In vitro biomechanical evaluation of the use of conventional and locking miniplate/screw systems for sagittal split ramus osteotomy.
OBJECTIVE
The aim of this in vitro study was to assess the biomechanical stability of 9 different osteosynthesis methods after sagittal split ramus osteotomy by simulating the masticatory forces and using a 3-point biomechanical test method.


METHODS
Forty-five polyurethane hemimandibles with bone-like consistency were randomly assigned to 9 groups (n = 5) and subjected to sagittal split ramus osteotomy. After 4-mm advancement of the distal segment, the bone segments were fixed by different osteosynthesis methods using 2.0-mm miniplate/screw systems: group A, one 4-hole conventional straight miniplate; group B, one 4-hole locking straight miniplate; group C, one 4-hole conventional miniplate and one bicortical screw; group D, one 4-hole locking miniplate and 1 bicortical screw; group E, one 6-hole conventional straight miniplate; group F, one 6-hole locking straight miniplate; group G: two 4-hole conventional straight miniplates; group H, two 4-hole locking straight miniplates; and group I, 3 bicortical screws in an inverted-L pattern. All models were mounted on a base especially constructed for this purpose. Using a 3-point biomechanical test model, the hemimandibles were loaded in compressive strength in an Instron machine (Norwood, MA) until a 3-mm displacement occurred between segments vertically or horizontally. Data were analyzed by analysis of variance and Tukey test (alpha = 1%).


RESULTS
The multiparametric comparison of the groups showed a statistically significant difference (P < .01) between groups that used 2 miniplates (groups G and H), 1 miniplate and 1 bicortical screw (groups C and D), and only bicortical screws (group I) compared with groups that used only 1 miniplate with 2 screws per segment (groups A and B) and 3 screws per segment (groups E and F).


CONCLUSIONS
The placement of 2.0-mm-diameter bicortical screws in the retromolar region, associated or not with conventional and locking miniplates with monocortical screws, promoted a better stabilization of bone segments. Locking miniplates presented a better performance in bone fixation in all groups.
Ribeiro-Junior
Paulo Domingos
PD
Maxillofacial Surgery and Traumatology, University of Sagrado, Coração, Bauru, SP, Brazil. paulodomingos@iocp.com.br
Magro-Filho
Osvaldo
O
Shastri
Kalpakam A
KA
Papageorge
Maria B
MB
D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D019245:Compressive Strength; D003799:Dental Stress Analysis; D004867:Equipment Design; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D008334:Mandible / Q000601:surgery*; D008953:Models, Anatomic; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation*; D010027:Osteotomy / Q000295:instrumentation; D011897:Random Allocation; D018709:Statistics, Nonparametric