Periodontal Outcomes in Orthodontic Patients With Skeletal Malocclusions Undergoing Orthognathic Surgery: A Comprehensive Review

Periodontal outcomes in orthodontic patients undergoing orthognathic surgery reflect a biologically complex treatment pathway rather than a single treatment-related event. This structured, comprehensive narrative review examined the available evidence on periodontal health in patients with skeletal malocclusions treated with combined orthodontic-orthognathic therapy, with emphasis on baseline periodontal vulnerability, presurgical orthodontic decompensation, surgery-related tissue response, post-treatment periodontal stability, and the major factors influencing prognosis. The search was conducted from database inception through May 2026. Evidence from 35 studies identified through PubMed, Scopus, Web of Science, and Embase was reviewed and interpreted comparatively according to treatment phase, periodontal outcome type, anatomic site, and level of clinical support. The evidence showed that periodontal risk was not distributed evenly across the treatment sequence. Baseline vulnerability was frequently present before treatment, particularly in the mandibular anterior region, where reduced alveolar support, thin phenotype, and unfavorable root position were common. Presurgical orthodontic decompensation emerged as the phase most consistently associated with periodontal challenge, especially in relation to alveolar bone loss, dehiscence, and fenestration around mandibular incisors. By contrast, orthognathic surgery itself appeared to contribute more often to short-term plaque-related and soft-tissue changes than to generalized long-term periodontal breakdown, although segmental procedures may carry greater site-specific risk. Overall, the current literature supports a model in which periodontal prognosis is phase-dependent, anatomically conditioned, and clinically modifiable. The strongest evidence points to the importance of early periodontal risk assessment, biologically controlled decompensation, and close interdisciplinary monitoring throughout orthodontic-surgical treatment.