{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:06:44Z","timestamp":1793120804800,"version":"4.5.0"},"reference-count":29,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: This manuscript addresses the limitations of traditional orthognathic surgery in achieving both functional and aesthetic correction in patients with Class II malocclusion and severe mandibular retrusion. Current techniques often struggle to simultaneously address mandibular deficiency and inadequate transverse dimension, leading to unsatisfactory outcomes. Methods: Seven male patients underwent bimaxillary osteotomy with mandibular advancement. A novel surgical plate, Implate, was used, which was designed to facilitate precise osteotomy and stabilization. Pre-surgical planning included CBCT scanning, 3D modeling, and surgical simulation. Postoperative assessments included clinical examinations, CT and OPT scans. Results: Implate successfully addressed the challenges of conventional techniques, minimizing the formation of bony steps and achieving a more harmonious facial profile. The minimally invasive procedure, with careful periosteal and muscle management, contributed to stable outcomes, and no complications were reported. At the 6-month follow-up, OPT analysis showed a mean mandibular width increase of 18.1 \u00b1 6.2 mm and vertical ramus height gains of 6.0 \u00b1 3.1 mm (left) and 5.8 \u00b1 1.7 mm (right). Conclusions: According to our preliminary experience, the integration of Implate into surgical practice offers a significant improvement in treating complex Class II malocclusions. By simultaneously correcting mandibular retrusion and width while minimizing complications, Implate provides a superior solution compared to traditional methods. This innovative approach highlights the potential of combining advanced surgical techniques with personalized 3D-printed implants to achieve optimal functional and aesthetic outcomes. Further prospective studies with controls and longer follow-up are needed to validate the efficacy and reproducibility of Implate in wider clinical use.<\/jats:p>","DOI":"10.3390\/jcm14145012","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T15:01:05Z","timestamp":1752591665000},"page":"5012","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Overcoming the Limitations of Conventional Orthognathic Surgery: A Novel Approach Using Implate"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1678-1564","authenticated-orcid":false,"given":"Valerio","family":"Ramieri","sequence":"first","affiliation":[{"name":"Ortognatica Roma, Via Nomentana 311, 00137 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2035-9638","authenticated-orcid":false,"given":"Laura Viola","family":"Pignataro","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tito Matteo","family":"Marianetti","sequence":"additional","affiliation":[{"name":"Ortognatica Roma, Via Nomentana 311, 00137 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-1458","authenticated-orcid":false,"given":"Davide","family":"Spadoni","sequence":"additional","affiliation":[{"name":"Ortognatica Roma, Via Nomentana 311, 00137 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1347-4013","authenticated-orcid":false,"given":"Andrea","family":"Frosolini","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Gennaro","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"De Ridder, L., Aleksieva, A., Willems, G., Declerck, D., and Cadenas de Llano-P\u00e9rula, M. (2022). Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19127446"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s00056-009-0821-2","article-title":"Class II treatment in adults: Comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery\u2014A cephalometric study to evaluate various therapeutic effects","volume":"70","author":"Kinzinger","year":"2009","journal-title":"J. Orofac. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ijom.2017.09.003","article-title":"Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: A systematic review and meta-analysis","volume":"47","author":"Raposo","year":"2018","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jebdp.2019.01.008","article-title":"Skeletal Stability After Mandibular Counterclockwise Rotational Advancement for Correction of Skeletal Class II Deformity\u2014A Systematic Review and Meta-analysis","volume":"19","author":"Hasprayoon","year":"2019","journal-title":"J. Evid. Based Dent. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.jcms.2014.06.008","article-title":"Asymmetric mandibular prognathism: Outcome, stability and patient satisfaction after BSSO surgery. A retrospective study","volume":"42","author":"Stenvik","year":"2014","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.jcms.2025.02.026","article-title":"Patient expectations and satisfaction in orthognathic surgery: A retrospective cohort study","volume":"53","author":"Akbulut","year":"2025","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Zammit, D., Ettinger, R.E., Sanati-Mehrizy, P., and Susarla, S.M. (2023). Current Trends in Orthognathic Surgery. Medicina, 59.","DOI":"10.3390\/medicina59122100"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.5125\/jkaoms.2023.49.3.107","article-title":"Mandibular midline osteotomy for correction of bimaxillary transverse discrepancy: A technical note","volume":"49","author":"Ramanathan","year":"2023","journal-title":"J. Korean Assoc. Oral Maxillofac Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/PRS.0000000000004652","article-title":"Refining Post-Orthognathic Surgery Facial Contour with Computer-Designed\/Computer-Manufactured Alloplastic Implants","volume":"142","author":"Lee","year":"2018","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jcms.2015.12.012","article-title":"The ideal male jaw angle\u2014An Internet survey","volume":"44","author":"Mommaerts","year":"2016","journal-title":"J Craniomaxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1002\/adhm.201100006","article-title":"Reduction of biofilm infection risks and promotion of osteointegration for optimized surfaces of titanium implants","volume":"1","author":"Gasik","year":"2012","journal-title":"Adv. Healthc. Mater."