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Does Fixation Method Affect Stability of Sagittal Split Osteotomy and Condylar Position?

Reza Tabrizi¹, Fereydoun Pourdanesh¹, Hassan Mirmohammad Sadeghi²

¹Associate Professor, Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons

|September 24, 2017

Summary

Bicortical screw fixation in sagittal split osteotomy may cause more condylar displacement. However, both monocortical and bicortical screw fixation methods showed similar surgical stability after one year.

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Area of Science:

Oral and Maxillofacial Surgery
Orthognathic Surgery
Surgical Fixation Techniques

Background:

Condylar position and stability are critical for successful sagittal split osteotomy (SSO).
Different fixation methods, including monocortical and bicortical screws, are used in SSO procedures.
Understanding the impact of fixation choice on condylar behavior is essential for optimizing surgical outcomes.

Purpose of the Study:

To compare condylar position and stability changes following mandibular setback via SSO using plate fixation with monocortical versus bicortical screws.
To evaluate the linear and angular changes in condylar position.
To assess the horizontal and vertical stability of the mandible post-surgery.

Main Methods:

Retrospective cohort study involving 50 patients undergoing mandibular setback with SSO.
Group 1: Fixation with a miniplate and 4 monocortical screws.
Group 2: Fixation with 3 bicortical screws.
Cone beam computed tomography (CBCT) scans used for pre- and post-operative evaluation at 1 year.
Condylar position assessed linearly (mediolateral) and angularly; mandibular stability evaluated at point B.

Main Results:

A significant difference in mediolateral condylar changes was observed between the two groups (P = .003).
No significant differences were found in angular condylar changes (P = .45).
No significant differences in vertical (P = .47) or horizontal relapse at point B were detected between the groups.

Conclusions:

Bicortical screw fixation may be associated with increased condylar displacement.
No significant differences in surgical stability were found between monocortical and bicortical screw fixation methods after one year.
The choice between monocortical and bicortical screws may influence initial condylar position but not long-term mandibular stability.