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Lee MY, Park JH, Park SJ, Chang NY, Chae JM. A finite element analysis of stress distribution with various directions of intermaxillary fixation using orthodontic mini-implants and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy. Orthod Craniofac Res 2024; 27:102-109. [PMID: 37496461 DOI: 10.1111/ocr.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This finite element analysis (FEA) aimed to assess the stress distribution in the mandible and fixation system with various directions of the intermaxillary fixation (IMF) using mini-implants (MIs) and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy (BSSRO). MATERIALS AND METHODS A total of nine mandibular advancement models were set according to the position of the MIs (1.6 mm in diameter, 8 mm in length) and direction of the IMF elastics (1/4 inch, 5 oz). Major and minor principal stresses in the cortical and cancellous bones, von Mises stresses in the fixation system (miniplate and monocortical screws), and bending angles of the miniplate were analysed. RESULTS Compressive and tensile stress distributions in the mandible and von Mises stress distributions in the fixation system were greater in models with a Class III IMF elastic direction and a higher IMF elastic force than in models with a Class II IMF elastic direction and a lower IMF elastic force. The bending angle of the miniplate was negligible. CONCLUSIONS Stress distributions in the bone and fixation system varied depending on the direction, amount of force, and position of IMF elastics and MIs. Conclusively, IMF elastics in the Class II direction with minimal load in the area close to the osteotomy site should be recommended.
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Affiliation(s)
- Mi-Young Lee
- Department of Orthodontics, Seoul National University Gwan-ak Dental Hospital, Seoul, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona, USA
- Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Sung-Jin Park
- Department of Oral and Maxillofacial Surgery, GangNam CHA Hospital, CHA University School of Medicine, Seoul, South Korea
| | - Na-Young Chang
- Department of Orthodontics, School of Dentistry, University of Wonkwang, Wonkwang Dental Research Institute, Iksan, South Korea
| | - Jong-Moon Chae
- Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona, USA
- Department of Orthodontics, School of Dentistry, University of Wonkwang, Wonkwang Dental Research Institute, Iksan, South Korea
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Biomechanical Effects of Different Miniplate Thicknesses and Fixation Methods Applied in BSSO Surgery Under Two Occlusal Conditions. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose
Finite element analysis (FEA) was used to evaluate the effects of different thicknesses, numbers, and positions of the miniplate applied in bilateral sagittal split osteotomy (BSSO) under two occlusal conditions.
Methods
An FEA model of the mandibles was constructed and combined with different thicknesses (0.6 or 1 mm), number (one or two), positions (upper or lower) of a miniplate and was divided into six models. In addition, external forces were applied to the muscles to simulate the intercuspal position (ICP) and right unilateral molar clench. This study used the reaction force of the temporomandibular joints and the stress of the mandible as observation indexes.
Results
The results of this study show that, under ICP, the 0.6 mm lower model generated greater TMJ force reaction compared to the 0.6 mm upper model. The same trend was seen in the 1 mm lower model compared to the 1 mm upper model. Regarding the stress of the bone on the screw-implanted sites, under ICP, screw 10 showed greater stress than screw 2, and screw 11 showed greater stress than screw 3. The stress values of the miniplates showed, under ICP, point 1-c was greater than point 3-c, and point 1-b was greater than point 3-b.
Conclusion
In the case of BSSO mandibular advancement surgery, implanting the miniplate at the upper position can reduce the force on the TMJ and the stress on the distal segment of the mandible. The miniplate can also resist the tensile stress more effectively. In addition, implanting two miniplates with thinner sizes may be an alternative in clinical practice.
