Comparison of Dal Pont, Hunsuck, Wolford, and Posnick Sagittal Split Osteotomy Designs: An Ex Vivo Ovine Study

This ex vivo experimental study aimed to comparatively evaluate 4 sagittal split osteotomy designs (Dal Pont, Hunsuck, Wolford, and Posnick) using ovine hemimandibles with respect to operative time, lingual split pattern, the occurrence of bad splits, and the position of the inferior alveolar nerve (IAN) within the osteotomized segments.

A total of 80 fresh ovine hemimandibles were randomly allocated into 4 equal groups (n=20 per group) using simple randomization. All osteotomies were performed under standardized conditions by a single surgeon. Operative time was recorded in seconds, lingual split patterns were classified according to the Lingual Split Scale (LSS), and the position of the IAN within the proximal or distal segment was determined.

Mean operative time differed significantly among the groups (P<0.001), with the shortest time observed in the Posnick group (696.95±71.20 s) and the longest in the Wolford group (1070.30±99.74 s). The distribution of lingual split patterns also differed significantly between groups (P=0.015); however, post hoc pairwise comparisons revealed a significant difference only between the Dal Pont and Posnick groups (P=0.029). No LSS4 (bad split) cases were observed in the Posnick group (0%), whereas the highest incidence occurred in the Dal Pont group (30.0%); nevertheless, this difference did not reach statistical significance (P=0.051). No significant differences were found among the groups regarding the position of the IAN within the osteotomized segments (P=0.531). Notably, the LSS2 pattern was not observed in any specimen.

The 4 osteotomy designs differed with respect to operative time and lingual split pattern but showed no statistically significant differences in the incidence of bad splits or the position of the IAN. Although the Posnick technique demonstrated a shorter operative time and a lower tendency for bad splits, no clear superiority was identified among the techniques regarding clinically critical outcomes. These findings should be interpreted cautiously when extrapolating results from an animal model to clinical practice.