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1051\/odfen\/2010307","article-title":"Surgical considerations in the treatment of skeletal hyperdivergence","volume":"13","author":"Tulasne","year":"2010","journal-title":"J. Dentofac. Anom. Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.4067\/S0717-95022009000400044","article-title":"Morphological description of mandibular canal in panoramic radiographs of Brazilian subjects: Association between anatomic characteristic and clinical procedures","volume":"27","author":"Amorim","year":"2009","journal-title":"Int. J. Morphol."},{"key":"ref_14","first-page":"157","article-title":"Case of Elongation of the under Jaw and Distortion of the Face and Neck, Caused by a Burn, Successfully Treated","volume":"9","author":"Hullihen","year":"1849","journal-title":"Am. J. Dent. Sci."},{"key":"ref_15","first-page":"552","article-title":"Double resection of inferior maxilla for protruding lower jaw","volume":"40","author":"Whipple","year":"1898","journal-title":"Dent. Cosm."},{"key":"ref_16","first-page":"268","article-title":"Double resection for the treatment of mandibular protrusion","volume":"65","author":"Angle","year":"1903","journal-title":"Dent. Cosm."},{"key":"ref_17","unstructured":"Blair, V.P. (1917). Surgery and Diseases of the Mouth and Jaws, Mosby."},{"key":"ref_18","first-page":"670","article-title":"Die chirurgische Therapie der Progenie","volume":"40","author":"Kostecka","year":"1931","journal-title":"Zahnarztl. Rundsch."},{"key":"ref_19","first-page":"361","article-title":"Zur Progenieoperation [Surgery of prognathism]","volume":"52","author":"Trauner","year":"1955","journal-title":"Osterr. Z. Stomatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hanna, T., Bansal, K., Ilesan, R.R., and Buchbinder, D. (2024). Hanna\u2019s Modified Sagittal Split Osteotomy (HSSO): An Alternative to Inverted L Osteotomy-Merging Function and Aesthetics for Enhanced Stability, Attractiveness, and Nerve Protection. J. Clin. Med., 13.","DOI":"10.3390\/jcm13123438"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0007-117X(82)80035-8","article-title":"Mechanisms of early skeletal release following surgical advancement of the mandible","volume":"20","author":"Epker","year":"1982","journal-title":"Br. J. Oral Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.asj.2009.09.006","article-title":"Masseter muscle reattachment after mandibular angle surgery","volume":"29","author":"Thomas","year":"2009","journal-title":"Aesthet. Surg. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40902-024-00449-2","article-title":"Virtual surgical plan with custom surgical guide for orthognathic surgery: Systematic review and meta-analysis","volume":"46","author":"Lee","year":"2024","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.jcms.2025.01.024","article-title":"Jawline improvement using patient-specific angle implants with virtual planning in orthognathic surgery","volume":"53","author":"Rios","year":"2025","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jaber, M., Abouseif, N., Hassan, M., and El-Ameen, A.M. (2024). Risk Factors Contributing to Symptomatic Miniplate Removal following Orthognathic Surgery: Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113335"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kauke-Navarro, M., Knoedler, L., Baecher, H., Sherwani, K., Knoedler, S., Allam, O., Diatta, F., Alperovich, M., and Safi, A.F. (2025). A systematic review of implant materials for facial reconstructive and aesthetic surgery. Front. Surg., 12.","DOI":"10.3389\/fsurg.2025.1548597"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1053\/joms.2001.26704","article-title":"Incidence of complications and problems related to orthognathic surgery: A review of 655 patients","volume":"59","author":"Panula","year":"2001","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.ijom.2004.10.021","article-title":"Neurosensory function of the inferior alveolar nerve after bilateral sagittal ramus osteotomy: A retrospective study of 68 patients","volume":"34","author":"Nesari","year":"2005","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.ijom.2010.11.017","article-title":"A long-term comparative study of two rigid internal fixation techniques in terms of masticatory function and neurosensory disturbance after mandibular correction by bilateral sagittal split ramus osteotomy","volume":"40","author":"Yamashita","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5012\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:10:10Z","timestamp":1760033410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":29,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14145012"],"URL":"https:\/\/doi.org\/10.3390\/jcm14145012","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]}}}