In Vitro Biomechanical Comparison of the Effect of Pattern, Inclination, and Size of Positional Screws on Load Resistance for Bilateral Sagittal Split Osteotomy

Abstract

The purpose of this in vitro investigation was to determine whether the pattern, angle of placement, or size of positional screws affected their ability to resist vertical loads resembling mastication in the bilateral sagittal split osteotomy system. Standardized bone substitutes were secured with three 12- to 16 mm-long, 1.85-, 2.0-, 2.1-, and 2.4-mm outer diameter, self-tapping titanium screws (Synthes, Solothurn, Switzerland) in various patterns using a positional screw technique. These patterns included transbuccal triangular, intraoral triangular, and transbuccal linear patterns. The models were secured in a jig and subjected to vertical loads by a mechanical testing unit (1475 UPM; Zwick, Ulm, Germany) until failure. Loading test data analysis was based on peak load values resulting in mechanical deformation of the system (1-, 3-, and 5-mm displacement), maximal force, and stiffness (load/displacement slope curve) for each group. Means and standard deviations were derived and compared for statistical significance using univariate analysis of variance with a confidence level of 95% (P values < .05). The designed study demonstrated that 1.85- and 2.0-mm-diameter positional screws provided similar stability in all 3 setups. Three screws placed in an inverted L pattern at 90° (simulating a transbuccal approach) showed significantly higher resistance to vertical forces for advancement movements at 1-, 3-, and 5-mm displacement when compared with the inverted L group of screws placed at an angle (intraoral approach) or 3 screws in a linear pattern placed at 90° (transbuccal approach) (P < .01). Under the conditions tested in this in vitro study, differences in the load resistance of positional screws placed in a transbuccal or intraoral approach could be demonstrated depending on the fixation technique. The transbuccal group of 3 screws in an inverted L pattern showed significantly greater stability than the intraoral group of 3 screws placed in an inverted L pattern and the transbuccal group of 3 screws in a linear pattern. Resistance to vertical loads with 1.85-mm screws was similar to that with the standard 2.0-mm screws in all 3 setups. The results of this study suggest that the angle of screw placement (surgical approach) and pattern have a greater influence on the stability of the bilateral sagittal split osteotomy system than the screw size.