# Multidisciplinary Planning in Orthognathic Surgery for Prosthetic Patients
## 4 Discussion  
For patients with skeletal malocclusion who are still in the growth period, orthodontic treatment that takes advantage of growth modification should be considered as the first  
Figure 6: A 40-year female patient with II dento-skeletal malocclusion: orthopanoramic, VTO, and intraoral views before (**a–e**) and after orthodontic surgery and new prosthetic rehabilitation (**A–E**). Figure 7: A 46-year male patient with III dento-skeletal malocclusion and extensive IV Kennedy’s class, caused by myeloid leukemia: intraoral view before orthodontic surgery, without (**a**) and with temporary prostheses (**b**), and after surgery and rehabilitation treatment (**c**). option for the correction of the underlying skeletal deformity. However, if the patient has already completed their growth, it is necessary to take other treatment approaches into account, such as orthodontic camouflage or orthodontic-surgical treatment. Orthodontic camouflage treatment is a compensatory orthodontic treatment that involves displacing teeth within the boundaries of the supporting bone to mask jaw discrepancy with the goal of attaining acceptable occlusion, aesthetics, and function. However severe cases with unacceptable facial profiles are only amenable to orthognathic surgery, which includes maxillary advancement, mandibular setback, or a combination of both [31; 32]. In this study, the multidisciplinary planning, and the orthognathic surgery of prosthetic patients with severe skeletal malformations of the maxilla-mandibular complex is described, especially those patients who hesitate in malocclusions of II or III Angle's dental-skeletal class and who present a total or partial edentulism or a fixed-type rehabilitation. According to [PERSON] et al., [PERSON] et al., and [PERSON] et al. 's works [4; 6; 24], the procedure for the rehabilitation of patients who are totally or partially edentulons candidates for orthognathic surgery begins with surgical and orthodontic analyses through clinical and radiographic examinations. Firstly, temporary prostheses, designed according to the patient's natural occlusion, are manufactured. Once the surgical treatment plan is established, based on clinical and radiographic analysis, prosthetic devices that can maintain predicted future occlusion form after surgery are produced. The results of these studies document the maintenance of post-operative occlusal stability, the absence of relapses, and the short-term success of rehabilitation. In contrast, [PERSON] et al. and [PERSON] et al. [33; 34], after routine clinical and radiographic analyses, preferred to insert implant fixtures before orthognathic surgery. Intraoperative occlusal stability was achieved by screwing temporary acrylic prostheses into some of the previously inserted implant fixtures. These prostheses were kept in place for the period of healing and then were replaced with total permanent implant prostheses, also in acrylic resin. The study carried out by [PERSON] reports a follow-up of 6 years that documents, at this distance of time, the clear functional and aesthetic improvement, the maintenance of occlusal and implant stability, and the absence of relapses. [PERSON]'s study, however, does not report follow-up. Although this study produced excellent results using mainly conventional methods, recent advances in 3D imaging for computer-assisted surgical planning and simulation have shown their utility in predicting better treatment outcomes for complex aesthetic rehabilitation involving orthodontic, orthognathic, and prosthetic interventions. The constantly evolving 3D technology might be a possible solution for the overall treatment simulation before the whole complex interdisciplinary treatment starts [35].