Sergio Olate

Background: Craniofacial malformations may affect maxillomandibular growth and TMJ function. Customized total TMJ replacement has been used for reconstruction in selected patients with severe congenital TMJ deficiencies. Objectives: To map and characterize the evidence on indications, surgical and prosthetic characteristics, associated procedures, outcomes, complications, and knowledge gaps of customized total TMJ replacement in patients with craniofacial malformations. Methods: This scoping review followed PRISMA-ScR guidelines. PubMed, Embase, Scopus, and Web of Science were searched from 1994 to 7 August 2026, with complementary searches in Google Scholar and OATD. Study selection and data extraction were independently performed by two reviewers, and findings were synthesized descriptively. Results: Seven studies comprising 36 patients aged 9–59 years were included. Forty-three TMJ replacements were performed (29 unilateral and 7 bilateral), most commonly using customized TMJ Concepts prostheses. Twenty-five patients (69.4%) had undergone previous surgery. Orthognathic surgery was part of the treatment pathway in all studies. Reported outcomes included mouth opening, facial symmetry, occlusion, and mandibular function; however, outcome reporting was heterogeneous, limiting attribution of these outcomes specifically to TMJ replacement. Conclusions: Evidence remains limited and heterogeneous, precluding conclusions regarding effectiveness, safety, predictability, or superiority. Prospective studies with standardized outcomes and long-term follow-up are needed.

Background/Objectives: Facial deformities compromise craniofacial aesthetics and functionality. Maxillofacial surgery and orthodontics require meticulous planning utilizing tomography and clinical photography. Although tomography provides precise information about bony structures, it has limitations in evaluating soft tissues. Three-dimensional photography emerges as a complementary alternative; however, there is limited information regarding morphological facial analysis in three dimensional (3D) images. Methods: A scoping review was conducted according to PRISMA-ScR guidelines and the Joanna Briggs Institute methodological framework. The MEDLINE (PubMed), Scopus, SciELO, and Web of Science databases were searched for studies published between 2017 and 2025 evaluating the use of 3D facial photography in orthodontics, orthognathic surgery, maxillofacial surgery, and related craniofacial applications. Two independent reviewers performed study selection and data extraction, with disagreements resolved by a third reviewer. Anatomical landmarks and facial measurements were descriptively synthesized according to facial regions and measurement type. Results: Out of 79 initially identified articles, 18 observational studies examining 3D facial photographs were included. Consequently, the “3D FullFace A” tool was developed, incorporating 13 midline points and 12 bilateral points, enabling 18 linear and 28 angular measurements for comprehensive facial analysis. Conclusions: Available evidence suggests that 3D facial photography is a promising tool for orthognathic surgical planning. Key advances identified include reliable stereophotogrammetric landmark identification, quantification of soft-tissue changes following orthognathic and orthodontic treatment, and characterization of facial asymmetry and proportionality.

Orthognathic surgery in patients with severe dental and periodontal compromise represents a significant clinical challenge, particularly in the presence of a history of prolonged compensatory orthodontics and suboptimal initial diagnosis. This report presents the case of a patient with a class III dentofacial deformity, 3-dimensional maxillary deficiency, mandibular prognathism, multiple tooth loss, and advanced periodontal disease. Management included periodontal therapy, initial dental rehabilitation, and the use of clear aligners as an orthodontic alternative, given the limited potential for conventional decompensation. An early orthognathic surgery approach was selected after a short aligner phase, with the aim of correcting the skeletal discrepancy and facilitating subsequent dental movements. The surgical procedure was performed using fully customized osteosynthesis systems in the maxilla, mandible, and chin, along with specific surgical guides, allowing precise execution without the need for intermediate or final splints. Surgery was completed without complications, and postoperative evaluation demonstrated skeletal stability and absence of dental or periodontal deterioration. This case demonstrates that the combination of aligners and patient-specific plates represents an effective and predictable strategy for the management of complex dentofacial deformities, particularly in scenarios with biological limitations, optimizing functional outcomes and reducing risks associated with prolonged conventional treatments.

