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Published on: November 8, 2024
Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic
Christof Urs Joss1, Isabella Maria Vassalli
1Research Assistant, Department of Orthodontics, University of Geneva, Geneva, Switzerland. christof.joss@medecine.unige.ch
Summary
Bilateral sagittal split osteotomy (BSSO) for mandibular advancement is effective for Class II cases but shows less stability than BSSO setback. Bicortical screws and miniplates offer similar short-term stability, though bicortical screws show higher long-term relapse rates.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthodontics
- Skeletal Reconstruction
Background:
- Bilateral sagittal split osteotomy (BSSO) is a common surgical procedure for mandibular advancement.
- Rigid internal fixation methods, including bicortical screws and miniplates, are used to stabilize the osteotomy.
- Understanding relapse patterns is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To systematically review and evaluate horizontal relapse after BSSO with different types of rigid internal fixation.
- To identify the multifactorial causes contributing to relapse following mandibular advancement surgery.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, Ovid, Cochrane Library, Google Scholar).
- 24 articles were selected from 488 identified studies, comprising 6 prospective and 18 retrospective studies.
- Postoperative follow-up periods ranged from 6 months to 12.7 years.
Main Results:
- Short-term relapse at point B varied: 1.5–32.7% for bicortical screws, 1.5–18.0% for miniplates, and 10.4–17.4% for bioresorbable bicortical screws.
- Long-term relapse at point B showed ranges of 2.0–50.3% for bicortical screws and 1.5–8.9% for miniplates.
- Bicortical screws were associated with higher long-term relapse rates compared to miniplates.
Conclusions:
- BSSO for mandibular advancement is a viable treatment for skeletal Class II malocclusion but demonstrates less stability than BSSO setback.
- Short-term skeletal stability shows minimal differences between bicortical screws and miniplates, regardless of fixation material.
- Relapse is multifactorial, influenced by condylar seating, advancement magnitude, soft tissue factors, mandibular plane angle, surgeon skill, and patient age; higher mandibular plane angles and advancements ≥ 6-7 mm increase horizontal relapse risk.
