## 2 Materials and Methods  
This study was conducted between 2005 and 2012 at the Department of Dentistry and Maxillofacial Surgery of the \"G.B. Rossi\" Hospital in Verona. The Institutional Review Board (IRB) of the University of Verona granted an exemption from ethical committee approval for the portion of the sample previously examined in earlier studies [16; 17]. A total of 229 patient underwent orthognathic surgery during those 7 years. The inclusion criteria were patients with of a dento-skeletal anterior open bite that required correction with combined orthodontic-surgical therapy, skeletal growth completed, an accentuated Curve of Spee, and a multisegment maxilla intervention. Patients with deep carious lesions, jaw injuries, arthritis, connective tissue diseases, and reduced anterior vertical dimension were excluded from the sample. To minimize potential confounding factors, only patients operated on by the same team (L.T. and A.D.) and following the same therapeutic protocol were included in the study. The selected sample consists of 44 adult patients, 28 females and 16 males, with an average age of 24 years (ranging from 18 to 43 years), all affected by dento-skeletal anterior open bite. All patients received combined orthodontic-surgical therapy for maxillomandibular deformities. The assessment was conducted using a specific joint test developed according to AAOP guidelines [4] to evaluate the progression of the main clinical signs associated with TMD. The parameters examined in the test were:  
a. Maximum mouth opening (OPEN): Expressed in mm, measured clinically by the distance between the incisal edges of the upper and lower central incisors. b. Presence of joint noises (CLICK): Unilateral or bilateral, such as clicks or pops, determined by palpation and auscultation of the TMJ during opening, closing, lateral, and protrusive movements. 3. Presence of parafunctions such as bruxism or clenching (GRIND), evaluated by assessing muscle tone and asking the patient about these habits during both night and day. 4. Episodes of joint locking (LOCK): Patients were asked to report any episodes of joint locking. 5. TMJ pain (ATM PAIN): assessed clinically by palpation of the joint, with patients reporting any spontaneous pain. 6. Muscle pain in the masticatory muscles (MUSC PAIN): Investigated through palpation of the muscles and patient reports of any spontaneous pain. 7. Presence of headaches (HA): Patients were asked if they suffered from headaches and to report the frequency and intensity of the condition. For each of the variables considered, the presence or absence of the symptom, as well as any decrease in the frequency and/or intensity of the symptom during the follow-up evaluation, was assessed. The tests were conducted before (T0) and after (T1) the combined orthodontic-surgical treatment. T0 indicates the presence or absence of symptoms before starting the ortho-surgical treatment, T1 represents the same tests after the treatment. No long-term evaluation was reported. At the initial visit, documentation was collected, including plaster study models, orthopantomographs of the dental arches, lateral cephalometric radiographs, and intraoral and extraoral photographs. Cephalometric analyses were than performed using Dolphin Software (Version 11.8), plaster models were mounted on an articulator, and the joint test was conducted at time 0. Once the orthodontic-surgical treatment plan was established, a CT scan of the facial complex was performed, the surgical simulation was carried out, and the orthodontic planning was finalized. The first phase of treatment involved pre-surgical orthodontics for approximately 18-24 months. All patients underwent orthognathic surgery, specifically, a Le Fort I os-teotomy on the maxilla (either single-piece or tripartite), and a bilateral sagittal split osteotomy on the mandibular arch. In the immediate postoperative period, patients wore inter-arch elastics for intermaximillary stabilization.