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Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing

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Abstract

Purpose

To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars.

Material and methods

A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique.

Results

A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020).

Conclusion

The results obtained support concomitant molar extraction with BSSO as a feasible option.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Giralt-Hernando M, Valls-Ontañón A, Guijarro-Martínez R, Masià-Gridilla J, Hernández-Alfaro F (2019) Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis. BMJ Open Respir Res 6(1):e000402

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ploder O, Sigron G, Adekunle A, Burger-Krebes L, Haller B, Kolk A (2021) The effect of orthognathic surgery on temporomandibular joint function and symptoms: what are the risk factors? A longitudinal analysis of 375 patients. J Oral Maxillofac Surg 79(4):763–773

    Article  PubMed  Google Scholar 

  3. Trauner R, Obwegeser H (1957) The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol. 10(7):677–689 (contd)

    Article  CAS  PubMed  Google Scholar 

  4. Trauner R, Obwegeser H (1957) The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. Ii. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 10(9):899–909

    Article  CAS  PubMed  Google Scholar 

  5. Obwegeser H (1964) The indications for surgical correction of mandibular deformity by the sagittal splitting technique. Br J Oral Surg 1:157–171

    Article  CAS  PubMed  Google Scholar 

  6. Aarabi M, Tabrizi R, Hekmat M, Shahidi S, Puzesh A (2014) Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy. J Oral Maxillofac Surg 72(12):2508–2513

    Article  PubMed  Google Scholar 

  7. Kim SG, Park SS (2007) Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg 65(12):2438–2444

    Article  PubMed  Google Scholar 

  8. Böckmann R, Meyns J, Dik E, Kessler P (2014) The modifications of the sagittal ramus split osteotomy: a literature review. Plast Reconstr Surg Glob Open 2(12):e271

    Article  PubMed  Google Scholar 

  9. Akhtar S, Tuinzing DB (1999) Unfavorable splits in sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87(3):267–268

    Article  CAS  PubMed  Google Scholar 

  10. Cetira Filho EL, Sales PHH, Rebelo HL, Silva PGB, Maffìa F, Vellone V, Cascone P, Leão JC, Costa FWG (2022) Do lower third molars increase the risk of complications during mandibular sagittal split osteotomy? Systematic review and meta-analysis. Int J Oral Maxillofac Surg 51(7):906–921

  11. Steenen SA, van Wijk AJ, Becking AG (2016) Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors. Int J Oral Maxillofac Surg 45(8):971–979

    Article  CAS  PubMed  Google Scholar 

  12. Mensink G, Verweij JP, Frank MD, Eelco Bergsma J, Richard van Merkesteyn JP (2013) Bad split during bilateral sagittal split osteotomy of the mandible with separators: a retrospective study of 427 patients. Br J Oral Maxillofac Surg 51(6):525–529

    Article  PubMed  Google Scholar 

  13. Balaji SM (2014) Impacted third molars in sagittal split osteotomies in mandibular prognathism and micrognathia. Ann Maxillofac Surg 4(1):39–44

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Steinbacher DM, Kontaxis KL (2016) Does simultaneous third molar extraction increase intraoperative and perioperative complications in orthognathic surgery? J Craniofac Surg 27(4):923–926

    Article  PubMed  Google Scholar 

  15. Camargo IB, Van Sickels JE, Curtis WJ (2015) Simultaneous removal of third molars during a sagittal split does not increase the incidence of bad splits in patients aged 30 years or older. J Oral Maxillofac Surg 73(7):1350–1359

    Article  PubMed  Google Scholar 

  16. Precious DS, Lung KE, Pynn BR, Goodday RH (1998) Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal-split osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85(4):362–365

    Article  CAS  PubMed  Google Scholar 

  17. Morton L, Downie I (2017) Surgical and social implications of extraction of mandibular third molars as a separate procedure before bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 55(9):937–939

    Article  CAS  PubMed  Google Scholar 

  18. Negreiros RM, Biazevic MG, Jorge WA, Michel-Crosato E (2012) Relationship between oral health-related quality of life and the position of the lower third molar: postoperative follow-up. J Oral Maxillofac Surg 70(4):779–786

    Article  PubMed  Google Scholar 

  19. Hernández-Alfaro F, Guijarro-Martínez R (2013) “Twist technique” for pterygomaxillary dysjunction in minimally invasive le fort i osteotomy. J Oral Maxillofac Surg 71(2):389–392