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He Y, Zhang H, Qiao J, Fu X, Xu S, Jin Q, Liu J, Chen Y, Yu B, Niu F. Biomechanical Evaluation of Seven Fixation Methods for Sagittal Split Ramus Osteotomy with Four Advancement Levels by Finite Element Analysis. Front Surg 2022; 9:891747. [PMID: 35599806 PMCID: PMC9114864 DOI: 10.3389/fsurg.2022.891747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mandibular sagittal split ramus osteotomy (SSRO) is a routine surgery to correct mandibular deformities, such as mandibular retrusion, protrusion, deficiency, and asymmetry. However, nonunion/malunion of the fragments and relapse caused by fixation failure after SSRO are major concerns. Rigid fixation to maintain postosteotomy segmental stabilization is critical for success. Additionally, understanding the biomechanical characteristics of different fixation methods in SSRO with large advancements is extremely important for clinical guidance. Therefore, the aim of the present study was to evaluate the biomechanical characteristics of different SSRO methods by finite element analysis. Methods SSRO finite element models with 5-, 10-, 15-, and 20-mm advancements were developed. Seven fixation methods, namely, two types of bicortical screws, single miniplate, dual miniplates, grid plate, dual L-shaped plates, and hybrid fixation, were positioned into the SSRO models. Molar and incisal biomechanical loads were applied to all models to simulate bite forces. We then investigated the immediate postoperative stability from four aspects, namely, the stability of the distal osteotomy segment, osteotomy regional stability, stress distribution on the mandible, and implant stress performance. Results The stability of the distal osteotomy segment and osteotomy region decreased when the advancement increased. All seven fixation methods displayed favorable biomechanical stability under minor advancement (5 mm). With large advancements, bicortical screws, dual miniplates, and grid plates provided better stability. The von Mises stress was concentrated around the screws close to the osteotomy region for the proximal segment for all fixation methods, and the von Mises stress on implants increased with larger advancements. With small advancements, five fixation methods endured tolerable maximum stresses of <880 MPa. A single miniplate and dual L-shaped plates generally suffered high stresses using larger advancements. The biomechanical characteristics were similar under molar and incisal loads. Conclusions The current study investigated the biomechanical properties of seven fixation devices after SSRO under molar and incisal loads. Generally, bicortical screws, grid plates, and dual miniplates provided better biomechanical stability using finite element analysis.
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da Silva Oliveira S, de Carvalho PHM, Sverzut CE, Trivellato AE. Does the type of sagittal split ramus osteotomy influence fixation strength? Evaluation of the mechanical behavior of two types of fixation used in three types of sagittal split ramus osteotomy. Oral Maxillofac Surg 2022; 26:633-639. [PMID: 35022847 DOI: 10.1007/s10006-022-01038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This study compared the mechanical behavior of two fixation techniques used in three sections representing the sagittal split ramus osteotomy (SSRO) in polyurethane replicas that were divided into groups, according to type of section, and sub-groups according to type of fixation, simulating 11-mm advancement and 6º clockwise mandibular rotation. METHODS Loads were applied in two regions, aiming at progressive application and consequent strength value, measured in kilogram-force in displacements of 1, 3, 5, and 7 mm, from the load application tip. Shapiro-Wilk test was performed, followed by two-way analysis of variance (ANOVA-2 way), and Bonferroni's multiple comparison. RESULTS The results showed no statistically significant difference in the type of section and type of fixation used when load was applied to the inter-incisor region. However, when load was applied to the first molar region, statistically significant difference was observed in 1-mm displacement, in which section described by Epker with two modifications showed greater strength, regardless of type of fixation used (p = 0.007). CONCLUSION In the application of load in the inter-incisor region, there was no statistical difference between the type of osteotomy and the type of fixation used. When applying loads to molars, there was a difference for the type of osteotomy, where the Epker osteotomy with 2 modifications presented greater resistance, regardless of the type of fixation used.
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Affiliation(s)
- Soraya da Silva Oliveira
- School of Dentistry of Ribeirão Preto (FORP-USP), University of São Paulo, Avenida Do Café, S/NRibeirão Preto, São Paulo, 14040-904, Brazil
| | - Pedro Henrique Mattos de Carvalho
- School of Dentistry of Ribeirão Preto (FORP-USP), University of São Paulo, Avenida Do Café, S/NRibeirão Preto, São Paulo, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- School of Dentistry of Ribeirão Preto (FORP-USP), University of São Paulo, Avenida Do Café, S/NRibeirão Preto, São Paulo, 14040-904, Brazil
| | - Alexandre Elias Trivellato
- School of Dentistry of Ribeirão Preto (FORP-USP), University of São Paulo, Avenida Do Café, S/NRibeirão Preto, São Paulo, 14040-904, Brazil.
