Long-Term Stability and Safety of Orthognathic-Orthodontic Correction for Skeletal Anterior Open Bite - A Systematic Review and Evidence Appraisal

Sep 30, 2026

This systematic review evaluated the long-term stability and complication profile of combined orthodontic and orthognathic surgical treatment for skeletal anterior open bite (AOB) in adolescents and adults. Searches across PubMed, the Cochrane Library, and Google Scholar identified English-language clinical studies from January 2004 to September 2025 meeting inclusion criteria, including nonsurgical comparators when outcomes were comparable. Twenty predominantly retrospective studies were analyzed for design, protocols, follow-up, cephalometric changes, relapse, complications, functional outcomes, and patient-reported measures. Evidence certainty was moderate for stability and cephalometrics, and low for complications. Overall, combined surgery showed reliable functional and esthetic improvement, while skeletal anchorage may offer a less invasive option in selected adults.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Introduction And Background

Long-term stability and safety evaluation

Surgical protocols and vertical control outcomes

Relapse patterns and myofunctional habits

Complications and evidence certainty assessment

Review began 11/23/2025 Review ended 12/02/2025 Published 12/09/2025 © Copyright 2025 Obeisi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98816 Open Access Review Article Long-Term Stability and Safety of OrthognathicOrthodontic Correction for Skeletal Anterior Open Bite: A Systematic Review and Evidence Appraisal Abdulrahman H. Obeisi 1, Meshari M. Alanazi 2, Suzan B. Natto 3, Hatim A. Alsalmi 4 , Asma A. Alzahrani 5 , Raghad A. Alotaibi 5 , Abdullah A. Aljari 6 , Soltan B. Alzahrani 7, Fahad B. Alamri 8, Abdulaziz F. Mohammed Alghamdi 9, Hattan S. Katib 10 1. Maxillofacial Surgery, Van Yuzuncu Yil University, Van, TUR 2. General Dentistry, Alexandria University, Alexandria, EGY 3. Periodontics, Al-Noor Specialist Hospital, Makkah Health Cluster, Ministry of Health, Mecca, SAU 4. General Dentistry, King Abdulaziz University, Jeddah, SAU 5. General Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU 6. General Dentistry, Sama Medical Center, Najran, SAU 7. Dentistry, Al Baha University, Al Bahah, SAU 8. Dental Medicine and Surgery, King Abdulaziz University Dental Hospital, Jeddah, SAU 9. General Dentistry, King Abdulaziz Medical City, National Guard Hospital, Jeddah, SAU 10. Dentistry, Specialized Dental Center, King Fahad Hospital, Madinah Health Cluster, Madinah, SAU Corresponding author: Hattan S. Katib, [hattan222333@gmail.com](hattan222333@gmail.com) Abstract This systematic review evaluated the long-term stability and complication profile of combined orthodontic and orthognathic surgical treatment for managing skeletal anterior open-bite (AOB) in adolescents and adults. An electronic search of PubMed, the Cochrane Library, and Google Scholar identified Englishlanguage clinical studies (published from January 2004 to September 2025) that included at least one group treated with combined orthodontic and orthognathic surgical correction. Nonsurgical comparators such as skeletal-anchorage-based intrusion or orthodontic camouflage were also included when comparable outcomes were reported. Twenty studies, comprising predominantly retrospective cohort studies, met the eligibility criteria. Data extraction focused on study design, sample characteristics, surgical and orthodontic protocols, follow-up duration, cephalometric changes, relapse, complications, functional outcomes, and patient-reported measures. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies, and certainty of evidence was summarized using Grading of Recommendations Assessment, Development and Evaluation. Most surgical protocols used Le Fort I maxillary impaction alone or in combination with bilateral sagittal split osteotomy and counterclockwise mandibular rotation. Across the included studies, AOB was consistently converted to a positive overbite, with mean improvements and long-term preservation of the initial skeletal correction. Skeletal-anchorage-based molar intrusion achieved comparable overbite closure through posterior intrusion and mandibular autorotation, with a reduction in lower anterior facial height and limited incisor elongation. The reported relapse rates were frequently associated with persisting myofunctional habits and unfavorable baseline skeletal patterns. Complications were generally infrequent and mild; the most common findings were transient temporomandibular symptoms or neurosensory disturbances, and serious or life-threatening events and reoperations were rare. The overall certainty of evidence was mainly moderate for stability and cephalometric outcomes and low for complications due to methodological limitations. Within these constraints, combined orthodontic and orthognathic surgery appears to provide reliable functional and esthetic improvement

FAQs

What was the main purpose of this systematic review?

To evaluate long-term stability and the complication profile of combined orthodontic and orthognathic surgical treatment for skeletal anterior open bite (AOB).

Which study designs and comparison types were included?

Twenty studies were included, predominantly retrospective cohort studies. Nonsurgical comparators such as skeletal-anchorage-based intrusion or orthodontic camouflage were also included when comparable outcomes were reported.

What did the review find about stability, relapse, and complications?

AOB was consistently converted to a positive overbite with long-term preservation of skeletal correction. Relapse rates were often linked to persisting myofunctional habits and unfavorable baseline skeletal patterns. Complications were generally infrequent and mild, with transient temporomandibular symptoms or neurosensory disturbances most commonly reported.

Sep 30, 2026

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