Postoperative stability of the hybrid method of rigid internal fixation in sagittal split osteotomy for orthognathic...

Bilateral sagittal split ramus osteotomy (BSSO) is a cornerstone of orthognathic surgery, yet the optimal fixation method for ensuring long-term stability remains debated, with hybrid fixation (combining monocortical plates and bicortical screws) emerging as a promising technique that balances rigidity and safety.

This systematic review attempted to assess whether the hybrid fixation system for bilateral sagittal split osteotomy in orthognathic surgery provides adequate long-term stability by summarizing the results of clinical studies. This systematic review was prepared according to the PRISMA guidelines and registered in PROSPERO under the number CRD42022331540. Evidence searches were performed by two independent investigators in MEDLINE/PubMed, Web of Science, Embase, LILACS, Scopus, Cochrane databases, gray literature, and manual search to verify if patients who have undergone orthognathic surgery with bilateral sagittal split osteotomy fixed with the hybrid system, achieve satisfactory mandibular long-term stability, regardless of comparisons between other fixation systems.

All studies included in this review attributed the long-term stability to the hybrid fixation system of the bilateral sagittal split osteotomy. Our findings indicate a positive relationship between long-term stability and hybrid fixation when accessing mandibular asymmetries. Methodological differences were found in the included studies, particularly in relation to the assessment of surgical outcomes, as well as a small number of participants studied.

The current evidence for hybrid fixation is too limited and biased to confirm superiority, highlighting an urgent need for robust, prospective trials.