Evaluation of Mandibular Fixation Techniques Using Monocortical Plates After Mandibular Setback Surgery

TL;DR

This study compares different jaw fixation techniques after surgery to see which provides the best stability and prevents unwanted jaw rotation.

Contribution

The study introduces a novel comparison of monocortical plate fixation techniques in mandibular setback surgery using CBCT scans.

Findings

Group 1 showed greater counterclockwise rotation of the proximal segments at 6 and 12 months.

Group 1 had smaller anterior and superior displacement of the pogonion at 12 months.

A single proximal screw may act as a fulcrum, insufficiently resisting postoperative clockwise rotation.

Abstract

This study aimed to evaluate mandibular fixation techniques using monocortical plates following sagittal split ramus osteotomy in skeletal Class III patients. Ninety-three patients were categorized into three groups based on fixation methods: four-hole miniplate with one proximal and two distal screws (Group 1); four-hole miniplate with four screws (Group 2); sliding plate with two proximal and one distal screws (Group 3). Cone-beam computed tomography scans were obtained at three time points: immediately postoperative (T1), 6 months (T2), and 12 months (T3). The yaw, roll, and pitch rotations of the proximal segment, as well as horizontal and vertical changes of the pogonion, were evaluated. Group 1 exhibited significantly greater counterclockwise rotation of the proximal segments at T2 (p = 0.021) and T3 (p = 0.035) compared to the other groups. Additionally, Group 1 showed significantly smaller anterior and superior displacement of the pogonion at T3 (0.97 ± 2.10 mm, p = 0.009; 0.03 ± 1.62 mm, p = 0.011, respectively). Following surgical wafer removal, intimate occlusal contact is archived and the elimination of premature contacts through postoperative orthodontic treatment contributes to counterclockwise autorotation of the mandible. Therefore, anterior and superior movements of the pogonion are expected if firm fixation between the proximal and distal segments is achieved. Therefore, these findings suggest that a single proximal screw, as seen in a three-screw fixation, may act as a fulcrum, insufficiently resisting postoperative clockwise rotation of the distal segments.

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