Skeletal Stability After Mandibular Counterclockwise Rotational Advancement for Correction of Skeletal Class II...

The aim of this systemic review was to compare surgical and postsurgical changes in the mandible after bilateral sagittal split osteotomy (BSSO) with counterclockwise (CCW) rotational advancement. A review of the current available dental literature regarding skeletal stability after mandibular CCW rotational advancement for skeletal Class II deformity was performed using a qualitative and quantitative analysis (meta-analysis).

Five databases were searched: PubMed, MEDLINE (Ovid), Science Direct, Scopus, and Web of Science. The systematic review and meta-analysis addressed the stability of BSSO CCW rotational advancement and the effect of the amount of CCW rotation on skeletal stability after BSSO advancement. Meta-analysis was performed only for studies reporting point B position in mm or mandibular plane angle in degrees before and after surgery and at follow-up.

The database search resulted in 284 articles after removal of duplicates, and an additional 3 articles were included from hand searches of the bibliographies of the selected articles and relevant reviews. Eight studies were included in the systematic review; all were retrospective case series, and all used rigid fixation. Only 1 study was of medium quality; all other studies were of low quality. Meta-analysis of 3 studies revealed a mean forward movement of 7.6 mm at point B (95% confidence interval [CI], 4.07 to 11.4), a mean downward movement of 2.6 mm (95% CI, -0.66 to 5.84), and a mean CCW rotation of mandibular plane of 4.3° (95% CI, -6.34 to -2.19) during surgery. After surgery, point B showed a mean backward movement of -0.18 mm (95% CI, -1.30 to 1.14), a mean upward movement of -0.5 mm (95% CI, -3.00 to 1.98), and a mean clockwise rotation of 0.1° (95% CI, -1.76 to 1.91).

Meta-analysis showed mandibular CCW rotational advancement is a stable procedure, both horizontally and vertically. However, the conclusions are far from robust due to the small sample size and poor quality of the reviewed studies.