    Article  PubMed  Google Scholar 

  20. Hernández-Alfaro F, Raffaini M, Paredes-de-Sousa-Gil A, Magri AS, Guijarro-Martínez R, Valls-Ontañón A (2017) Three-dimensional analysis of long-term stability after bilateral sagittal split ramus osteotomy fixed with a single miniplate with 4 monocortical screws and 1 bicortical screw: a retrospective 2-center study. J Oral Maxillofac Surg 75(5):1036–1045

    Article  PubMed  Google Scholar 

  21. Ellis E (2007) A method to passively align the sagittal ramus osteotomy segments. J Oral Maxillofac Surg 65(10):2125–2130

    Article  PubMed  Google Scholar 

  22. Winter G (1926) Impacted mandibular third molar. American Medical Book, St. Louis

    Google Scholar 

  23. Pell GJ, Gregory BT (1933) Impacted mandibular third molars: Classification and modified techniques for removal. Dent Dig 39:330–338

  24. Haas Junior OL, Guijarro-Martínez R, Sousa Gil AP, Méndez-Manjón I, Valls-Otañón A, de Oliveira RB, Hernández-Alfaro F (2019) Cranial base superimposition of cone-beam computed tomography images: A voxel-based protocol validation. J Craniofac Surg 30(6):1809–1814

  25. Hernández-Alfaro F, Guijarro-Martínez R (2014) On a definition of the appropriate timing for surgical intervention in orthognathic surgery. Int J Oral Maxillofac Surg 43(7):846–855

    Article  PubMed  Google Scholar 

  26. Shoshani-Dror D, Shilo D, Ginini JG, Emodi O, Rachmiel A (2018) Controversy regarding the need for prophylactic removal of impacted third molars: an overview. Quintessence Int 49(8):653–662

    PubMed  Google Scholar 

  27. Doucet JC, Morrison AD, Davis BR, Gregoire CE, Goodday R, Precious DS (2012) The presence of mandibular third molars during sagittal split osteotomies does not increase the risk of complications. J Oral Maxillofac Surg 70(8):1935–1943

    Article  PubMed  Google Scholar 

  28. Smith BR, Rajchel JL, Waite DE, Read L (1991) Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy. J Oral Maxillofac Surg 49(2):112–116

    Article  CAS  PubMed  Google Scholar 

  29. Verweij JP, Mensink G, Fiocco M, van Merkesteyn JP (2014) Presence of mandibular third molars during bilateral sagittal split osteotomy increases the possibility of bad split but not the risk of other post-operative complications. J Craniomaxillofac Surg 42(7):e359-363

    Article  PubMed  Google Scholar 

  30. Mehra P, Castro V, Freitas RZ, Wolford LM (2001) Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars. J Oral Maxillofac Surg 59(8):854–858 (discussion 859)

    Article  CAS  PubMed  Google Scholar 

  31. Steenen SA, Becking AG (2016) Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns. Int J Oral Maxillofac Surg 45(7):887–897

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors wish to especially thank all the staff members at the Institute of Maxillofacial Surgery, Teknon Medical Center (Barcelona, Spain), for their administrative and clinical support.

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Authors and Affiliations

  1. Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain

    Adaia Valls-Ontañón, David Neagu-Vladut & Federico Hernández-Alfaro

  2. Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    Adaia Valls-Ontañón & Federico Hernández-Alfaro

  3. Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark

    Özlem Kesmez & Thomas Starch-Jensen

  4. Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain

    Sergi Triginer-Roig

Authors
  1. Adaia Valls-Ontañón
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  5. David Neagu-Vladut
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  6. Federico Hernández-Alfaro
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Contributions

• Conception and design of the study: Valls-Ontañón A, Kesmez Ö, Hernández-Alfaro F.

• Data acquisition: Valls-Ontañón A, Kesmez Ö.

• Data analysis: Valls-Ontañón A, Kesmez Ö.

• Drafting and/or critical review of the article: Valls-Ontañón A, Kesmez Ö, Starch-Jensen T, Triginer-Roig S, Neagu-Vladut D, Hernández-Alfaro F.

• Final approval of the manuscript: Valls-Ontañón A, Kesmez Ö, Starch-Jensen T, Triginer-Roig S, Neagu-Vladut D, Hernández-Alfaro F.

Corresponding author

Correspondence to Adaia Valls-Ontañón.

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Ethical approval

Ethical approval was obtained from the Ethics Committee of Teknon Medical Center (Barcelona, Spain).

Consent to participate

Patient written consent was obtained to access the CBCT database.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Valls-Ontañón, A., Kesmez, Ö., Starch-Jensen, T. et al. Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing. Oral Maxillofac Surg 28, 345–353 (2024). https://doi.org/10.1007/s10006-023-01148-4

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  • DOI: https://doi.org/10.1007/s10006-023-01148-4

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