Temporomandibular joint (TMJ) ankylosis compromises essential functions such as chewing, phonation, and breathing. Surgical treatment aims to restore mandibular mobility and prevent the recurrence of joint fusion. This article describes a technical variation based on Puricelli biconvex arthroplasty, using surgical cement, screw fixation, and 3D-printed cutting guides based on virtual planning, allowing for greater precision in joint reconstruction. In this work, we present the step-by-step process used in the customization of cutting guides, virtual planning, and the production of the interposition material with PMMA associated with fixation with titanium screws as a hybrid method for the treatment of recurrent TMJ ankylosis. This reported technique is demonstrated to be reproducible, low-cost, and effective.

Background: Mentoplasty plays a central role in facial harmony, particularly in the correction of chin asymmetries. Advances in digital planning and three-dimensional (3D) printing have enabled the development of patient-specific surgical guides; however, their clinical implementation in public healthcare settings remains limited by workflow complexity and accessibility. Methods: This case series describes three patients who underwent asymmetric mentoplasty using customized, in-house-manufactured 3D-printed cutting and positioning guides. Virtual surgical planning was performed using cone-beam computed tomography (CBCT) data, followed by guide design and fabrication through an in-house digital workflow. Postoperative CBCT was used for descriptive assessment of the correspondence between planned and achieved chin positions using predefined linear reference points. Results: Across the three cases, postoperative CBCT analysis demonstrated encouraging agreement between virtual planning and achieved surgical outcomes. The customized guides facilitated accurate transfer of the planned osteotomy and chin positioning in both symmetric and asymmetric movements. No major intraoperative or postoperative complications were observed. Guide fabrication required low material consumption, enabling rapid in-house production with minimal direct material cost. Conclusions: Within the limitations of a small case series, the proposed in-house digital workflow demonstrated technical feasibility and encouraging agreement between planned and achieved chin positioning in selected asymmetric mentoplasty cases. Further studies with larger samples and standardized accuracy assessment methods are required to confirm these preliminary observations.