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Bilateral mandibular condylar replacement with a custom temporomandibular joint plate system: simulation-guided correction of anterior open bite

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A secondary anterior open bite may develop after a mandibular condyle fracture, particularly when an initial conservative treatment fails to restore vertical ramus height or joint function. Herein, we describe a patient with unstable preexisting occlusion who developed a persistent anterior open bite after bilateral condylar neck fractures were managed conservatively. Bilateral condylar reconstruction was planned through virtual surgical simulation and executed with patient-specific guides to accurately reproduce the intended mandibular position. Partial replacement of the mandibular condyle was selected because the soft tissues within the mandibular fossae, including the discs, remained intact and demonstrated functional mobility over the articulating surfaces. Postoperative evaluation revealed close agreement between the planned and achieved mandibular positions, with less than two millimeters of deviation, and stable occlusion was maintained during long-term follow-up. This case illustrates the potential of digitally assisted planning to achieve predictable outcomes in patients with complex secondary deformities.

Abstract

A secondary anterior open bite may develop after a mandibular condyle fracture, particularly when an initial conservative treatment fails to restore vertical ramus height or joint function. Herein, we describe a patient with unstable preexisting occlusion who developed a persistent anterior open bite after bilateral condylar neck fractures were managed conservatively. Bilateral condylar reconstruction was planned through virtual surgical simulation and executed with patient-specific guides to accurately reproduce the intended mandibular position. Partial replacement of the mandibular condyle was selected because the soft tissues within the mandibular fossae, including the discs, remained intact and demonstrated functional mobility over the articulating surfaces. Postoperative evaluation revealed close agreement between the planned and achieved mandibular positions, with less than two millimeters of deviation, and stable occlusion was maintained during long-term follow-up. This case illustrates the potential of digitally assisted planning to achieve predictable outcomes in patients with complex secondary deformities.

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