Biomechanical Stress Distribution on Fixation Screws Used in Bilateral Sagittal Split Ramus Osteotomy: Assessment of 9 Methods via Finite Element Method

Bohluli, Behnam; Motamedi, Mohammad Hosein Kalantar; Bohluli, Pedram; Sarkarat, Farzin; Moharamnejad, Nima; Tabrizi, M.H. Seif

doi:10.1016/j.joms.2010.03.014

Cited by 31 publications

(21 citation statements)

References 12 publications

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“…As reported by various researchers, using rigid fixation techniques after bilateral sagittal split ramus osteotomy will optimize the stability, but this stability is not influenced by this rigid fixation method, although the most commonly suggested technique is bicortical screws in inverted-L position (6,21,(28)(29)(30)(31)(32)(33). Furthermore, rigid fixation will facilitate positioning and stabilizing of the proximal segment, which is an important factor of early relapse.…”

Section: Discussionmentioning

confidence: 99%

The Effect of the Mandibular Fixation Method after Bilateral Sagittal Split Ramus Osteotomy on Postoperative Stability: A Literature Review

Yaripoor¹,

Janbaz²

2016

Avicenna J Dent Res

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Context: Using a reliable fixation method after ramus sagittal split osteotomy in order to reduce the chances of treatment relapse and condyle changes is still one of the most noteworthy issues discussed among maxillofacial surgeons. In this study, the results of the up-to-date papers were collected, which identify the effects of the fixation method on the post-operative results, to give the reader a comprehensive view of the new concepts. Evidence Acquisition: The most frequent mandibular surgeries, setbacks, and advancements via the bilateral sagittal split osteotomy technique were used for a literature search due to the abundance of related articles. Consequently, the following keywords were applied: sagittal split ramus osteotomy, orthognathic surgery, rigid fixation, non-rigid fixation, postoperative relapse, and postoperative stability. Results: The articles were classified according to the surgery procedure: mandibular advancement surgery or mandibular setback surgery. The relapse pattern can be divided into two categories: an early relapse, which is strongly related to the surgery procedure, and a late relapse, which can be attributed to the physiologic changes, such as a growth map. The contributing factors can be considered to be the following: a change in ramus in inclination, the mandibular plane, and the fixation type. Conclusions: Using rigid fixation techniques after bilateral sagittal split ramus osteotomy will optimize the stability, but this stability is not influenced by the method of this rigid fixation; although the most commonly suggested technique, bicortical screws, is in the inverted-L position

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Section: Discussionmentioning

confidence: 99%

The Effect of the Mandibular Fixation Method after Bilateral Sagittal Split Ramus Osteotomy on Postoperative Stability: A Literature Review

Yaripoor¹,

Janbaz²

2016

Avicenna J Dent Res

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“…The inferior alveolar nerve and the roots carefully considered while positioning the bicortical bone fixation screws and screws positioned as far as each other. At the techniques with bicortical screws, the positioning of screws was selected on the superiorposterior of the plates as described in similar studies [10,11]. Performed occlusal loads and directions given at Tables 2 and 3.…”

Section: Preparation Of a 3-dimensional Mandible Model Viamentioning

confidence: 99%

Fixation Methods for Mandibular Advancement and Their Effects on Temporomandibular Joint: A Finite Element Analysis Study

Demircan

Ureturk

Apaydin

et al. 2020

BioMed Research International

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Objectives. Bilateral sagittal split osteotomy (BSSO) is a common surgical procedure to correct dentofacial deformities that involve the mandible. 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. In this study, our aim is to determine first stress distribution values at the temporomandibular joint (TMJ) and second displacement amounts of each mandibular bone segment. Methods. A three-dimensional virtual mesh model of the mandible was constructed. Then, BSSO with 9 mm advancement was simulated using the finite element model (FEM). Fixation between each mandibular segment was also virtually performed using seven different combinations of fixation materials, as follows: miniplate only (M), miniplate and a titanium bicortical bone fixation screw (H), miniplate and a resorbable bicortical bone fixation screw (HR), 3 L-shaped titanium bicortical bone fixation screws (L), 3 L-shaped resorbable bicortical bone fixation screws (LR), 3 inverted L-shaped titanium bicortical bone fixation screws (IL), and 3 inverted L-shaped resorbable bicortical bone fixation screws (ILR). Results. At 9 mm advancement, the biggest stress values at the anterior area TMJ was seen at M fixation and LR fixation at posterior TMJ. The minimum stress values on anterior TMJ were seen at L fixation and M fixation at posterior TMJ. Minimum displacement was seen in IL method. It was followed by L, H, HR, M, ILR, and LR, respectively. Conclusion. According to our results, bicortical screw fixation was associated with more stress on the condyle. In terms of total stress value, especially LR and ILR lead to higher amounts.

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“…There is no consensus on which permutation or number of screws required and usually is surgeon preference. Although, some in-vitro and FEA studies have shown that the use of 3 bi-cortical screws in an inverted -L pattern is the more stable approach (20)(21)(22)(23)(24)(25)(26).…”

Section: Bi-cortical Screws Fixationmentioning

confidence: 99%

Comparison of Three Internal Fixation Techniques in Mandibular Sagittal Split Osteotomy, A Finite Element Analysis

Hassan

Stassen

Ring

2018

British Journal of Oral and Maxillofacial Surgery

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The sagittal split osteotomy is a versatile technique used in Mandibular orthognathic surgery. There are many types of internal fixation techniques available to provide fixation following the mandible split. The choice of fixation is mainly on surgeon preference, and can range from bi-cortical screws fixation and miniplate fixation. This study used Finite Element Analysis to investigate biomechanical properties of three internal fixation techniques. A pre-operative CT scan of a patient's skull was used to develop a half fully dentate mandible computer model. A sagittal split osteotomy was performed on the computer model and all fixation techniques applied to the model. Finite element analysis was used to study the effect of different fixation techniques on various mandibular movements and force magnitudes. The results of this study have shown consistently that the bi-cortical screws fixation records the least stress and displacement in all simulation models. Stress is mostly concentrated in the inferior-distal screw for the bi-cortical screws fixation whereas the stresses in miniplates are generally dissipated in the connector region of the plate. The 1.7mm miniplate was the least rigid fixation. The stresses in surrounding bone of the fixations were variable for each technique. Miniplate fixations had higher bone stresses in the setback movement but lower with mandibular advancements. Within the limitations of the study, the application of bi-cortical screws has shown to be the most rigid fixation, although with increased stresses in surrounding bone at mandibular advancements. The 1.7mm and 2.0mm miniplates are less rigid than the bi-cortical screws but handled stresses within the ultimate yield strength. Stress The force per unit area applied to an object. Von Mises Stress The equivalent tensile stress used to predict the yielding of materials, when they are placed under loads from different directions.

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Biomechanical Stress Distribution on Fixation Screws Used in Bilateral Sagittal Split Ramus Osteotomy: Assessment of 9 Methods via Finite Element Method

Cited by 31 publications

References 12 publications

The Effect of the Mandibular Fixation Method after Bilateral Sagittal Split Ramus Osteotomy on Postoperative Stability: A Literature Review

The Effect of the Mandibular Fixation Method after Bilateral Sagittal Split Ramus Osteotomy on Postoperative Stability: A Literature Review

Fixation Methods for Mandibular Advancement and Their Effects on Temporomandibular Joint: A Finite Element Analysis Study

Comparison of Three Internal Fixation Techniques in Mandibular Sagittal Split Osteotomy, A Finite Element Analysis

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