Orthodontic treatment in adult patients with a skeletal discrepancy can be challenging. 50% of my patients are adults and elevated percentage of these adult patients who come to our practice have a severe malocclusion. According to Proffit, we have 2 options to treat these patients: to try to compensate the skeletal malocclusion only with orthodontics or performorthognathic surgery. In this conference, I am going to analyze the advantages and disadvantages of these two options focusing my attention in the treatment of skeletal open bite. A skeletal anterior open-bite is a challenging malocclusion for the orthodontist due to the difficulty of the treatment and the inestability of the correction. Treatment options for the adult patient include extractions, anterior extrusion with intermaxillary elastics, posterior intrusion using skeletal anchorage, occlusal adjustment and orthognathic surgery. Patient compliance plays a key role in the treatment and the posttreatment stability. I am going to analyze which cases are worth performing orthognathic surgery and in which cases we can get an acceptable result only with orthodontics.