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Geçkil N, Can Tukel H. In vitro comparison of fixation methods used in sagittal split osteotomy with a major advancement and counterclockwise rotation. Br J Oral Maxillofac Surg 2021; 60:617-622. [DOI: 10.1016/j.bjoms.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
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Kuik K, Ho JPTF, de Ruiter MHT, Klop C, Kleverlaan CJ, de Lange J, Hoekema A. Stability of fixation methods in large mandibular advancements after sagittal split ramus osteotomy: an in vitro biomechanical study. Br J Oral Maxillofac Surg 2020; 59:466-471. [PMID: 33468331 DOI: 10.1016/j.bjoms.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
Sagittal split ramus osteotomy (SSRO) with large mandibular advancements is a common surgical procedure and could be indicated for patients with sleep apnoea. As a large variety of fixation methods is used for the stabilisation of SSRO, a biomechanical test model was used to analyse which fixation technique was most stable. For this in vitro study, 80 polyurethane hemimandibles with a prefabricated SSRO were used as substrates. Loads in Newtons were recorded at displacements of the mandibular incisive edge at 1mm, 3mm and 5mm. The samples were divided into two groups: mandibular advancements of 10mm and 15mm. In both groups, four fixation techniques were used: (A) one four-hole miniplate; (B) two four-hole miniplates; (C) one four-hole miniplate plus one bicortical screw; and (D) three bicortical screws in an inverted-L arrangement. In group 1, three bicortical screws resulted in the best stability, and in group 2, two miniplates resulted in the best stability. The use of two miniplates did not show significant differences between both groups. Other fixation methods showed more stability with 10mm advancements. This study therefore suggests that in SSRO with advancements exceeding 10mm, the use of two miniplates is the optimal means of providing rigid fixation.
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Affiliation(s)
- K Kuik
- Department of Oral & Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - J P T F Ho
- Department of Oral & Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M H T de Ruiter
- Department of Oral & Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Klop
- Department of Oral & Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C J Kleverlaan
- Department of Dental Material Sciences, Faculty of Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - J de Lange
- Department of Oral & Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - A Hoekema
- Department of Oral & Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral Kinesiology, Faculty of Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
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de Carvalho PHM, Oliveira SDS, Favaro M, Sverzut CE, Trivellato AE. Which type of method shows the best mechanical behavior for internal fixation of bilateral sagittal split osteotomy in major advancements with clockwise rotation? Comparison of four methods. Oral Maxillofac Surg 2020; 25:27-34. [PMID: 32661574 DOI: 10.1007/s10006-020-00883-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the four methods for bilateral sagittal osteotomy fixation. METHODS In this study, 56 replicas of whole mandibles made of rigid polyurethane were used. After simulation of major advancement (11 mm) with clockwise rotation of the mandible (6o) in relation to the occlusal plane, the bone segments were fixed with plates and screws of the 2.0-mm system on both the right and left sides: group I, double "H" plate; group II, two mini-plates; group III, "hybrid technique"; and group IV, three bicortical screws in the "inverted L" pattern. The mandibles were submitted to load on the central incisors and right first molar. RESULTS The mean value of group I was higher than those of groups IV and II in the displacement of 1 mm (F = 4.705; p = 0.010) with load on the incisor. The mean value of group III was higher than those of groups I and II in the displacement of 1 mm (F = 5.166; p = 0.007) and 3 mm (F = 5.166; p = 0.007). The mean value of group IV was higher than that of group II (F = 3.142; p = 0.044) with load on the molar. CONCLUSION Therefore, after the analyses, the hybrid technique was the one that showed the best results.
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Affiliation(s)
- Pedro Henrique Mattos de Carvalho
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Soraya da Silva Oliveira
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Matheus Favaro
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil.
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Investigation of a Modified Novel Technique in Bilateral Sagittal Splitting Osteotomy Fixation: Finite Element Analysis and In Vitro Biomechanical Test. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8707389. [PMID: 32685538 PMCID: PMC7320274 DOI: 10.1155/2020/8707389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 12/02/2022]
Abstract
Purpose To evaluate the biomechanical properties of the modified novel 2-hole monocortical plate fixation (2HMCPf) and traditional 4-hole monocortical plate fixation (4HMCPf) techniques in bilateral sagittal splitting osteotomy (BSSO) synthesis using a finite element analysis (FEA) and an in vitro biomechanical test with the application of a shearing loading force on a sawbone mandible model. Materials and Methods A three-dimensional mandible models were generated using the geometry obtained from the computerized tomography image of a sawbone mandible. Plates and screws were generated and combined with the mandible in a CAD environment. The 2HMCPf and traditional 4HMCPf techniques for BSSO osteosynthesis were then analyzed under the occlusal load using the FEA. An in vitro biomechanical test was executed to verify the result of FEA. The force on fixation failure and pattern of failure were recorded. Results The results revealed that the von Mises Stress on the mandible cortical bone (75.98 MPa) and the screw/plate (457.19 MPa) of the 2HMCPf group was lower than that of the 4HMCPf group (987.68 MPa, 1781.59 MPa). The stress concentrated on the central region of the 4HMCPf group and the distal set of the 2HMCPf group. In vitro study using the sawbone mandible model showed mechanical failure at the region of the proximal segment near the osteotomy site with the 4HMCPf group (average 32.198 N) but no failure on the fixation sites with the 2HMCPf group. Instead, the mandible sawbone fractured on the condyle neck region (average 44.953 N). Conclusion From the biomechanical perspective, we proved that the 2HMCPf method was able to withstand a higher shearing loading force than the 4HMCPf fixation method in BSSO osteosynthesis.
