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Three Different Fixation Modalities following Mandibular Setback Surgery with Sagittal Split Ramus Osteotomy: A

Majid Eshghpour1, Sahand Samieirad2, Zahra Shooshtari1

  • 1Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran.

World Journal of Plastic Surgery
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Summary

Miniplate fixation offers superior biomechanical stability for mandible fractures compared to bicortical screws. This technique aids in faster recovery and reduced complications after bilateral sagittal split osteotomy (BSSO) surgery.

Keywords:
BicorticalBilateral sagittal split osteotomyFinite element analysisMaxillofacial surgery

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Biomechanical Engineering
  • Dental Implantology

Background:

  • Sufficient skeletal stability is crucial post-maxillofacial surgery to prevent complications and relapse.
  • Effective stabilization of osteotomized segments promotes functional recovery and optimal healing.
  • Bilateral sagittal split osteotomy (BSSO) is a common procedure requiring robust fixation methods.

Purpose of the Study:

  • To qualitatively compare stress distribution patterns in a virtual mandible model.
  • To evaluate three distinct intraoral fixation techniques following BSSO.
  • To determine the most biomechanically advantageous fixation method for BSSO.

Main Methods:

  • A 3D virtual mandible model was created from CT scans.
  • Bilateral sagittal split osteotomy (BSSO) with a 3mm setback was simulated.
  • Finite element analysis (FEA) assessed stress, strain, and displacement under occlusal loads for three fixation methods: two bicortical screws, three bicortical screws, and a miniplate.

Main Results:

  • Stress predominantly concentrated at the fixation points across all tested methods.
  • While bicortical screws showed greater rigidity, they exhibited higher stress and displacement values compared to miniplates.
  • Miniplate fixation demonstrated superior biomechanical performance over bicortical screw fixation (two or three screws).

Conclusions:

  • Miniplate fixation is the most biomechanically favorable option for BSSO.
  • Fixation with two and three bicortical screws showed progressively less favorable outcomes.
  • Intraoral miniplate fixation, potentially with monocortical screws, is a viable treatment for skeletal stabilization after BSSO setback surgery.