SAVAGE, ST. PAUL AND MINNEAPOLIS, MINNESOTA – When many people think of correcting skeletal asymmetry, they often think of orthognathic surgery.

Savage Orthodontist Dr. Trudy Bonvino wants more parents to be aware that a wide range of facial asymmetry issues in children can be corrected or improved considerably with various non-surgical orthodontic treatment methods, provided the issue is identified before the child has completed growth.

“Orthodontic technology provides us with several non-surgical solutions,” said Bonvino, who is the orthodontist on staff at Cosmopolitan Orthodontics, a Savage orthodontics practice. “The earlier a child can get an orthodontic evaluation, the sooner potential problems can be addressed.”

The American Association of Orthodontists recommends that children be evaluated by an orthodontist by age 7, said Bonvino, a Savage braces expert. One reason is to identify problems- including asymmetry- that can be corrected or made less severe through early intervention.

However, it is important to note that all hope is not lost if asymmetry isn’t corrected at a young age, said Dr. Jennifer Eisenhuth, who owns Cosmopolitan Orthodontics.

As more adults seek orthodontic treatment and facial asymmetry is diagnosed in them, more inquiries are made into alternatives to orthognathic surgery, even if it means the end result is not the same as it would have been with surgery, Eisenhuth said.

For many adults with asymmetry, because they have dealt with it their entire lives, they see even a slight improvement as being better than none at all, Bonvino said. Many adults are willing to deal with potential relapse if it means avoiding an invasive surgery.

However, that’s not often the option an orthodontist prefers, and because orthodontists are aware of the excellent results that can be achieved through orthognathic surgery, they tend to seek the most ideal result for our patients, she added.

Facial skeletal asymmetry is the condition where there is a lack of proportion in the facial features. It can happen naturally, as a result of poor habits, or be the result of trauma, such as a fractured jaw. Skeletal asymmetry should be corrected because it can adversely effect jaw movement, create abnormal wear patterns on the teeth and inhibit a person’s ability to chew properly, said Bonvino, who also is a Savage Invisalign provider.

Facial asymmetry in children can be the result of thumb-sucking, cross bites, mouth-breathing, tongue-thrust swallow patterns and cleft palate, she said. In those cases, if caught early enough, Bonvino can correct the foundation of the asymmetry and increase the opportunity for the remaining facial structures to follow suit during upcoming growth.

The fact that children have not finished growing works to the advantage of non-surgical treatment. Alterations can be made as the child’s bones continue to grow and further develop.

“Ideally, facial asymmetry is noticed and corrected while the patient is young- in the neighborhood of eight to nine years old,” said the Savage Invisible braces provider. “Correction can be successful if the patient is a bit older- eleven to thirteen years old- but is less likely to be fully corrected. The result will be improved, but compromised from ideal.”

Once a person with facial asymmetry reaches adulthood and growth stops, correcting the malocclusion can be difficult without surgical intervention.

“But it’s not impossible, if the patient understands that the results may be improved, but not ideal,” Eisenhuth said.

When Bonvino and Eisenhuth treat adults with facial asymmetry, they first perform an evaluation to determine whether the asymmetry is the result of skeletal or dental causes before a treatment strategy can be planned.

For adults who decide against orthognathic treatment, camouflaging the asymmetry through orthodontic mechanics is an option, Bonvino said. In select cases, Eisenhuth and Bonvino use mini-implants to help reposition the teeth and achieve more uniform alignment, which can improve and sometimes correct the asymmetry.

“Even with that, relapse will be rampant,” Bonvino said. “So, facial asymmetry in an adult is a tricky road. If the patient is willing to accept an outcome that perhaps is less than ideal, some improvement may be possible, but obviously the best answer is orthognathic surgery.”

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