Mandibular Prognathism in Barcelona
What Is Prognathism?
Mandibular prognathism occurs when the lower jaw appears excessively prominent in relation to the upper jaw. It is commonly associated with a Class III malocclusion, in which the lower teeth are positioned in front of the upper teeth.
However, the visible prominence of the lower jaw does not always mean that the mandible is the only problem. The underlying cause may be:
- Insufficient development of the upper jaw, known as maxillary hypoplasia.
- Excessive growth of the lower jaw, known as mandibular hyperplasia.
- A combination of maxillary hypoplasia and mandibular hyperplasia.
- Facial asymmetry or abnormal growth affecting one side more than the other.
Identifying the exact skeletal cause is essential. Moving only the mandible backwards may correct the bite but leave insufficient support in the midface. In other patients, maxillary advancement alone may not provide adequate correction. The surgical plan must therefore be based on the complete facial structure—not simply on the position of the lower teeth.
At Clínica Birbe in Barcelona, Dr Joan Birbe evaluates the bite, facial proportions, airway, smile, symmetry and soft-tissue profile before recommending treatment.
How Can Mandibular Prognathism Affect You?
Mandibular prognathism can affect appearance, dental function and oral health. Its effects vary according to the severity and associated facial pattern.
Patients may experience:
An underbite or Class III malocclusion.
Difficulty biting or chewing certain foods.
Excessive dental wear.
Crossbite or open bite.
Facial asymmetry.
A prominent lower jaw or chin.
Reduced projection of the upper lip, cheeks or midface.
Speech difficulties in selected cases.
Gum recession or periodontal overload.
Temporomandibular joint symptoms.
Difficulty achieving stable orthodontic correction without surgery.
Some patients mainly seek treatment because of functional problems. Others are concerned about facial imbalance, particularly the relationship between the upper jaw, lips, nose, lower jaw and chin. Orthognathic surgery addresses these structures together and can therefore improve both occlusion and facial balance.
Diagnosis and Facial Assessment
- Dental occlusion and the degree of Class III discrepancy.
- Maxillary and mandibular position.
- Facial symmetry and dental midlines.
- Vertical facial proportions.
- Incisor exposure at rest and when smiling.
- The occlusal plane.
- Lip support and soft-tissue balance.
- Chin projection.
- Nasal proportions.
- Temporomandibular joint function.
- Airway and breathing considerations when clinically relevant.
Treatment Process
Orthodontic treatment
Mild dental Class III cases may sometimes be managed through orthodontic compensation. Teeth are repositioned to improve the bite without changing the underlying jaw structure. In adults with a significant skeletal discrepancy, orthodontics alone cannot reposition the maxilla or mandible. Excessive dental compensation may also compromise gum health, tooth inclination or facial aesthetics. In these cases, combined orthodontic and orthognathic treatment may provide a more complete and stable correction.Maxillary advancement
When the principal problem is insufficient upper-jaw development, a Le Fort I osteotomy can advance the maxilla. Maxillary advancement can:- Correct the dental relationship.
- Improve upper-lip support.
- Increase midfacial projection.
- Improve the relationship between the nose, lips and chin.
- Avoid unnecessary mandibular setback in selected patients.
Mandibular repositioning
A mandibular osteotomy may be used when excessive mandibular growth is the principal component of the deformity. The amount and direction of movement must be planned carefully. Excessive setback may adversely affect facial balance or airway dimensions in some patients. For this reason, the mandible should never be evaluated independently from the maxilla, chin and complete facial profile.Bimaxillary surgery
Bimaxillary surgery repositions both the upper and lower jaws. It may be recommended when the deformity affects both jaws or when correcting the occlusal plane is necessary. It can be particularly useful in patients with:- Combined maxillary hypoplasia and mandibular hyperplasia.
- Significant facial asymmetry.
- Open bite or crossbite.
- Long-face or short-face patterns.
- Dental and facial midline discrepancies.
- A need for clockwise or counter-clockwise rotation of the maxillomandibular complex.
Genioplasty and complementary procedures
The chin must be assessed separately from the mandibular dental segment. After correction of the jaws, some patients may still benefit from genioplasty to adjust chin projection, height, width or symmetry. Genioplasty is not automatically required. It is recommended only when it provides a meaningful improvement in facial balance. Other complementary procedures, such as rhinoplasty or customised facial implants, should also be evaluated individually and must not replace correct skeletal diagnosis.Surgery First for Mandibular Prognathism
In conventional orthognathic treatment, orthodontic preparation is performed before surgery. This aligns and decompensates the teeth so that the jaws can be placed in the planned position. The Surgery First protocol changes the sequence: surgery is performed before most of the orthodontic treatment. This can provide an earlier facial correction and may reduce the total duration of treatment in appropriately selected patients. Surgery First is not suitable for every Class III case. Selection depends on factors such as:- Initial dental alignment.
- Transverse discrepancies.
- Degree of dental compensation.
- Stability of the intended postoperative bite.
- Need for dental extractions.
- Complexity of the skeletal movement.
- Coordination between the surgeon and orthodontist.
3D Virtual Planning: Precision and Predictability
Each orthognathic procedure is planned using three-dimensional imaging and virtual surgical planning. This allows the surgical team to analyse facial asymmetry, dental occlusion, skeletal relationships and the airway and to simulate the proposed bone movements before surgery. The planning process may include:- Integration of CBCT and intraoral scan data.
