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Stability after bilateral sagittal split osteotomy setback surgery with rigid internal fixation: a systematic review.
Christof Urs Joss1, Isabella Maria Vassalli
1Department of Orthodontics, University of Geneva, Geneva, Switzerland. christof.joss@medecine.unige.ch
Summary
This review on bilateral sagittal split setback osteotomy found relapse rates stable long-term. Key factors influencing relapse include condyle seating, setback amount, and soft tissue dynamics.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthodontics
- Skeletal Class III Correction
Background:
- Bilateral sagittal split osteotomy (BSSO) is a common procedure for mandibular setback.
- Rigid internal fixation is typically used to stabilize the osteotomy.
- Understanding relapse patterns is crucial for long-term treatment success.
Purpose of the Study:
- To systematically review relapse rates and contributing factors following BSSO with rigid internal fixation.
- To assess the stability of BSSO for mandibular setback in skeletal Class III correction.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, Ovid, Cochrane Library, Google Scholar).
- 14 articles were selected from 488 initially identified studies.
- Studies included a mix of prospective and retrospective designs with follow-up periods ranging from 6 weeks to 12.7 years.
Main Results:
- Short-term horizontal relapse varied significantly: 9.9%-62.1% at Point B and 15.7%-91.3% at pogonion.
- Long-term relapse showed a narrower range: 14.9%-28.0% at Point B and 11.5%-25.4% at pogonion.
- No substantial difference was observed between short-term and long-term relapse rates.
Conclusions:
- Bilateral sagittal split osteotomy combined with orthodontics is an effective and stable treatment for skeletal Class III malocclusion.
- Relapse is multifactorial, influenced by condylar seating, setback magnitude, soft tissues, muscle activity, growth, and gender.
- Further research should isolate BSSO outcomes by excluding concurrent surgeries like genioplasty or maxillary procedures.
