Evaluation of the Different Methods for Fixation of Sagittal Ramus Split Osteotomy of the Mandibular Ramus in Relation to Stability for Mandibular Advancement: A Systematic Review (original) (raw)
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The British journal of oral & maxillofacial surgery, 2016
We have evaluated the resistance to displacement of six stable methods of fixation of a sagittal split ramus osteotomy (SSRO) in the mandibular advancement with counterclockwise rotation. We tested 60 synthetic hemimandibles in six groups of 10 each: Group I - fixation with a straight four-hole 2.0mm miniplate; Group II - a straight six-hole 2.0mm miniplate; Group III - two straight 2.0mm four-hole miniplates; Group IV - an eight-hole 2.0mm (grid plate); Group V - a 2.0mm four-hole straight miniplate and 2.0×12mm bicortical screw; and Group VI - a straight four-hole 2.0mm locking miniplate. We applied a linear force in the region between the canine and the first premolar using a universal testing machine (EMIC- DL2000) with a loading cell of 10 KN. The loads at 1, 3, and 5mm displacement were recorded (N) and the data transmitted from the load cell to a computer. Results were analysed using analysis of variance (ANOVA) (p<0.001) and the Tukey post-test for comparison of the signi...
Journal of Cranio-Maxillofacial Surgery, 2014
Purpose: To investigate postoperative intersegmental displacement and relapse following bilateral sagittal split ramus osteotomy (BSSRO) by comparing three different fixation methods: group A (sliding plate), group B (miniplate) and group C (bicortical screws). Materials and methods: The present retrospective study included 55 patients with mandibular prognathism who were treated with BSSRO. To evaluate skeletal changes, cone-beam computed tomography was taken before surgery (T0), three days after surgery (T1), and 6 months after surgery (T2). Differences among the three groups were assessed using a one-way analysis of variance, where P < 0.05 was accepted as statistically significant. Results: There were no significant differences among the three groups in demographic data and the amount of mandibular setback. In skeletal changes and condylar axis changes, there were no statistically significant differences among the three groups. However, there were statistically significant postoperative skeletal changes in group C (bicortical screws) at all landmarks. The mean horizontal relapse rate was 1.9% in group A (sliding plate); 4.8% in group B (miniplate); and 15.4% in group C (bicortical screws). Conclusion: The sliding plate system has good adaptability to the proximal segment after mandibular setback with BSSRO, and behaves according to semi-rigid fixation principles.
Morphometric Study of Mandibular Ramus Related to Sagittal Ramus Split Osteotomy and Osteosynthesis
Journal of Craniofacial Surgery, 2012
The objective of this study was to quantify the cortical bone thickness of the mandibular ramus to determine conditions related to sagittal split ramus osteotomy and placement of screws. The patient sample comprised 44 subjects of ages ranging from 46 to 52 years (mean age, 49 years). The cone-beam computed tomography was performed and realized 3 cuts in the third molar area (section A), 5 mm posterior (section B), and 5 mm posterior to the latter (section C). Measurement in the cortical areas of the superior and inferior levels related to mandibular canal and measurement related to the total width of the mandible was executed. Intraclass correlation coefficient with P G 0.05 was used. The result showed that the buccal and lingual cortical zone did not present statistical differences, and the minor value was 1.5 mm for each one. There were no differences in the superior and inferior cortical bone, and the total width of the mandible was between 15.9 and 8.5 mm in the anterior area, between 17.4 and 12.8 mm in the middle area, and between 18 and 8.8 mm in the posterior area. The distance superiorly to the mandibular canal presented a minimal SD with a mean of 8.5 mm in the anterior region, 10.6 mm for the middle region, and 12.5 mm in the posterior region. In conclusion, the cortical thickness of the mandibular ramus in the adult population is particularly strong and offers a good anchorage for screw insertion in sagittal split ramus osteotomy.
Biomechanical Evaluation of Sagittal Split Ramus Osteotomy Fixation Techniques in Mandibular Setback
Applied Sciences
The objective of this study was to evaluate and compare the biomechanical behavior of internal fixation techniques in bilateral sagittal split ramus osteotomies (BSSROs) for mandibular setback. Artificial polyurethane mandibles were used in this study. The distal segment of the mandible was repositioned in an 8-mm setback position. All mandibles were divided into three groups: Group 1 had a straight plate with a four-hole monocortical fixation, Group 2 had a curved plate with a four-hole monocortical fixation, and Group 3 had a three–inverted L-type bicortical screw fixation. Vertical loads were applied on the incisal edge by a material testing system. The resistance force at 1, 3, 5, and 10 mm of displacement was analyzed. From the experimental results, Group 1 showed significantly lower results than Groups 2 and 3. No significant difference was observed between Groups 2 and 3 at 1, 3, and 5 mm of displacement. However, at 10 mm of displacement, the resistance force of Group 3 was ...
