Optimal placement of bicortical screws in sagittal split-ramus osteotomy of mandible

When a bicortical screw is used for the rigid fixation of sagittal split-ramus osteotomy, by definition the threads of the screw should engage in the buccal plates as well as in the lingual plates. In a study of six dry mandibles we found that when 2 and 2.7 mm screws are used in noncountersunk holes, it is almost certain that a thread will engage the buccal cortical plate. With countersinking 55% of the 2.7 mm and 27% of the 2.0 mm screws had no threads engaged in the buccal cortical plate. This changes these screws from bicortical to compression type. An anatomic study of bone thickness demonstrated that the thickest buccal and lingual cortical plates were in the superior border of the ramus, just distal to the last molar. In addition, a change in the intercondylar distance before and after surgery was observed in every mandible.