Pre-Surgical Double-Jaw Surgery for Asymmetry, Underbite, and Gummy Smile Treatment with Invisalign Lite

Hello.

This is Apgujeong Orthodontic Clinic.

Today, I’d like to introduce a case of pre-surgical double-jaw surgery treatment for asymmetry and underbite.

When severe skeletal asymmetry or similar issues make it difficult to achieve a complete solution with orthodontic treatment alone, orthodontic treatment combined with double-jaw surgery is needed.

In the past, the process always had to go through pre-surgical orthodontics, double-jaw surgery, and post-surgical orthodontics.

Nowadays, depending on the condition, there are many cases where pre-surgical treatment, meaning double-jaw surgery first, is performed, followed only by finishing orthodontic treatment.

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Today, I’ll introduce a case in which post-surgical orthodontic treatment was simply completed with Invisalign Lite after pre-surgical double-jaw surgery.

This patient was referred from a hospital specializing in oral and maxillofacial surgery.

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Double-jaw surgery had been planned due to asymmetry, gummy smile, and other concerns.

After a one-month recovery period following pre-surgical treatment, this was the occlusion state when the patient visited our clinic in January 2025.

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One lower front tooth shows discoloration.

Sometimes the nerve temporarily dies right after surgery and then recovers, so we will observe it for now.

The two front teeth show protrusion of the NaBichi teeth.

The molar occlusion is open.

The alignment of the front teeth is crooked.

A case at this level can be resolved within 14 aligners.

In other words, Invisalign Lite is sufficient.

Starting in February 2025, the patient began wearing the first set of 14 aligners.

Whether it is double-jaw surgery or contouring surgery, immediately after surgery involving the facial bones, the surgery itself acts as a kind of trauma, and due to the RAP phenomenon, there is a golden period for tooth movement in which teeth move quickly while root resorption is minimal.

If this period is used appropriately, post-surgical orthodontic treatment can be completed quickly and safely.

Here is the condition after all 14 aligners were worn in June 2025.

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Several hooks for elastics to stabilize the molar occlusion have been attached.

The lower front tooth, which had discolored immediately after surgery, is recovering its normal color as the nerve returns.

The occlusion is in good condition.

The alignment is also nearly complete.

Now, let’s look at the facial appearance comparison before the double-jaw surgery and after post-surgical orthodontic treatment.

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If we compare the facial appearance before double-jaw surgery and after post-surgical orthodontic treatment, you can see that, in addition to alignment, the canting of the occlusal plane caused by asymmetry and the gummy smile have improved.

The improvement in the gummy smile and canting was achieved through double-jaw surgery, not post-surgical orthodontic treatment.

Sometimes, after double-jaw surgery, the amount of upper front tooth exposure decreases significantly.

In other words, the face becomes smaller and more attractive, but the front teeth are not visible well, creating another concern.

However, this patient maintained good front tooth exposure even after double-jaw surgery.

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The angle of the front teeth is also good.

To further improve the slight midline discrepancy and the slight front-tooth alignment, additional aligners were made.

Here is the condition after wearing all the additional aligners for about three months from July to October 2025.

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The midline is exactly aligned.

The molar occlusion shows a tight Class I occlusion relationship.

Now let’s look at the before-and-after occlusion comparison.

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It took a total of 10 months from surgery to completion of post-surgical orthodontic treatment.

There is no root resorption, and root parallelism is good.

I hope this post is helpful for those considering double-jaw surgery.