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Sigua-Rodriguez EA, Caldas RA, Goulart DR, Hemerson de Moraes P, Olate S, Ricardo Barão VA, Ricardo de Albergaria-Barbosa J. Comparative evaluation of different fixation techniques for sagittal split ramus osteotomy in 10 mm advancements. Part two: Finite element analysis. J Craniomaxillofac Surg 2019; 47:1015-1019. [DOI: 10.1016/j.jcms.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/12/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
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Sigua-Rodriguez EA, de Medeiros RC, Goulart DR, Bomfim-Azevedo VL, Olate S, de Albergaria-Barbosa JR. Comparative evaluation of different fixation techniques of the sagittal split ramus osteotomy in 10 mm advancements: Mechanical testing and screw insertion torque. J Craniomaxillofac Surg 2018; 46:2082-2087. [DOI: 10.1016/j.jcms.2018.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 08/11/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022] Open
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Shin SH, Kang YJ, Kim SG. The effect of botulinum toxin-A injection into the masseter muscles on prevention of plate fracture and post-operative relapse in patients receiving orthognathic surgery. Maxillofac Plast Reconstr Surg 2018; 40:36. [PMID: 30538972 PMCID: PMC6261083 DOI: 10.1186/s40902-018-0174-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023] Open
Abstract
Background Botulinum toxin-A (BTX-A) injection into muscle reduces muscular power and may prevent post-operative complication after orthognathic surgery. The purpose of this study was (1) to evaluate BTX-A injection into the masseter muscle on the prevention of plate fracture and (2) to compare post-operative relapse between the BTX-A injection group and the no injection group. Methods Sixteen patients were included in this study. Eight patients received BTX-A injection bilaterally, and eight patients served as control. All patients received bilateral sagittal split ramus osteotomy for the mandibular setback and additional surgery, such as LeFort I osteotomy or genioplasty. Post-operative plate fracture was recorded. SNB angle, mandibular plane angle, and gonial angle were used for post-operative relapse. Results Total number of fractured plates in patients was 2 out of 16 plates in the BTX-A injection group and that was 8 out of 16 plates in the no treatment group (P = 0.031). However, there were no significant differences in post-operative changes in SNB angle, mandibular plane angle, and gonial angle between groups (P > 0.05). Conclusions BTX-A injection into the masseter muscle could reduce the incidence of plate fracture.
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Affiliation(s)
- Sung-Ho Shin
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo 25457 Republic of Korea
| | - Yei-Jin Kang
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo 25457 Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo 25457 Republic of Korea
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Gursoytrak B, Unsal N, Demetoglu U, Simsek HO, Saglam H, Dolanmaz D. Biomechanical evaluation of hybrid fixation method of sagittal split ramus osteotomy in mandibular advancement. J Craniomaxillofac Surg 2018; 46:2063-2068. [PMID: 30446327 DOI: 10.1016/j.jcms.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/20/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE In this study, eight different fixation methods applied after sagittal split ramus osteotomy (SSRO) were compared experimentally. MATERIALS AND METHODS SSRO was performed to 48 sheep hemimandibles in eight groups of 6 each. Group A- a four hole standard miniplate; Group B- a four hole standard miniplate and one bicortical screw; Group C-a four hole locking plate; Group D-a four hole locking plate and one bicortical screw; Group E-a six hole straight miniplate; Group F-a six hole straight miniplate and one bicortical screw; Group G- a sliding plate, which was specifically designed for SSRO; Group H- sliding plate and one bicortical screw. RESULTS In terms of measured values of displacement, the highest degrees of displacement were observed in decreasing order in Groups G, C, A, and E. The least displacement values were detected in Groups H, F, D and B with values being very close to each other. For linear force applied up to 70N, 3 mm or higher displacement values were not seen in any fixation system. CONCLUSION According to the results of study, all systems are suitable for clinic usage. However, intermaxillary fixation or functional elastics may be needed for sliding plate systems during the healing period of hard tissue.
