Patients diagnosed with jaw deformity after middle age often have periodontal disease and missing teeth. In such cases, periodontal and prosthetic treatment is required in addition to orthodontic treatment. Therefore, surgical orthodontic treatment for middle-aged patients requires a more careful approach than for younger patients. This is a report of two representative cases. Case 1: A 51-year-old male patient with the chief complaint of masticatory dysfunction by anterior cross bite was referred to our hospital. A diagnosis of mandibular prognathism was made and surgical orthodontic treatment was initiated. This patient had severe periodontal disease and missing teeth, which required periodontal treatment combined with periodontal surgery and prosthetic treatment before the surgical orthodontic treatment. In the surgical orthodontic treatment, anchor screws were used to support the vertical occlusal stop lost due to the missing teeth. After the presurgical orthodontic treatment, sagittal split ramus osteotomy was performed. Finally, partial dentures for the upper and lower jaws were fabricated for the final prosthesis. Case 2: A 62-year-old female patient with the chief complaint of masticatory dysfunction by anterior cross bite was referred to our hospital. A diagnosis of mandibular prognathism was made and surgical orthodontic treatment was initiated. The periodontal disease was mild, but multiple teeth were missing. To shorten the treatment period, presurgical orthodontic treatment was minimized and prosthetic treatment was also applied. In the surgical orthodontic treatment, anchor screws were also used in this case to restore the vertical occlusal stop lost due to the missing teeth. After the presurgical orthodontic treatment, sagittal split ramus osteotomy was performed. Finally, partial dentures on the left side for the upper and lower jaws were fitted for the final prosthesis.