Adults with a severe underbite (lower jaw has out grown upper jaw significantly) frequently require surgery, in addition to orthodontic treatment, to put the upper and lower jaw bones in balance.

In growing patients we can often times keep the upper jaw growing in pace with the lower jaw by using a protraction headgear or face mask. This is worn to sleep in and is used in conjunction with an upper expander to protract or move the upper jaw and teeth forward. Early orthodontic intervention can sometimes eliminate the need for more invasive and costly surgical procedures.