thorough Limestone Hills consultation includes 3D CBCT imaging, skeletal analysis, and a complete bite evaluation; in some cases the orthodontic plan alone can correct the bite, and in others a non-surgical alternative such as MARPE or selective extraction mechanics can resolve the discrepancy. Dr. Viecilli reviews every case against this question before recommending surgical referral.

When surgery is the right answer, Limestone Hills handles the orthodontic phases (pre-surgical alignment + post-surgical detailing) and coordinates directly with the partnering oral surgeon’s office. Patients receive a single unified treatment plan with a clear timeline, defined orthodontic and surgical fees, and one orthodontic team that follows the case from intake to retention.

Cost & Insurance

Limestone Hills verifies the orthodontic portion of insurance benefits at the consultation. The surgical portion of the case is verified and coordinated with the partnering oral surgeon’s office, which has its own billing team for the surgical and anesthesia fees.

The orthodontic phases (pre-surgical and post-surgical) are billed as a comprehensive orthodontic case at Limestone Hills, with the same financing options available to non-surgical patients: in-house monthly financing through OrthoSync (0% interest, no credit check), Cherry, CareCredit, or pay-in-full with the 3% comprehensive-fee discount.

The surgeon’s practice issues a separate cost estimate for the operating-room procedure, anesthesia, and any in-hospital or surgical-center fees. Most medical insurance plans cover orthognathic surgery when medical-necessity criteria are met; the surgeon’s office handles the medical-insurance pre-authorization. Patients receive both estimates (orthodontic + surgical) before any phase begins, so the total treatment commitment is transparent from the start.

Frequently Asked Questions

How do I know if I need jaw surgery?

The 3D CBCT scan at the free Limestone Hills consultation answers this question. If the bones are in the wrong position relative to one another and tooth-only movement cannot produce a stable bite, Dr. Viecilli discusses the surgical pathway and refers to a partnering oral surgeon for the surgical consult.

How long does combined orthodontic-surgical treatment take?

Most combined cases run 24 to 36 months end-to-end. Pre-surgical orthodontics typically takes 6 to 12 months, the surgery itself is one operating-room visit with 6 to 8 weeks of healing, and post-surgical orthodontics finishes the bite over 6 to 12 more months.

Does insurance cover the surgery?

Medical insurance (not dental) typically covers orthognathic surgery when there is a documented functional indication: airway obstruction, inability to chew, severe TMJ pain. The partnering oral surgical practice handles the medical pre-authorization. Dental insurance covers the orthodontic component up to the lifetime orthodontic maximum, same as any other orthodontic case.

Can I avoid surgery with aligners or MARPE?

Sometimes. MARPE can resolve mild-to-moderate maxillary transverse deficiency in adults that previously required SARPE surgery. Mild Class II cases sometimes resolve with TADs (temporary anchorage devices) and Class II elastics instead of mandibular advancement surgery. Severe skeletal discrepancies and asymmetric growth still require surgical correction; no aligner or MARPE workaround produces a stable result for those cases.

What is the recovery like?

Most patients are off work for 1 to 2 weeks after orthognathic surgery. Soft-food diet for 4 to 6 weeks. Significant facial swelling that peaks at day 3 to 5 and resolves over 4 to 6 weeks. Numbness in the lip and chin (Class II/III cases) that resolves over 6 to 12 months. Most patients return to full normal activity by week 8. Limestone Hills schedules adjustment visits during the recovery so the orthodontic phase resumes seamlessly.

Conditions Surgical Orthodontics Treats

Most patients arrive on this page after being told their bite cannot be corrected by braces or aligners alone. The conditions that most commonly route to surgical coordination:

Severe overbite with a Class II skeletal jaw relationship.
Skeletal underbite (Class III) where growth has completed.
Skeletal open bite that cannot be closed with TADs alone.
Severe transverse deficiency requiring SARPE plus an in-house palatal expander.
Pre-surgical braces alignment followed by post-surgical refinement at Limestone Hills Orthodontics.
Browse all orthodontic appliances used during the surgical workflow.
Ready to discuss? Book a surgical-coordination consultation — includes a complimentary 3D CBCT for skeletal evaluation.