Orthognathic surgery, commonly called corrective jaw surgery, is not simply a procedure for changing facial appearance. It is the surgical correction of skeletal abnormalities involving the maxilla, mandible or both jaws to improve their relationship, function and facial balance.
The American Association of Oral and Maxillofacial Surgeons defines orthognathic surgery as surgical correction of skeletal abnormalities of the mandible, maxilla or both, with improvement of form and function as the primary treatment goal.
For the surgeon, however, planning where the jaw should move is only part of the challenge.
The planned skeletal movement must eventually be translated into a controlled osteotomy, where bone is divided along a carefully selected path before the jaw segment can be repositioned.
This makes diagnosis, virtual planning, osteotomy design and surgical instrument selection closely connected.
Why Is Orthognathic Surgery Performed?
Some bite problems originate mainly from tooth position and can be managed orthodontically. Others result from an underlying skeletal discrepancy that orthodontic tooth movement alone cannot adequately correct.
Examples include significant mandibular prognathism or retrognathism, skeletal Class II or Class III relationships, facial asymmetry, anterior open bite, vertical maxillary excess and transverse jaw discrepancies.
These conditions can affect more than appearance. Jaw discrepancies may be associated with difficulties in chewing, swallowing, speaking, occlusion and other aspects of oral function.
Recent evidence also supports the broader patient impact of treatment.
A 2024 systematic review by Schaefer and colleagues evaluated 23 prospective studies involving 1,039 patients. All included studies reported improvement in quality-of-life measures following orthognathic therapy, with particularly notable changes in social and aesthetic domains.
What Are the Main Types of Orthognathic Surgery?
The surgical procedure depends on which part of the facial skeleton requires repositioning.
A Le Fort I osteotomy allows repositioning of the maxilla and can be used to correct vertical, anteroposterior and transverse maxillary discrepancies.
A bilateral sagittal split osteotomy, commonly abbreviated as BSSO or BSSRO, divides the mandibular ramus so the tooth-bearing mandibular segment can be repositioned.
When both jaws contribute significantly to the deformity, bimaxillary or double-jaw surgery may combine maxillary and mandibular osteotomies.
Genioplasty may also be performed independently or together with orthognathic surgery when chin position requires modification to improve facial balance.
Although these procedures involve different anatomical regions, they share an important principle:
The jaw must be divided in a controlled way before it can be repositioned predictably.
From Virtual Surgical Planning to the Operating Room
Modern orthognathic surgery increasingly begins with three-dimensional planning rather than relying only on conventional two-dimensional cephalometric analysis and model surgery.
CT or CBCT data, digital dental models and facial information can be integrated into virtual surgical planning (VSP) to simulate osteotomies and jaw movements before surgery.
A 2024 systematic review and meta-analysis by Lee, Oh and Kim found that virtual surgical planning improved the accuracy of transferring planned jaw positions compared with conventional planning. The use of patient-specific surgical guides further improved agreement between the virtual plan and postoperative skeletal position.
This changes the way we should think about osteotomy.
The objective is not simply to “cut through bone.”
The osteotomy is the physical translation of a three-dimensional treatment plan.
What Happens During an Orthognathic Osteotomy?
An osteotomy is a deliberate surgical division of bone.
Depending on the procedure, surgeon preference and anatomical situation, bone cutting may involve rotary surgical burs, reciprocating or oscillating saws, osteotomes and piezoelectric instruments.
No single instrument is ideal for every cut.
Instrument selection depends on factors such as cortical thickness, access, cutting direction, nearby neurovascular anatomy and the geometry of the planned osteotomy.
Alrefai and colleagues examined piezoelectric and conventional osteotomy techniques in a 2022 systematic review and meta-analysis. Their analysis suggested potential advantages of piezoelectric surgery in blood loss and neurosensory outcomes, although operative-time findings and the available evidence indicate that each technology involves different clinical trade-offs.
The relevant question is therefore not:
Which instrument is universally best?
It is:
Which cutting geometry provides the required access and control for this particular part of the osteotomy?
Where Do Lindemann Burs Fit in Orthognathic Surgery?
The Lindemann bur is a rotary bone-cutting instrument with elongated cutting geometry that can support directional osteotomy and cortical bone preparation.
Its relevance to orthognathic surgery is supported by clinical literature.
