## 1 Introduction  
The temporomandibular joint (TMJ) is a double condyloid joint, characterized by a biconcave fibrocartilaginous disc interposed between the mandibular condyle and the glenoid fossa of the temporal bone, creating two distinct cavities that function as two joints in series [1]. Due to the anatomical complexity of this structure and the wide range of movements it can perform, temporomandibular disorders (TMD) are quite common.  
It is estimated that TMD affects 5-12% of the general population, with a higher prevalence in women than in men [2]. The etiology of TMD is complex and multifactorial, involving biomechanical, neuromuscular, biopsychosocial, and biological factors [3].  
The American Academy of Orofacial Pain (AAOP) defines temporomandibular dysfunction (TMD) as a set of clinical signs affecting the masticatory muscles, the temporomandibular joint (TMJ), and associated structures [4]. The primary clinical signs of TMD include joint noises, limitations or deviations in mandibular movements during opening,closing, protrusion, and lateral movements, tenderness or pain in the TMJ upon palpation, and otologic symptoms such as tinnitus and dizziness.  
Non-invasive treatments are effective in managing TMD, with new promising options emerging. Surgery is reserved for severe cases and is ideally combined with conservative therapies [5]. The correlation between malocclusions and TMD has long been debated in the literature, with no consensus on the role of occlusal factors in TMD. Some authors [6] argue that malocclusions are rarely associated with signs of TMD. Among the various malocclusions cited, a bilateral open bite greater than 3 mm appears to be associated with TMD signs. As the degree of occlusal and skeletal discrepancy increases, the likelihood of developing joint disorders also increases. Other authors [7] contend that individuals possess varying degrees of physiological adaptability to disharmonies or interferences, with this adaptability limit differing from person to person. Therefore, it can be stated that malocclusion in itself does not necessarily contribute to the onset of TMJ disorders [8; 9]. Anterior open bite is a severe malocclusion characterized by the absence of overbite when the teeth are in maximum intercuspation [10; 11; 12; 13]. A correct overbite, ranging between 2 and 4 mm, is essential to ensure proper occlusion and is a key objective in dental treatments. The problems associated with anterior open bite are numerous and often proportional to the severity of the condition, necessitating correction. The literature presents various treatment options [14; 15], including non-surgical and combined orthodontic-surgical approaches.  
In adult patients with completed growth and significant vertical skeletal discrepancy, therapeutic options are greatly reduced, with orthognathic surgery often being the only effective method to correct the defect and maintain stable results over time [16; 17]. Although orthognathic surgery is widely used to correct various dentofacial deformities, there is a gap in the literature regarding its impact on TMJ dysfunction [18].  
Therefore, the objectives of this research are: (1) to evaluate the progression of the health and functionality of the temporomandibular joint (TMJ) in adult patients treated with pre-surgical orthodontics and orthognathic surgery for skeletal anterior open bite, and (2) to assess whether the treatment and the resolution of the malocclusion can influence the health status of the TMJ.