Journal of Maxillofacial and Oral Surgery, 2021
The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus. SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5 mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5 mm displacement of the segments. Resistance force...
Skeletal Relapse Following Sagittal Split Ramus Osteotomy Advancement
Journal of Maxillofacial and Oral Surgery, 2014
Background Sagittal split ramus osteotomy (SSRO) is an accepted and standard procedure to address mandibular corpus deficiency. The relapse following the mandibular advancement has a negative impact both on clinician and patient. Purpose To analyse the hard tissue changes and to investigate relapse following SSRO advancement procedure. Materials and Methods A retrospective review of 21 patients treated by bilateral SSRO advancement at our institute was conducted. Lateral cephalograms obtained at pre-treatment (T1), pre-surgery (T2), 2 months (T3) and 2 years post-surgery (T4) were evaluated by an independent investigator. The data T2-T3 revealed immediate postoperative changes, and T3-T4 revealed skeletal relapse following surgery after 2 years. Results Twelve females and nine males with age ranging from 16 to 24 years underwent mandibular advancement. The mean follow-up period was 2 years 7 months ± 4 months. The mean mandibular advancement at pogonion was 5.1 ± 1.25 mm with significant improvement in SNB, ANB, CoGn, maxillo-mandibular differential and SN:GoPg ratio following surgery. Comparison of the outcomes following surgery revealed that the mean relapse at pogonion was 0.2 ± 0.44 mm. B point, mandibular corpus length, anterior and posterior facial height remained stable with no significant relapse following mandibular advancement. Conclusion Sagittal split ramus osteotomy within the range of mandibular advancement is a stable procedure.
Journal of Cranio-Maxillofacial Surgery, 2002
In order to minimize post-operative relapse after mandibular setback using bilateral sagittal split ramus osteotomy, we have recently tried a technique, i.e. intentional ostectomy of the posterior part of the distal segment. The aim of this study was to evaluate the effects of this technique on the frequencies and extent of post-operative relapse. Patients: This study was based on 61 cases of mandibular prognathism. The traditional sagittal split was performed in 24 cases (average age: 22.073.8) as a control group and the technique of additional distal ostectomy was used in the other 37 cases (average age: 23.273.2) as a test group. Methods: Horizontal and vertical changes in the position of the body of the mandible were measured to determine the amount of long-term post-operative relapse. The amount of relapse was compared between groups and the statistical significance of the differences was evaluated. Results: The relapse index of the test group was significantly lower than that of the control group in the 6-and 12-month post-operative periods (p40.005). The horizontal relapse index and facial length relapse index of the test group were lower than those of the control group 12 months post-operatively (po0.05). Conclusion: This method should be considered as a useful method to maximise long-term post-operative stability.
Journal of Oral and Maxillofacial Surgery, 2013
Purpose: To determine whether specific morphologic features of the mandibular ramus can predict increased surgical time and blood loss in sagittal split-ramus osteotomy (SSRO). Materials and Methods: The clinical and morphologic features of the mandibular ramus, obtained from computed tomographic images (n ϭ 50), were analyzed to predict the surgical time, the time required for ablation of the medial mandibular ramus, and the time required for sectioning of the mandible in performing a modified Obwegeser SSRO. Results: Significant factors associated with surgical time were an anterior border of the ramus at least 10.5 mm wide, a maximal length of the thickened ramus of at least 8.5 mm, and a distance from the mandibular incisor to the posterior border of the mandible of at least 97.5 mm. There were significant differences in blood loss between the 2 axial aspects of the medial ramus. Conclusions: The greater protrusion of the medial oblique ridge, thickened ramus, and longer distance from the mandibular incisors to the posterior border of the mandible may increase the surgical time and blood loss in patients undergoing classic SSRO. When planning or performing an SSRO, the morphologic features obtained from computed tomographic images may help surgeons gain a better understanding of the potential difficulties when the surgical site involves the medial aspect of the ascending ramus of the mandible.