A 2022 retrospective study examining 1,120 bilateral sagittal split ramus osteotomies compared osteotomies performed using a Lindemann burr, reciprocating saw or piezosurgery. Only five bad splits occurred across the entire sample, and the investigators found no significant association between instrument type and bad-split incidence.
This does not mean that every BSSO should be performed with a Lindemann bur. Rather, it demonstrates that Lindemann burs are established rotary instruments within conventional orthognathic osteotomy workflows.
For clinicians using an HP straight-handpiece system, the MR.Bur HP162 Lindemann Carbide Bur provides a narrow Lindemann geometry intended for bone cutting and osteotomy applications. MR.Bur specifies a 1.6 mm head and one-piece carbide construction for the HP162.
In this context, HP162 is best understood as a directional bone-cutting instrument, not as a replacement for every saw, osteotome or piezoelectric device used during jaw surgery.
Bone Cutting and Bone Refinement Are Different Objectives
Once an osteotomy has been created, the next requirement may no longer be a long directional cut.
Localized cortical irregularities or selected bone surfaces may require more controlled refinement.
This is where a different bur geometry becomes useful.
The MR.Bur HP141E Round Carbide Bur within the Lindemann Kit HP is positioned for localized cortical bone removal and refinement of bone surfaces after osteotomy. Its round geometry creates a different tissue interaction from the elongated side-cutting design of HP162.
The distinction is clinically important:
HP162 Lindemann → directional osteotomy and bone cutting
HP141E Round Carbide → localized bone refinement and contouring
Rather than asking one bur to perform every surgical task, selecting geometry according to the objective allows the instrumentation to follow the surgical plan.
Why Accuracy Matters After the Osteotomy
A technically completed osteotomy is not the endpoint of orthognathic treatment.
The mobilized jaw segment must be positioned according to the planned occlusion and skeletal relationship, stabilized and followed through healing.
A 2024 systematic review and meta-analysis by Kim and colleagues included 49 studies of orthognathic surgery for facial asymmetry. The review reported significant improvements in hard- and soft-tissue symmetry and quality of life, while also identifying postoperative skeletal relapse during follow-up and substantial heterogeneity within the available evidence.
More recently, a 2026 systematic review examining 65 studies and 6,482 patients similarly concluded that orthognathic surgery can provide substantial skeletal and quality-of-life improvements, while emphasizing complications, neurosensory changes, relapse risk and the importance of long-term follow-up.
Successful corrective jaw surgery therefore depends on much more than the osteotomy itself.
Diagnosis → Digital Planning → Controlled Osteotomy → Jaw Repositioning → Fixation → Follow-Up
Frequently Asked Questions
Is orthognathic surgery the same as corrective jaw surgery?
Yes. Orthognathic surgery is commonly referred to as corrective jaw surgery. It involves surgical repositioning of the maxilla, mandible or both to correct clinically significant skeletal jaw discrepancies.
What is an osteotomy in jaw surgery?
An osteotomy is a planned surgical cut through bone. In orthognathic surgery, it allows a jaw segment to be mobilized and repositioned according to the treatment plan.
What instruments are used for orthognathic osteotomy?
Instrument selection varies according to the procedure and surgeon. Conventional osteotomy may involve surgical saws, rotary bone-cutting burs such as Lindemann burs, osteotomes or piezoelectric devices.
Can a Lindemann bur be used in orthognathic surgery?
Yes, Lindemann burs have been described and studied as rotary bone-cutting instruments in orthognathic procedures including bilateral sagittal split osteotomy. Their use depends on the planned osteotomy, anatomy and surgical technique.
Where does MR.Bur HP162 fit?
The MR.Bur HP162 Lindemann Carbide Bur is designed for directional bone cutting and osteotomy applications. In an orthognathic workflow, it may be considered for selected rotary bone-cutting steps when Lindemann geometry and an HP straight handpiece are appropriate.
The Clinical Takeaway
Orthognathic surgery demonstrates an important surgical principle:
Precision begins before the bone is ever cut.
Three-dimensional diagnosis defines the skeletal problem. Virtual planning determines the intended movement. The osteotomy creates the pathway that makes that movement possible.
Instrument selection should therefore follow the osteotomy objective rather than habit alone.
A Lindemann bur such as MR.Bur HP162 can support controlled directional bone cutting, while a round surgical carbide such as HP141E can support more localized bone refinement.
The goal is not simply to cut bone efficiently.
It is to translate a carefully planned skeletal correction into controlled surgical movement while respecting anatomy, stability and long-term function.
