Abstract
BackgroundThe location of the lateral osteotomy cut during bilateral sagittal split osteotomy (BSSO) varies according to the surgeon's preference, and no consensus has been reached regarding the ideal location from the perspective of biomechanics. The purpose of this study was to evaluate the mechanical behavior of the mandible and screw-miniplate system among three lateral osteotomy designs for BSSO by using three-dimensional (3-D) finite element analysis (FEA).MethodsThe Trauner-Obwegeser (TO), Obwegeser (Ob), and Obwegeser-Dal Pont (OD) methods were used for BSSO. In all the FEA simulations, the distal segments were advanced by 5 mm. Each model was fixed by using miniplates. These were applied at four different locations, including along Champy's lines, to give 12 different FEA miniplate fixation methods. We examined these models under two different loads.ResultsThe magnitudes of tooth displacement, the maximum bone stress in the vicinity of the screws, and the maximum stress on the screw-miniplate system were less in the OD method than in the Ob and TO methods at all the miniplate locations. In addition, Champy's lines models were less than those at the other miniplate locations.ConclusionsThe OD method allows greater mechanical stability of the mandible than the other two techniques. Further, miniplates placed along Champy's lines provide greater mechanical advantage than those placed at other locations.
Highlights
The location of the lateral osteotomy cut during bilateral sagittal split osteotomy (BSSO) varies according to the surgeon’s preference, and no consensus has been reached regarding the ideal location from the perspective of biomechanics
Maximum bone stress, and maximum von Mises stress Comparisons of the predicted central incisor displacements, maximum predicted bone mechanical stress in the vicinity of the screws, and maximum predicted von Mises stress in the screw-miniplate system on incisal loading and contralateral molar loading are shown in Table 1 and Table 2, respectively
On comparing the three BSSO techniques, the Obwegeser-Dal Pont (OD) method showed the least central incisor displacement, least maximum bone mechanical stress in the screw vicinity, and least von Mises stress in the screw-miniplate system on both loadings, followed by the Ob method and TO method
Summary
The location of the lateral osteotomy cut during bilateral sagittal split osteotomy (BSSO) varies according to the surgeon’s preference, and no consensus has been reached regarding the ideal location from the perspective of biomechanics. Bilateral sagittal split osteotomy (BSSO) is the most common orthognathic surgical procedure [1] It was first described by Trauner and Obwegeser in 1957 [2]. Several modifications of the technique have been introduced with the aim of improving surgical convenience, minimizing morbidity, and maximizing procedural stability. These modifications include the technique described by Dal Pont [3]; it is generally recognized that the buccal osteotomy cut of the Obwegeser-Dal Pont method is positioned more anteriorly than that of the Obwegeser method [4], thereby increasing the amount of cancellous bone contact. Numerous studies have been conducted to compare the different types of fixation techniques, experiments comparing different BSSO techniques for use in orthognathic surgery are limited [7]
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