Severe maxillary atrophy is a significant challenge for implant-supported rehabilitation, often requiring complex reconstructive or adaptive procedures. Contemporary patient-specific subperiosteal implants, designed through digital planning and fabricated using titanium additive manufacturing technology, have re-emerged as a viable alternative in patients for whom conventional implants are not feasible. This report describes the management of a 45-year-old patient with a class III facial deformity and severe maxillary atrophy. An initial diagnostic phase was performed to achieve anterior and inferior repositioning of the edentulous maxilla through a Le Fort I osteotomy and reconstruction using an iliac crest graft to reestablish vertical dimension. This was followed by the use of a stabilization splint with an esthetic anterior reference and a transitional prosthetic rehabilitation to achieve balanced bilateral occlusion. On the basis of this prosthetic setup, digital planning and design of a patient-specific subperiosteal implant were performed, optimizing bone support areas and prosthetic emergence. Surgery was carried out using a lateral approach independent from the prosthetic access, with fixation of the structure using osteosynthesis screws to achieve primary mechanical stability. Immediate splinting was performed using a fixed prosthesis anchored to the 4 connections of the subperiosteal implants. After an initial stabilization period, follow-up demonstrated complete system stability, efficient occlusion, and adequate 3-dimensional support for oral and facial rehabilitation, achieving satisfactory functional and esthetic outcomes.

Background: Unilateral progressive condylar growth (UPCG) represents a complex clinical condition characterized by abnormal enlargement of the mandibular condyle, leading to progressive facial asymmetry and functional impairment. Objectives: The aim of this review is to analyze the biological, clinical, and therapeutic factors guiding condylectomy, assess the current role and scope of proportional condylectomy, and propose an algorithm to guide its indication in patients with UPCG. Methods: A narrative review was conducted to analyze the biological, clinical, and therapeutic factors involved in the indication for condylectomy in patients with progressive unilateral condylar growth. Studies including patients diagnosed with unilateral condylar hyperplasia or condylar osteochondroma who underwent surgical treatment were considered to evaluate clinical indications, timing of intervention, and outcomes. Special attention was given to the concept of proportional condylectomy. Results: Current evidence indicates that early intervention may control disease progression, reduce the severity of residual deformity, and minimize the need for secondary orthognathic surgery. The integration of clinical findings, three-dimensional imaging, and patient-specific factors is essential for appropriate treatment planning. Conclusions: Based on these considerations, a structured clinical algorithm is proposed to guide decision-making in patients with unilateral progressive condylar growth. This approach supports individualized treatment strategies aimed at optimizing functional and esthetic outcomes.

Facial asymmetry is defined as a clinical discrepancy between the 2 sides of the face and is considered multifactorial in origin. It may affect any facial region, although it is most frequently observed in the lower third of the face. In this context, the mandibular condyle represents a primary growth center whose variations in behavior may lead to changes in volume and morphology. The aim of this study was to analyze the morphologic characteristics of the mandibular condyle in subjects with facial asymmetry associated with sagittal class II deformity (AF-CII) and in subjects with facial asymmetry associated with sagittal class III deformity (AF-CIII). A cross-sectional study was conducted including candidates for orthognathic surgery. Cone-beam computed tomography (CBCT) was used for dentofacial assessment. Condylar width and condylar height were measured, and both condyles were evaluated in each scan to identify the larger and smaller condyle relative to the contralateral side. Condylar morphology was classified as convex (normal) or irregular/flattened based on the characteristics of the superior articular surface. A total of 119 subjects with facial asymmetry and sagittal skeletal deformity were analyzed and divided into AF-CII and AF-CIII groups. In the AF-CIII group, only 4 subjects (3.27%) presented unilateral condylar morphologic alterations. In contrast, the AF-CII group demonstrated greater morphologic variability, with condylar alterations observed in 67.24% of cases, including both unilateral and bilateral changes. Statistically significant differences in condylar dimensions were identified between AF-CII and AF-CIII subjects ( P =0.0001). Conclusions: Facial asymmetry in patients with sagittal dentofacial deformity is associated with differences in mandibular condylar size. AF-CII is related to condylar morphologic alterations, whereas AF-CIII does not demonstrate relevant morphologic changes. Facial deviation predominantly occurs toward the side of the smaller condyle.

