Total Mandibular subapical osteotomy to correct Class II with inferior alveolar retrusion

The TSAR-osteotomy, a total subapical and ramus osteotomy: A technical note

There are several treatment options to treat a class II dentofacial deformity with a pronounced chin. A total subapical osteotomy is one of these options. This type of osteotomy was refined to total subapical and ramus (TSAR) osteotomy. In this technical note, a detailed and schematic presentation of the TSAR osteotomy is presented step by step. The surgical approach to the TSAR osteotomy is divided into three parts. The first part consists of the horizontal osteotomy at the level of the ramus, the second part approaches the corticotomy to release and protect the mental nerve and the third part consists of connecting the horizontal ramus osteotomy and the local corticotomy around the mental nerve. In this third part, it is important that the inferior alveolar nerve (IAN) is actively sought and protected.

Evaluation of different fixation methods with finite element analysis in total mandibular subapical osteotomy

PURPOSE

The purpose of the study was to evaluate the stress distribution in various miniplates that were used in cases that underwent advancement with total mandibular subapical osteotomy (TMSO) using finite element analysis (FEA).

MATERIAL AND METHOD

Cone beam computed tomography (CBCT) images of a patient with appropriate bone tissues were used as a reference for the modeling of the mandible. In all mandibular models, horizontal TMSO was performed in a region 5 mm away from the apex of the teeth and vertical TMSO was performed in the retromolar region, 10 mm posterior to the second molar tooth. After TMSO, the dentoalveolar segment was advanced 3 mm and miniplates were placed symmetrically at four points for fixation. Four different miniplates with 2.0 mm thickness were used. Three different forces were applied to the models. Stress distribution on the models was evaluated using maximum von Mises stress values.

RESULTS

The maximum von Mises stress occurred in Y + I and Y + L models following the application of 300 N force from the incisal. An evaluation of posterior unilateral force indicated that the stress was remarkably high in the models with a posterior I-plate. The stress in the Y + I model was higher under unilateral force compared to the stress in other models. Under posterior bilateral force, the maximum von Mises stress values ​​occurred in the I-plates of T + I, Y + I, and L + I models (1006, 1012, and 1004 MPa, respectively).

CONCLUSION

Within the limitations of our study, we found that the ideal stress distribution was in the T + L and L + L plate combinations in the plates used for fixation after advancement with TMSO.