The effect of different hybrid rigid internal fixation techniques on the postoperative stability following a mandibular advancement using a bilateral sagittal split ramus osteotomy: A retrospective three-dimensional comparative study

Abstract

Objective: To three-dimensionally evaluate post-operative mandibular stability following bilateral sagittal split ramus osteotomies between hybrid and non-hybrid rigid internal fixation techniques.

Materials and method: Seventy adults with skeletal class II deformity who underwent bilateral split sagittal osteotomy with mandibular advancement were included. Patients were divided into four groups based on their fixation techniques: hybrid technique (HT) groups I, II, and IV received a 4-hole 2 mm miniplate with either a bicortical screw (BS), additional 2 mm 4-hole miniplate, or two-hole miniplate, while non-HT group III received a 4-hole 2 mm miniplate with four mini-screws (MS). Measurements were taken pre-operatively (T0), immediately postoperatively (T1), and ≥1 year after surgery (T2) using 3D Slicer software.

Results: Age, sex, and follow-up period did not correlate significantly with postoperative relapse or stability. Significant differences were observed in the advancement on the right side between groups II, III, and IV and on the left side between groups I, III, and IV. However, the type of surgical intervention showed no significant effect on postoperative relapse and stability. All groups of fixations showed satisfactory stability with irrelevant relapse (< 2 mm or 2°).

Conclusion: The study demonstrated satisfactory and comparable stability among different fixation groups on patients undergoing mandibular advancement following bilateral split sagittal osteotomy. The results highlighted the importance of considering the degree of advancement when planning orthognathic surgery and managing postoperative outcomes.

Keywords: Hybrid technique; Orthognathic surgery; Rigid internal fixation; Sagittal split osteotomy; Skeletal relapse.