CAD/CAM-guided total condylar remodelling for the management of active mandibular condylar hyperplasia.

Abstract

The purpose was to describe a novel computer-aided design/computer-aided manufacturing (CAD/CAM)-guided surgical technique for the management of active mandibular condylar hyperplasia (CH) based on virtual surgical planning (VSP), incorporating combined proximal and lateral condylar remodelling to optimise condyle-fossa adaptation, occlusal relationships, and facial symmetry. The proposed technique integrates three-dimensional imaging, VSP, and patient-specific CAD/CAM cutting guides. Unlike conventional high or proportional condylectomy, the approach includes a planned lateral reduction of condylar width in addition to proximal condylar resection. Surgical planning follows principles analogous to orthognathic surgery, prioritising functional joint congruency over symmetry alone. CAD/CAM-guided total condylar remodelling allows precise three-dimensional modification of condylar height and transverse width, resulting in improved immediate condyle-fossa congruency and elimination of intra-articular dead space. In selected patients, improved immediate symmetry may facilitate postoperative orthodontic-only management. CAD/CAM-guided total condylar remodelling expands the surgical armamentarium for active CH by addressing transverse condylar discrepancies that are not corrected by traditional condylectomy techniques. This anatomically driven approach may improve immediate joint adaptation and optimise treatment options in patients with active unilateral condylar hyperplasia.