- Three-dimensional skeletal and dental analysis.
- Simulation of maxillary and mandibular movements.
- Assessment of the occlusal plane and facial symmetry.
- Planning of an associated genioplasty when indicated.
- Production of CAD/CAM surgical splints or customised guides.
Recovery time
📋 Recovery Timeline After Orthognathic Surgery
| Stage | Approximate Timeframe | What to Expect |
|---|---|---|
| Hospital stay | 1–2 nights | Pain management, continuous facial ice application, and a cold liquid diet |
| First week | Days 1–7 | Swelling peaks between days 3 and 5, liquid diet, rest at home, and time off work |
| Weeks 2–3 | Days 8–21 | Significant reduction in swelling, soft puréed diet, and the start of mouth-opening exercises and occlusal retraining |
| First month | 30 days | Return to work in most cases and a soft diet that does not require puréeing |
| 2–3 months | 60–90 days | Gradual return to a normal diet, resumption of gentle exercise (walking, stationary cycling), and a bite that already feels functional |
| 6 months | 180 days | Advanced bone healing, unrestricted sports activities, and near-complete recovery of sensation in the lower lip and chin |
| 12 months | 1 year | Final occlusal, aesthetic, and facial results |
Duration of treatment
⏳ Estimated Treatment Timeline
| Stage | Estimated Duration |
|---|---|
| Diagnostic assessment and 3D planning | 4–8 weeks |
| Pre-surgical orthodontics (traditional protocol) | 6–18 months |
| Pre-surgical orthodontics (Surgery First approach) | 2–8 weeks |
| Orthognathic surgery (hospital stay) | 1–2 nights |
| Post-surgical orthodontics (traditional protocol) | 3–6 months |
| Post-surgical orthodontics (Surgery First approach) | 8–14 months |
| Follow-up and healing | Up to 12 months after surgery |
| Overall treatment (traditional protocol) | Approximately 12–24 months |
| Overall treatment (Surgery First approach) | Approximately 10–16 months |
Frequently Asked Questions
Can braces correct mandibular prognathism without surgery?
Braces can reposition the teeth but cannot significantly change the position of the adult jaw bones. Mild dental discrepancies may be camouflaged orthodontically, while significant skeletal Class III cases may require orthognathic surgery.
Is mandibular setback always necessary?
No. Some patients who appear to have a prominent mandible principally have an underdeveloped upper jaw. Treatment may involve maxillary advancement, mandibular repositioning or bimaxillary surgery, depending on the diagnosis.
Is bimaxillary surgery better than single-jaw surgery?
Not in every case. The appropriate procedure is the least extensive operation capable of achieving the functional and facial objectives safely and predictably. Bimaxillary surgery provides greater control when both jaws or the occlusal plane require correction.
Can prognathism surgery correct facial asymmetry?
Orthognathic surgery can substantially improve skeletal asymmetry by using differential movements on each side. Minor residual asymmetry may remain because no human face is perfectly symmetrical and the soft tissues do not always respond identically.
Can I undergo Surgery First?
Possibly. Candidacy depends on dental alignment, transverse coordination, skeletal movements and the stability of the initial postoperative bite. A complete orthodontic and surgical assessment is required.
Can genioplasty be performed at the same time?
Yes, when the chin requires an independent adjustment after the jaws have been positioned. Genioplasty may alter projection, height, width or symmetry, but it is not necessary in every patient.
How long does the complete treatment take?
The duration depends on the orthodontic protocol and complexity of the case. Conventional treatment includes presurgical orthodontics, surgery and postoperative finishing. Surgery First may reduce the presurgical phase but still requires postoperative orthodontic treatment.
Will 3D planning show my exact final appearance?
No simulation can guarantee the final soft-tissue result. Three-dimensional planning is primarily used to design and transfer the skeletal and dental movements accurately. It also helps explain the intended changes and treatment objectives.
Dr. Joan Birbe: ABOMS certified specialist
Dr Joan Birbe is an oral and maxillofacial surgeon with European specialist training and certification by the American Board of Oral and Maxillofacial Surgery.
ABOMS certification confirms that a surgeon has successfully completed a rigorous professional evaluation process and remains committed to maintaining appropriate credentials, continuing education, self-assessment and periodic competency requirements.
Dr Birbe has maintained his ABOMS Diplomate status since 2001. This international qualification complements more than 25 years of clinical experience in orthognathic surgery, facial surgery and the treatment of complex dentofacial deformities.
Why Choose Clínica Birbe for Surgery?
At Clínica Birbe, orthognathic treatment combines specialist surgical experience, multidisciplinary coordination and individualised 3D planning.
Dr Birbe personally evaluates each patient and determines the most appropriate movements according to facial proportions, dental occlusion, airway considerations and the patient’s functional and aesthetic objectives.
Every treatment plan is coordinated with the orthodontic team and adapted to the patient’s anatomy and priorities. The objective is to achieve a stable bite, balanced facial proportions and a natural result while clearly explaining the expected benefits, limitations, risks and recovery process.
Clínica Birbe receives patients from Barcelona, elsewhere in Spain and abroad. Consultations can be conducted in English, Spanish, Catalan or French.
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