## 4 Discussion
described similar results between the two orthodontic techniques; however, in their study, the clear aligners also showed better immediate findings than fixed appliances [51]. As is well known, treatment with clear aligners involves an initial phase of digital treatment planning. The virtual setup provides the possibility to simulate the surgical repositioning of the bone bases in order to ensure perfect alignment between the bone bases and teeth. The digital treatment planning stage offers the benefits of precise planning fortooth movements before surgery and accurate visualization of the post-surgical occlusion through simulated surgery. The combination of CBCT scans with virtual setups also avoids potential root displacements outside the original bone structure. Therefore, in line with other studies, we observed the achievement of desired skeletal and aesthetic outcomes following orthognathic surgery associated with clear aligners [52; 53]. Regarding the treatment duration, pre-surgical orthodontic therapy was shorter in patients treated with clear aligners than those with fixed appliances (15-21 months versus 3 years). On the contrary, post-surgical treatment was much shorter in patients with fixed appliances (6 months) compared to those with clear aligners (25-33 months). Overall, therapy with clear aligners lasted 4-6 months longer than the fixed one. Surgical treatment takes time, and, thus, a patient's motivation is essential. One of the most critical problems for patients is undergoing orthodontic treatment for several months with a temporary deterioration in aesthetics and oral hygiene, especially in the case of fixed appliances. However, it is likely that combining a digital design and a surgery-first approach may reduce the treatment duration [54]. Thanks to orthodontic treatment and orthognathic surgery, our adult patients with skeletal Class III malocclusion showed better function and aesthetics, achieving an optimal occlusion, a proper relationship between bone bases, a balanced profile, and improved overall facial aesthetics. The same results would hardly have been achieved without the aid of 3D-assisted orthognathic surgery. In fact, the orthodontic treatment alone would have led purely to dental compensation without showing predictable functional and aesthetic improvements. When planning orthognathic surgery, it is crucial to consider temporo-mandibular joint disorders (TMD) to ensure success and minimize complications. Key considerations include comprehensive preoperative evaluation, involving the assessment of TMJ signs and symptoms through imaging studies and clinical examination. The surgery's effect on occlusion and the potential risk of exacerbating pre-existing TMJ disorders should be carefully weighed. Close postoperative monitoring and management of TMJ function are crucial, with interventions such as physical therapy or pharmacotherapy being needed. The decision to proceed with orthognathic surgery in the presence of TMD depends on various factors, including skeletal malocclusion, occlusal abnormalities, the ineffectiveness of conservative TMD treatments, the severity of TMJ pathology, and patient preference. Collaboration between specialists is essential for developing individualized treatment plans. Pre-existing TMJ pathology, whether symptomatic or not, can lead to unfavorable outcomes when only orthognathic surgery is performed. These conditions include articular disk dislocation, idiopathic condylar resorption (ICR), condylar hyperplasia, osteochondoma, and congenital deformities. Symptoms may include TMJ pain, headaches, myofasical pain, and TMJ dysfunction. When these conditions coexist with dentofacial deformities, they are best treated with concomitant TMJ and orthognathic surgery. With accurate diagnosis, treatment planning, appropriate surgical procedures, and proper post-surgical management, favorable outcomes can be achieved [55].