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Stability of bilateral sagittal split ramus osteotomy: rigid fixation versus transosseous wiring
J L Berger1, V Pangrazio-Kulbersh, S N Bacchus
1University of Detroit Mercy, School of Dentistry, Department of Orthodontics, Detroit, MI, USA. jberger@mnsi.net
Abstract:
Although many improvements have been made in orthodontic surgical procedures for mandibular retrognathism, relapse continues to occur. This study was designed to compare the stability of rigid and nonrigid fixation between 2 groups of patients who had undergone mandibular advancement surgery via sagittal split ramus osteotomy. Retrospective cephalometric measurements were made on 54 randomly selected orthognathic surgical patients. The patients, 7 males and 47 females, were divided into 2 groups: 28 patients stabilized by means of rigid fixation and 26 patients fixated with interosseous wires. The age of the patients ranged from 15.3 to 49.7 years. Lateral cephalograms were used to evaluate each patient at 3 distinct intervals: 7.0 +/- 2.0 days before surgery (T1), 34.4 +/- 15.0 days postsurgery (T2), and 458 +/- 202 days after sagittal split osteotomy (T3). Eighteen linear and angular measurements were recorded and differences between the 3 time periods were evaluated. Statistical analyses were performed to assess the differences in the 2 fixation types between and within each group at different time intervals. The following measurements showed statistically significant skeletal relapse over time, for the P value.0028: Co-Go, ANS-Xi-Pm, IMPA, overbite, and overjet. The remaining variables showed no statistically significant relapse. The only measurement that showed a statistically significant group difference between T1 and T2 was DC-Xi-Pm. Results of the study led to the following conclusions: there was statistically significant relapse in mandibular length, lower anterior face height, mandibular arc, lower incisor inclination, overbite, and overjet in each group, regardless of the type of fixation. The potential was greater for relapse in patients stabilized with transosseous wiring. Although multifactorial, relapse in overbite and overjet may be a combination of skeletal and dental changes. (Am J Orthod Dentofacial Orthop 2000;118:397-403).