Skeletal Deformities

What Is A Skeletal Deformity?

A skeletal deformity in the face means that parts of the face either grew too much or too little. Sometimes the bones do not connect, which is called cleft. Facial skeletal deformities most often occur in the lower third of the face. Overbite, underbite, open bite, protruding jaw and asymmetry are different types of facial deformities.

The deformity presents itself in 3 ways: mild, moderate, and severe.

Please note that only in mild cases, orthodontics alone can achieve decent results without compromising facial aesthetics. In moderate and severe cases, only jaw surgery can achieve the best results.


There are two types of overbites: horizontal and vertical. Horizontal overbites involve teeth that go out in front of the bottom teeth when biting. Vertical overbites involve the top teeth overlapping the bottom teeth. The two overbites can appear very different, but are both caused by dental or skeletal issues. When the overbite has dental origin, it means that the teeth are the issue. This can be corrected by orthodontic treatment alone. The skeletal overbite means that the jaw is the problem and it needs to be corrected surgically. The first step in determining whether you need braces or surgery is determining whether the cause of your overbite is dental or skeletal. This can have an immense impact on the treatment path that is taken.

Open Bite

Open bite can be caused by many issues, such as condylar resorption, thumb sucking during childhood, trauma, and a large tongue.

Protruding Jaw/Underbite

It is very rare to see excess growth of the upper jaw (maxilla) in a forward direction. The mandible can be frequently forward, but this condition has to be carefully assessed. This is because sometimes the lack of growth in the upper jaw gives the illusion of a protruding lower jaw.

Gummy Smile

A gummy smile can be caused by a short lip, short teeth or most commonly vertical maxillary growth (VME).

Do you have a weak jawline, small chin and gummy smile? These are the typical signs of VME.


This condition is caused by condylar hyperplasia where basically one side of the jaw grows longer. The growing upper jaw follows this pattern, creating a cant. As a result, a crooked smile is commonly seen.

Cleft Palate

The palate is the roof of your mouth and made of bone and muscle. It is covered by a thin, wet skin that forms the red covering inside the mouth. You can feel your own palate by running your tongue over the top of your mouth. Its purpose is to separate your nose from your mouth. The palate has an extremely important role during speech because when you talk, it prevents air from blowing out of your nose instead of your mouth. The palate is also very important when eating since it prevents food and liquids from going up into the nose.

As in cleft lip, a cleft palate occurs in early pregnancy when separate areas of the face that have developed individually do not join together properly. A cleft palate presents when an opening in the roof of the mouth exists. The back of the palate is called the soft palate and the front is known as the hard palate. A cleft palate can range from just an opening at the back of the soft palate to a nearly complete separation of the roof of the mouth (soft and hard palate).

Sometimes, a baby with a cleft palate may have a small chin. Few babies with this combination may have difficulties with breathing. This condition is known as Pierre Robin sequence. Since the lip and palate develop separately, it is possible for a child to be born with a cleft lip, palate or both. Cleft defects occur in about 1 out of every 800 babies. Children born with either or both of these conditions usually need the skills of several professionals to manage the problems associated with the defect such as feeding, speech, hearing and psychological development.

What Are The Causes Of A Skeletal Deformity?

The most common reason an individual will develop an overbite/underbite is from it being congenital. There are also other causes that many people do not think of. They can also stem from poor childhood habits that include prolonged thumb sucking, pacifier use, tongue thrusting, or nail biting. These habits can develop during our early development stages as children. This is the same time that the jaw begins to grow, which can cause unevenness and jaw issues. When the overbite has developed or formed completely it can cause many other issues. The position of the overbite can cause physical pain and limitations.

What Are The Signs And Symptoms Of A Skeletal Deformity?

Some of the physical limitations include problems chewing and eating, jaw pain from strained muscles, speech impediments, lisp, gum disease, worn tooth enamel, soft tissue damage, and damage to the front teeth due to their position. It can also cause self-esteem issues and make an individual self-conscious if the jaw protrudes out. Self-esteem issues can then continue into psychological problems.

What Are The Risk Factors?

Skeletal deformities are most often congenital. Benign tumors in the jaw, condylar resorption and trauma are some risk factors of skeletal deformity.

How Is A Skeletal Deformity Diagnosed?

