Role of Different Rigid Fixation in Stability after Bilateral Sagittal Split Osteotomy Advancement Surgery: A Systematic Review

Abstract

Bilateral sagittal split osteotomy (BSSO) for mandibular advancement is the treatment option for mandibular retrognathia. Major concern in the surgical correction of skeletal class II is postsurgical relapse. The etiology of relapse is multifactorial, involving the proper seating of condyles, the amount of advancement, the soft tissue and muscles, the mandibular plane angle, the remaining growth and remodeling. Through the use of the modern metal plates and screws after osteotomy, the stability can be already achieved in a technique so-called "rigid internal fixation" (RIF), without using "intermaxillary fixation" (IMF). RIF methods contribute to postoperative bone healing and masticatory function. Furthermore, using RIF method, instead of intermaxillary rigid fixation, can initiate the early improvement of oral hygiene. Usually bicortical bone fixation screw or miniplates with monocortical bone fixation screw were used to gain stability after BSSO. On the other hand, the use of resorbable screw materials had been reported. Here we presented a systematic review on Role of different rigid fixation in stability after bilateral sagittal split osteotomy advancement surgery and concluded that bicortical screws (stainless steel, titanium, bioresorbable) and miniplates fixation after mandibular advancement there is no statistically significant difference in skeletal stability and a favourable relationship between the amount of relapse and amount of advancement.