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Affiliation(s)
- Burcu Gursoytrak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey.
| | - Nurdan Unsal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Selçuk University, Konya, Turkey
| | - Umut Demetoglu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey
| | - Hasan Onur Simsek
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey
| | - Haci Saglam
- Department of Mechanical Engineering, Faculty of Technology, Selcuk University, Konya, Turkey
| | - Dogan Dolanmaz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Kuik K, De Ruiter MHT, De Lange J, Hoekema A. Fixation methods in sagittal split ramus osteotomy: a systematic review on in vitro biomechanical assessments. Int J Oral Maxillofac Surg 2018; 48:56-70. [PMID: 30017569 DOI: 10.1016/j.ijom.2018.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/12/2018] [Accepted: 06/26/2018] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review was to assess the stability of rigid internal fixation (RIF) techniques in sagittal split ramus osteotomy (SSRO) based on in vitro biomechanical assessments, with particular interest in large mandibular advancements. In general, RIF methods can be divided into three groups: bicortical screws, miniplates, and a combination of the two. An electronic search of the PubMed, CINAHL, and Embase databases was performed, and studies published between January 2003 and March 2018 were screened for inclusion. Comparative studies with an in vitro experimental design, using biomechanical assessments to measure the stability of RIF methods in SSRO, were included. Of 104 unique studies identified in the initial search, 24 were included. Twenty-two of these 24 studies analyzed an advancement of the mandible of 7mm or less. The use of a single four-hole or six-hole miniplate was less stable than the use of bicortical screws, hybrid techniques, double miniplates, or grid plates. Two studies analyzed advancements of 10mm, for which two miniplates placed in parallel and a grid plate showed most stability. Although there was agreement between studies with regard to results, more biomechanical studies are required to quantify the stability of fixation methods in larger mandibular advancements.
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Affiliation(s)
- K Kuik
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - M H T De Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J De Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Hoekema
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands
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Ulu M, Soylu E, Kelebek S, Dikici S, Oflaz H. Comparative study of biomechanical stability of resorbable and titanium fixation systems after sagittal split ramus osteotomy with a novel designed in-vitro testing unit. J Craniomaxillofac Surg 2018; 46:299-304. [PMID: 29295797 DOI: 10.1016/j.jcms.2017.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sagittal split ramus osteotomy (SSRO) is one of the most popular surgical procedures for correction of mandibular deformities. Several clinical and biomechanical studies exist in the literature which, comparing the stability of different osteosynthesis materials and techniques, were performed using two or three-point biomechanical test models. The aim of this study was to compare the stability of biodegradable and titanium materials for SSRO on one-piece polyurethane mandible samples which were fixed in a novel designed 6-point testing unit. MATERIALS AND METHODS 16 polyurethane one piece replicas of human mandibles were used and bilateral SSRO were performed by the manufacturer according to Dal Pont modification. Mandibles were fixed with titanium and PLLA/PGA fixation materials. Displacement amounts were measured under loading forces using a non-contact extensometer, and strain values at the screws were recorded by strain gauges. RESULTS Bicortical titanium screws (Group 2) showed significantly lower displacement values, while bicortical PLLA/PGA screws (group 4) showed significantly higher displacement values at 40-360 N forces. (p < 0.05). The highest strain value was measured on screws that were inserted upright in a proximal segment near the osteotomy line. CONCLUSION To achieve more realistic results in biomechanical studies, test models should imitate jaw movements and test environments should be as similar as possible to physiological conditions. Newly designed six-point testing units will contribute to future biomechanical studies.
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Affiliation(s)
- Murat Ulu
- Izmir Katip Celebi University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Izmir, Turkey
| | - Emrah Soylu
- Gaziosmanpasa University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Tokat, Turkey.
| | | | - Serkan Dikici
- Izmir Katip Celebi University, Faculty of Engineering, Department of Biomedical Engineering, Izmir, Turkey
| | - Hakan Oflaz
- Izmir Katip Celebi University, Faculty of Engineering, Department of Biomedical Engineering, Izmir, Turkey
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Klein G, Mendes G, Ribeiro Junior P, Viswanath A, Papageorge M. Biomechanical evaluation of different osteosynthesis methods after mandibular sagittal split osteotomy in major advancements. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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