For an experienced clinician, diagnosing deformities is done by clinical evaluation. The X-ray are then taken to confirm the findings.

What Are The Possible Treatments For A Skeletal Deformity?

The best treatment for skeletal deformities is to have corrective jaw surgery (orthognathic). Again, only in mild cases orthodontic treatment can properly and safely align the bite without sacrificing the facial aesthetics.


Invisalign is a great treatment option for those who do not want the appearance of having braces. Typically older individuals will opt for invisalign because it is transparent and not readily visible. The aligner shifts the teeth as a retainer would and is worn for at least twenty-two hours each day. The aligner will need to be changed every two weeks so that the teeth continue to shift into place and are corrected. The treatment process can take up to 1-2 years to align the teeth. It can also assist with overbites to a certain point. If the overbite is not severe it can assist in correcting it. New precision cuts allow for rubber bands to be utilized as they are in typical braces. . The determination to utilize invisalign can be made after the teeth are fully examined. If the overbite is considered to be moderate to severe, pre-surgical orthodontics is needed.


Braces are the most common treatment for mild dentofacial deformities. They involve a two stage process, and the first step is to fasten the metal brackets on the teeth. The metal wire is used to straighten and align teeth to where they need to be. The amount of time that it takes to make the teeth straight is dependent on each individual. This could take months or years depending on the severity. Once the teeth are straight the second step of the process can begin. The bite deformity can be fixed in stage two which involves adding the rubber bands, coils, and springs. Putting these in place will slowly shift the teeth and NOT THE JAWLINE into place in order to move it to where it is supposed to be. This treatment plan can take many years.

Invisalign VS Braces

There are many benefits to both invisalign and braces. Invisalign can be removed from the teeth and taken off which makes the teeth very easy to clean. The teeth can be brushed and flossed as normal which can assist in good oral hygiene. Braces are not removed from the teeth which can make it challenging to clean the teeth thoroughly. Preventing tooth decay and gum problems can be difficult with braces. A positive aspect of invisalign is that it is a transparent solution that others will not notice. Braces are visible because they are metal and involve rubber bands. Ceramic braces work the same way as metal braces, but the brackets are either clear, or match the color of the teeth. The cost of ceramic braces is higher than regular braces, but they are not as visible.

Tooth Extraction

This procedure should be taken serious when it comes to treating malocclusion. The clinician must understand the facial harmony and function. If skeletal deformities exist, teeth should not be removed prior to consultation with a jaw surgeon. Having said that, only in mild cases, the orthodontist can decide if Teeth extractions are necessary depending on the spacing of the mouth. When more space is needed and the teeth are crowded, some of them may need to be extracted. This allows the teeth that are being moved to have enough room to shift into the proper position. Once the extraction is completed, the teeth can be shifted as normal with either invisalign or braces.


There are many times where invisalign and braces are unable to correct teeth and jaw problems. Corrective jaw surgery restores the bite, airway and facial harmony. The timing of the surgery depends on many factors, but in general, younger patients do better with the healing process. In our office, we see patients of all ages from all over the country.

Jaw surgery is usually performed inside of the mouth. This eliminates scarring on the exterior areas of the face including the jaw, chin, and around the mouth area. Orthognathic surgery will involve cuts being made in the jawbone. This allows the surgeon to position the jaw in the correct place to eliminate problems the patient is currently experiencing. Repositioning and properly aligning the jaw will be followed by screws and plates securing the jaw in the new potion. In some cases, new bone may be needed to be added to the jaw. The bone and new jaw position will be secured temporary with wires.

Are There Preventative Steps To Avoid Skeletal Deformities?

To this day, there are no preventative measures that can avoid deformity in the jaws.

What Are The Risks If Left Untreated?

Skeletal deformities in the face can cause lack of self esteem. People with this condition may also develop pain in the TMJ, muscle tension, inability to chew properly and have speech problems.

Meet Dr. Majid Jamali

Dr. Jamali, a board-certified oral and maxillofacial surgeon, practices a full scope of oral and maxillofacial surgery with expertise ranging from dental implant surgery and wisdom tooth removal to corrective jaw surgery. This also includes techniques designed to rebuild bone structure with minimal surgical intervention and optimal patient comfort. We can also diagnose and treat facial pain, facial injuries, and fractures. Learn More »

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