The evolution of TMJ-replacements has been driven by advancements in personalization, materials and digital planning technologies. However, there is little data on how surgeons perceive the prosthetic systems and their limitations in practice. The perspective from surgeons is critical to identifying the gap between current technology and clinical need. Using an international, structured survey based on a modified Delphi methodology, including expert validation, pilot testing and global distribution through professional networks, the status of the TMJ-replacement ecosystem was obtained. The questions covered aspects such as the workflow, the integration of components, the design features, the use of materials, the fixation strategy for each component, and usability of surgical guides. The responses were quantitatively analyzed using descriptive statistics. 250 surgeons were included; the majority of surgeons preferred to have all elements of the TMJ-replacement system provided by a single system or company (i.e., the prosthesis and plates), with 86.0% of surgeons indicating this preference and 71.2% of surgeons indicating that having access to STL files for use in surgical navigation is an important feature. Approximately 88.4% of surgeons indicated that flexibility in the design of the prosthesis is important, while 61.6% of respondents indicated that design issues contribute to failures of TMJ prostheses. Issues related to the fixation of the prosthetic components, particularly screw loosening, were also commonly reported by surgeons with respect to failure. Surgeons also indicated concerns with regard to the bulkiness (73.2%) and the fit accuracy (68.4%) of the surgical guides. In terms of material selection, 78.0% of respondents preferred to be able to choose the type of metal alloy for the TMJ replacement system. TMJ replacement is viewed by surgeons as a system-dependent procedure that requires the integration of design, materials, fixation and digital workflow. The currently available prosthetic solutions only partially meet the needs of surgeons.

Maxillary segmentation during Le Fort I osteotomy enables complex 3-dimensional repositioning, facilitating transverse expansion, vertical modification, and dentoalveolar torque adjustment. However, its execution remains controversial due to the risk of periodontal, dental, and vascular complications related to the location and design of the interradicular osteotomy. The aim of this technical note is to describe a standardized and safe protocol for maxillary segmentation based on the use of piezoelectric technology. The technique proposes bilateral segmentation between the canine and lateral incisor following orthodontic preparation to increase root divergence. An “H-pattern” osteotomy is used to define 2 lateral segments, an anterior segment (premaxilla), and an intermediate bony island, allowing independent mobilization. The surgical sequence includes controlled osteotomies performed with a piezoelectric device, direct visualization of the nasal floor, and progressive deepening toward the palatal cortex before completing the crestal separation. This protocol, systematically applied since 2014, has improved surgical control, preserved bone vascularization, and reduced the risk of periodontal injury. Protocolized maxillary segmentation using piezoelectric technology represents a safe, reproducible, and efficient approach to optimize outcomes in orthognathic surgery involving Le Fort I segmentation.

Facial feminization surgery is becoming increasingly common, and its technical challenges remain significant. Precision surgery and minimally invasive techniques require new approaches to improve treatment options. The aim of this technical note is to present a surgical guide that enables accurate chin osteotomies in the vertical, transverse, and sagittal dimensions. A single guide is stabilized on the anterior teeth using maxillomandibular fixation, eliminating the need for screw anchorage. One central guide allows for both the superior and inferior horizontal osteotomies for chin volume reduction, as well as the midline vertical osteotomies for transverse chin narrowing, all with high precision. Its application strategy is presented alongside a comparison with other chin osteotomy guides recently described in the literature, including a critical analysis of their key features.

Background: Mandibular advancement is a commonly performed surgical procedure for the treatment of mandibular retrognathia and Class II dentofacial deformities; however, large advancements impose increased mechanical demands on fixation systems. Despite the availability of various fixation strategies, standard straight plate systems remain widely used worldwide due to their availability, cost-effectiveness, and clinical familiarity. Continuous biomechanical evaluation of these systems is therefore required to optimize stability and performance under demanding conditions. Objectives: The aim of this study was to evaluate the influence of plate design, plate thickness, and fixation architecture on the mechanical stability of mandibular advancement using finite element analysis. Methods: A three-dimensional finite element model simulating a unilateral mandibular osteotomy with a 10 mm gap was generated as mandibular advancement was developed. Fifteen fixation configurations were analyzed, including variations in plate design (simple and reinforced plates with partial or total inferior mesh extension), plate thickness (0.8 mm and 1.0 mm), and fixation architecture using independent plate systems (LN) or integrated fixation systems (FM). A vertical load was applied to the lower central incisor to simulate functional loading. Outcome measures included global equivalent stress considering screws and plate, equivalent stress within the plate, and global deformation of the fixation system. Results: The analyses demonstrated distinct mechanical behaviors among the evaluated configurations. Differences in stress distribution and deformation were observed according to plate design, thickness, and fixation architecture. Reinforced designs, increased plate thickness, and integrated fixation systems showed reduced deformation and more favorable stress distribution when compared with simple plate configurations. Conclusions: Plate design, thickness, and fixation architecture influenced the mechanical stability of mandibular advancement, supporting the importance of biomechanical optimization of standard fixation systems, particularly in large mandibular advancements.