Abstract
Objective
The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus.
Materials and Methods
SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5 mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5 mm displacement of the segments. Resistance forces were obtained in Newtons (N), and statistical analysis was performed using the software R v. 3.5 with significance level of 0.05. Linear mixed models were used to compare the force required to move each type of plate.
Results
The results showed that the resistance of SSO was better accomplished using two titanium miniplates and KLS resorbable plate showed the least resistance. However, both titanium and resorbable plates behaved similarly in small displacements, which are most commonly observed in BSSO postoperative time.
Conclusion
It can be concluded that both resorbable and non-resorbable systems might offer suitable mechanical resistance in the procedures where there are no mechanical postoperative complications.
Similar content being viewed by others
References
Miloro M, Ghali GE, Larsen PE, Waite PD (2004) Peterson’s principles of oral and maxillofacial surgery, 2nd edn. B.C. Decker, Inc., London
Erkmen E, Simşek B, Yücel E, Kurt A (2005) Comparison of different fixation methods following sagittal split ramus osteotomies using three-dimensional finite elements. Int J Oral Maxillofac Surg 34(5):551–558
Ochs MW (2003) Bicortical screw stabilization of sagittal split osteotomies. J Oral Maxillofac Surg 61(12):1477–1484
Böstman O (1994) Economic considerations on avoiding implant removals after fracture fixation by using absorbable devices. Scand J Soc Med 22(1):41–45
Rokkanen PU, Böstman O, Hirvensalo E et al (2000) Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials 21(24):2607–2613
Buijs GJ, van der Houwen EB, Stegenga B, Bos RR, Verkerke GJ (2007) Mechanical strength and stiffness of biodegradable and titanium osteofixation systems. J Oral Maxillofac Surg 65(11):2148–2158
Peltoniemi HH, Ahovuo J, Tulamo RM, Törmälä P, Waris T (1997) Biodegradable and titanium plating in experimental craniotomies: a radiographic follow-up study. J Craniofac Surg 8(6):446–453
Goldstein JA (2001) The use of bioresorbable material in craniofacial surgery. Clin Plast Surg 28(4):653–659
Gómez-Barrachina R, Montiel-Company JM, García-Sanz V, Almerich-Silla JM, Paredes-Gallardo V, Bellot-Arcís C (2020) Titanium plate removal in orthognathic surgery: prevalence, causes and risk factors. A systematic literature review and meta-analysis. Int J Oral Maxillofac Surg. 49(6):770–778
Agnihotry A, Fedorowicz Z, Nasser M, Gill KS (2017) Resorbable versus titanium plates for orthognathic surgery. Cochrane Database Syst Rev 10(10):CD006204
Asprino L, Consani S, de Moraes M (2006) A comparative biomechanical evaluation of mandibular condyle fracture plating techniques. J Oral Maxillofac Surg 64(3):452–456
Armstrong JEA, Lapointe HJ, Hogg NJV, Kwok AD (2001) Preliminary investigation of the biomechanics of internal fixation of sagittal split osteotomies with miniplates using a newly designed in vitro testing model. J Oral Maxillofac Surg 59:191–195
Pereira Filho VA, Iamashita HY, Monnazzi MS, Gabrielli MF, Vaz LG, Passeri LA (2013) In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate. Int J Oral Maxillofac Surg 42(3):316–320
Chuong CJ, Borotikar B, Schwartz-Dabney C, Sinn DP (2005) Mechanical characteristics of the mandible after bilateral sagittal split ramus osteotomy: comparing 2 different fixation techniques. J Oral Maxillofac Surg 63(1):68–76
Oguz Y, Watanabe ER, Reis JM, Spin-Neto R, Gabrielli MA, Pereira-Filho VA (2015) In vitro biomechanical comparison of six different fixation methods following 5-mm sagittal split advancement osteotomies. Int J Oral Maxillofac Surg 44(8):984–988
Brasileiro BF, Grempel RG, Ambrosano GM, Passeri LA (2009) An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: advancement surgery. J Oral Maxillofac Surg 67(4):809–817
Sato FR, Asprino L, Consani S, de Moraes M (2010) Comparative biomechanical and photoelastic evaluation of different fixation techniques of sagittal split ramus osteotomy in mandibular advancement. J Oral Maxillofac Surg 68(1):160–166
Al-Moraissi EA, Al-Hendi EA (2016) Are bicortical screw and plate osteosynthesis techniques equal in providing skeletal stability with the bilateral sagittal split osteotomy when used for mandibular advancement surgery? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 45(10):1195–1200
Harada K, Watanabe M, Ohkura K, Enomoto S (2000) Measure of bite force and occlusal contact area before and after bilateral sagittal split ramus osteotomy of the mandible using a new pressure-sensitive device: a preliminary report. J Oral Maxillofac Surg 58(4):370–374
Throckmorton GS, Ellis E 3rd (2001) The relationship between surgical changes in dentofacial morphology and changes in maximum bite force. J Oral Maxillofac Surg 59(6):620–627
Van Sickels JE, Peterson GP, Holms S, Haug RH (2005) An in vitro comparison of an adjustable bone fixation system. J Oral Maxillofac Surg 63(11):1620–1625
Al-Moraissi EA, Ellis E 3rd (2015) Biodegradable and titanium osteosynthesis provide similar stability for orthognathic surgery. J Oral Maxillofac Surg 73(9):1795–1808
Joss CU, Vassalli IM (2009) Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg 67(2):301–313
Yang L, Xu M, Jin X et al (2014) Skeletal stability of bioresorbable fixation in orthognathic surgery: a systemic review. J Craniomaxillofac Surg 42(5):e176–e181
Funding
Not applicable.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
Not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Costa, D.L., Torres, A.M., Bergamaschi, I.P. et al. Assessment of Resorbable and Non-resorbable Fixation Systems in Sagittal Split Ramus Osteotomy: An In vitro Study. J. Maxillofac. Oral Surg. 21, 779–784 (2022). https://doi.org/10.1007/s12663-021-01581-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12663-021-01581-6