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

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 English-language 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 for skeletal AOB, with skeletal anchorage representing a less invasive alternative in carefully selected adult patients.