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

Abstract

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. 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 6months prior to BSSO (control group), comprising at least 1year 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. 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 3.7min (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). The results obtained support concomitant molar extraction with BSSO as a feasible option.