Adaptation Skills and Temporomandibular Joint Neutrality: A Case Report of a Failed Orthognathic Surgery Intervention

The present study describes the case of a severe surgical complication in a 42-year-old female patient undergoing bimaxillary orthognathic surgery for the correction of skeletal class III, where a detachment of the surgical plates and fibrous healing of the palatal suture occurred. The aim of this study was to enlighten two important concepts: (I) how occlusal and mandible position changes can be well tolerated by the temporomandibular joint even in the case of a failed orthognathic surgery; (II) how a prosthodontic approach based on the search for occlusal stabilization made it possible to manage a complicated clinical case. Clinical Presentation: Clinically, the patient presented an occlusal instability and a split and mobile maxillary bone with respect to the cranial base. The case was resolved using full-mouth prosthodontic rehabilitation to fix the occlusal instability and guide maxillofacial surgeons, establishing the new occlusal position during an orthognathic reintervention. Clinical Relevance: The function was reestablished independently on any treatment planning centered on the temporomandibular joint repositioning concepts. However, although neuromuscular plasticity and the patient’s adaptation skills can explain the clinical success in such complex rehabilitations, these findings must be interpreted with caution due to the limited generalizability inherent to the study’s design.