Three-dimensional changes in the mandibular condyle in skeletal class III patients treated with orthognathic surgery: a systematic review

Abstract

This systematic review aimed to evaluate the available evidence on the incidence and quantification of 3-dimensional changes in mandibular condyles after orthognathic surgery by bilateral sagittal split osteotomy (BSSO), with or without maxillary surgery, in class III symmetrical or asymmetrical individuals. The databases PubMed, Lilacs, Web of Science, Embase, SciELO, Scopus, EBSCO, Cochrane, and Google Scholar were surveyed and the study was registered on the PROSPERO (CRD42022383594). The selected studies met the criteria established by the PICO model: 1: Population – individuals over 18 years of age with class III dentofacial skeletal deformities; 2: Intervention – orthognathic surgery using BSSO; 3: Comparison – condylar tomographic measurements (volume, thickness, height, and width) prior to the surgical procedure; and 4: Results – condylar tomographic measurements (volume, thickness, height, and width) at least 12 months after surgery. Initially, 800 articles were identified. After excluding 694 duplicates and screening 153, nine studies met the inclusion criteria for data extraction and analysis. Six evaluated class III symmetrical individuals, and three assessed those with mandibular asymmetry. A total of 233 patients (92 males and 141 females) were studied. Analysis of 466 condyles revealed minimal bone remodelling, with resorption averaging from −0.03 to −0.94 mm and apposition from 0.01 to 0.34 mm. Data analysis showed minimal changes in condylar morphology post BSSO with or without maxillary surgery, indicating predictable skeletal stability. Bias (ACROBAT-NRSI guidelines) did not affect data reliability, and no occlusal changes were observed. The main limitations of the study were heterogeneous imaging techniques, varied study designs, diverse populations, and inconsistent protocols. Further trials with standardised cone-beam computed tomography are needed to enhance remodelling and volume measurement reliability. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.