###### Abstract  
_Background_: The aim is to assess the current evidence-based knowledge about treatment decisions for skeletal malocclusion in adult borderline patients. _Methods_: A literature search was conducted through three databases. Inclusion criteria were restricted to systematic reviews, prospective, retrospective, and control studies. Only articles comparing orthodontic camouflage and orthognathic surgical treatment for Class II and Class III malocclusions in adult patients were selected to be reviewed. _Results_: Seven articles concerning Class II and nine concerning Class III met the inclusion criteria. Scientific evidence was poor due to low methodological quality. _Conclusions_: Surgical treatment was found to better improve skeletal and soft-tissue cephalometric values, whereas camouflage treatment mainly involved dentalveolar movements. Aesthetic changes, as perceived by the patient, were not significantly different in the two groups. Recently improved surgical techniques, differing from those described in the analyzed articles, may provide similar or more stable outcomes compared with orthodontic-only treatment. Although some cephalometric variables can be helpful, the most important parameters for treatment selection are the patient's presenting complaint and their self-image perception. Further studies with larger sample sizes and similar pretreatment conditions, and considering patient self-evaluation of esthetics and function, should be undertaken. Dedicated  
the orthodontic field by facilitating dental movements that were previously only achievable by means of orthognathic surgery [9]. Complex malocclusions can be resolved through orthodontic treatment by means of TADs, driving the more complicated movements such as molar intrusion, distalization, and molar protraction [9]. However, according to a recent systematic review on Class III camouflage orthodontic treatment by [PERSON] et al., most of this recent information is derived from case reports and expert opinions, which lack stronger evidence and predictable clinical reproducibility [10]. In addition, recent interest in patient satisfaction during health care provision has grown significantly. Patients' perceptions and expectations have become increasingly important in justifying health services delivery and ensuring overall health care quality [9]. A recent systematic review concludes that final esthetic outcome, perceived social benefits, type of orthognathic surgery, sex, and changes in patient self-concept during treatment were associated with satisfaction. Treatment length, sensation of functional impairment and/or dysfunction after surgery, and perceived omitted information about surgical risks were associated with patient dissatisfaction [11]. Historically, [PERSON] and [PERSON] introduced the \"envelope of discrepancy\" concept. The Proffit diagram illustrates the quantitative relationship of three basic treatment possibilities for a skeletal discrepancy. When a moderate discrepancy exists and there is no growth potential, orthodontic camouflage could be applied by displacing the teeth to obtain proper function despite the jaw relationship, which produces a dental compensation for the skeletal discrepancy. However, the envelope outlines the sagittal limits of hard tissue changes towards an ideal occlusion, but does not include transversal limits in skeletal discrepancy, soft tissue evaluation and patients' complaints, resulting in an incomplete method of treatment decision in borderline cases [4; 12]. It is suggested that orthodontic camouflage of skeletal malocclusions would have acceptable results if there were an average or short facial pattern, mild anteroposterior jaw discrepancy, dental crowding lower than 4-6 mm, normal soft tissue features (nose, lips, chin), and no transverse skeletal problems.