Participants, eligibility criteria, and settings
malocclusion
Patients seeking orthodontic-surgical treatment with an orthodontics first approach at the Department of Orthodontics, University Medical Center Goettingen, Germany, were enrolled consecutively. The eligibility criteria for participants were adults over 18 years old, orthodontic therapy with fixed appliance, pronounced malocclusion (skeletal class II: Wits appraisal > 2 mm; skeletal class III: Wits-appraisal <  − 2 mm), and indication for combined orthodontic-surgical treatment (classified as grade 4 or higher using the index of orthognathic functional treatment need [