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The goal of pre-surgical orthodontics is to prepare the patient for maxillofacial surgery in expectation of jaw bone movements in the three spatial planes. Accuracy in the diagnostic phase and the communication with the maxillofacial surgeon are critical for estabilishing the results that the dentist and the patient want to achieve. The types of dentofacial deformities or developmental anomalies of the jaw bones that require preventive orthodontic treatment are: dentoskeletal disharmonies of skeletal class 2 and 3, (incompatibility of shape and function between the jaw bones) traumatic pathologies affecting the temporomandibular joints and bones or obstructive sleep apnoea syndrom that may benefit from bimaxillary advancements and relative modifications of the interdental relations or from reconstructive bone surgery (grafts, sinus lifts). These operations not only have a functional therapeutic purpose, but can restore harmony and improve facial aesthetics on the frontal and lateral plane. The pictures below show how bone alteration may influence the patient’s profile. After orthodontic-surgical treatment, the profile as well as facial aesthetics have reached an harmonic balance of proportions.