Comparison of customized plate position guide and conventional methods for condylar positioning in mandibular reconstruction

Objectives: Precise restoration of condylar position during mandibular reconstruction is critical for achieving optimal occlusion, temporomandibular joint (TMJ) function, and facial symmetry. This study aimed to compare the three-dimensional (3D) accuracy of condylar positioning using prebent plates with a customized plate position guide (CPPG) versus conventional methods (CM) in mandibular reconstruction following tumor resection. Methods: Sixteen patients undergoing mandibular reconstruction for tumor resection were enrolled and evenly divided into two groups. The CPPG group (n = 8) received reconstruction using prebent plates guided by a customized plate position guide developed through virtual surgical planning, while the CM group (n = 8) underwent conventional prebent plate placement. Pre- and postoperative computed tomography (CT) data were used for 3D comparative analysis of intercondylar distance, condylar angulation, condylar axis orientation, and positional deviations (medial-lateral, superior-inferior, anterior-posterior). Statistical analyses were performed using t-tests and Chi-square tests, with significance set at p < 0.05. Results: The CPPG group exhibited significantly smaller deviations in the medial-lateral position of the most superior point of the affected condyle (1.05 ± 1.28 mm) compared to the CM group (2.94 ± 1.50 mm; p < 0.05). Similarly, deviations in condylar axis orientation were significantly reduced across all planes: coronal (1.29° ± 1.77 vs. 5.24° ± 3.20), sagittal (3.34° ± 2.12 vs. 25.78° ± 17.24), and transverse (2.39° ± 1.64 vs. 7.54° ± 3.53) (p < 0.01 for all). No significant differences were found in superior-inferior or anterior-posterior deviations or in operative duration between groups. Conclusions: The customized plate position guide demonstrated superior 3D accuracy in restoring condylar position compared with conventional prebent plate methods. Its integration into mandibular reconstruction workflows enhances surgical precision, reduces intraoperative variability, and may improve postoperative TMJ function and facial symmetry. This innovation underscores the potential of virtual surgical planning and 3D-printed guidance systems in modern maxillofacial reconstruction.