Long-Term Outcomes and Relapse Risk in Adult Protrusive Malocclusion: A Comparative Literature Review of Orthodontic and Orthognathic Treatment Modalities

Introduction: Adult protrusive malocclusion presents significant challenges due to the absence of craniofacial growth and limited adaptability of periodontal and neuromuscular structures. Achieving long-term stability requires precise diagnosis, controlled biomechanics, and retention planning. Orthodontic camouflage may suit mild-to-moderate discrepancies, whereas combined orthodontic–orthognathic treatment is preferred for severe skeletal imbalances. Relapse remains a concern across modalities, influenced by periodontal fiber memory, condylar remodeling, dentoalveolar compensation, and retention strategies. Materials and Methods: A structured literature review following PRISMA guidelines included studies published between 2015 and 2025. Databases searched were PubMed, ScienceDirect, and Google Scholar. Inclusion criteria: adult patients with skeletal protrusive malocclusion treated via camouflage mechanics or orthognathic surgery, reporting outcomes ≥1 year. Five studies met all criteria. Data on treatment modality, skeletal pattern, follow-up, stability, relapse, and condylar changes were extracted. Narrative synthesis was performed due to methodological heterogeneity. Results and Discussion: Orthognathic surgery consistently demonstrated superior skeletal and dental stability with minimal relapse up to 10 years and favorable condylar adaptation. Orthodontic camouflage showed greater variability with relapse primarily due to torque loss, dentoalveolar compensation, and unresolved skeletal discrepancies. High-angle cases benefited from miniscrew-assisted intrusion and counterclockwise rotation, but findings were limited. Retention protocols critically influenced outcomes, particularly for non-surgical cases. Conclusion: Orthognathic surgery provides predictable long-term outcomes for adults with significant protrusive skeletal discrepancies. Camouflage is appropriate only for mild cases and carries higher relapse risk, especially in torque and condylar stability. Careful biomechanical planning, skeletal assessment, and long-term retention are essential to maintain post-treatment stability.