The therapeutic paradox in managing condylar resorption with orthognathic surgery in skeletal class II patients: Reason resorption vs. result resorption

Abstract

Mandibular condylar resorption remains a controversial clinical condition because of its multifactorial etiology and progressive course. According to the literature, mandibular condylar resorption is more prevalent in young female patients and those with skeletal Class II malocclusions characterized by mandibular retrognathia. In orthodontic treatment, the standard approach to mandibular condylar resorption involves initially stabilizing the condyle using a stabilization splint, accompanied by simultaneous muscle deprogramming. After splint therapy, Class II malocclusions—which often worsen—are typically addressed through bimaxillary orthognathic surgery. During bimaxillary surgery, counterclockwise rotation and anterior advancement of the mandible can introduce new biomechanical stresses on the already weakened condylar structures, paradoxically resulting in further resorption. This article aims to raise awareness among orthodontists regarding the etiology of mandibular condylar resorption, differential diagnosis, risk classification, causes of postoperative resorption, and possible preventive strategies. © 2025 American Association of Orthodontists.