Bilateral Sagittal Split Osteotomy with or Without Concomitant Removal of Third Molars: a Retrospective Cohort Study of Related Complications and Bone Healing

Overview

Journal Oral Maxillofac Surg

Specialties Dentistry
General Surgery

Date 2023 Mar 24

PMID 36959345

Authors

Adaia Valls-Ontanon

Ozlem Kesmez

Thomas Starch-Jensen

Sergi Triginer-Roig

David Neagu-Vladut

Federico Hernandez-Alfaro

Affiliations

Soon will be listed here.

Abstract

Purpose: To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars.

Material And Methods: A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique.

Results: A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020).

Conclusion: The results obtained support concomitant molar extraction with BSSO as a feasible option.

References

Giralt-Hernando M, Valls-Ontanon A, Guijarro-Martinez R, Masia-Gridilla J, Hernandez-Alfaro F . Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea-hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis. BMJ Open Respir Res. 2019; 6(1):e000402. PMC: 6797338. DOI: 10.1136/bmjresp-2019-000402. View

Ploder O, Sigron G, Adekunle A, Burger-Krebes L, Haller B, Kolk A . The Effect of Orthognathic Surgery on Temporomandibular Joint Function and Symptoms: What are the Risk Factors? A Longitudinal Analysis of 375 Patients. J Oral Maxillofac Surg. 2020; 79(4):763-773. DOI: 10.1016/j.joms.2020.11.010. View

TRAUNER R, OBWEGESER H . The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol. 1957; 10(7):677-89; contd. DOI: 10.1016/s0030-4220(57)80063-2. View

TRAUNER R, OBWEGESER H . The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 1957; 10(9):899-909. DOI: 10.1016/s0030-4220(57)80041-3. View

OBWEGESER H . THE INDICATIONS FOR SURGICAL CORRECTION OF MANDIBULAR DEFORMITY BY THE SAGITTAL SPLITTING TECHNIQUE. Br J Oral Surg. 1964; 1:157-71. DOI: 10.1016/s0007-117x(63)80067-0. View

Aarabi M, Tabrizi R, Hekmat M, Shahidi S, Puzesh A . Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy. J Oral Maxillofac Surg. 2014; 72(12):2508-13. DOI: 10.1016/j.joms.2014.05.008. View

Kim S, Park S . Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg. 2007; 65(12):2438-44. DOI: 10.1016/j.joms.2007.05.030. View

Bockmann R, Meyns J, Dik E, Kessler P . The modifications of the sagittal ramus split osteotomy: a literature review. Plast Reconstr Surg Glob Open. 2015; 2(12):e271. PMC: 4292253. DOI: 10.1097/GOX.0000000000000127. View

Akhtar S, Tuinzing D . Unfavorable splits in sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87(3):267-8. DOI: 10.1016/s1079-2104(99)70230-1. View

10.

Steenen S, van Wijk A, Becking A . Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors. Int J Oral Maxillofac Surg. 2016; 45(8):971-9. DOI: 10.1016/j.ijom.2016.02.011. View

11.

Mensink G, Verweij J, Frank M, Bergsma J, van Merkesteyn J . Bad split during bilateral sagittal split osteotomy of the mandible with separators: a retrospective study of 427 patients. Br J Oral Maxillofac Surg. 2013; 51(6):525-9. DOI: 10.1016/j.bjoms.2012.10.009. View

12.

Balaji S . Impacted third molars in sagittal split osteotomies in mandibular prognathism and micrognathia. Ann Maxillofac Surg. 2014; 4(1):39-44. PMC: 4073460. DOI: 10.4103/2231-0746.133074. View

13.

Steinbacher D, Kontaxis K . Does Simultaneous Third Molar Extraction Increase Intraoperative and Perioperative Complications in Orthognathic Surgery?. J Craniofac Surg. 2016; 27(4):923-6. DOI: 10.1097/SCS.0000000000002648. View

14.

Camargo I, Van Sickels J, Curtis W . Simultaneous Removal of Third Molars During a Sagittal Split Does Not Increase the Incidence of Bad Splits in Patients Aged 30 Years or Older. J Oral Maxillofac Surg. 2015; 73(7):1350-9. DOI: 10.1016/j.joms.2015.01.023. View

15.

Precious D, Lung K, Pynn B, Goodday R . Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal-split osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85(4):362-5. DOI: 10.1016/s1079-2104(98)90057-9. View

16.

Morton L, Downie I . Surgical and social implications of extraction of mandibular third molars as a separate procedure before bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg. 2017; 55(9):937-939. DOI: 10.1016/j.bjoms.2017.09.004. View

17.

Negreiros R, Biazevic M, Jorge W, Michel-Crosato E . Relationship between oral health-related quality of life and the position of the lower third molar: postoperative follow-up. J Oral Maxillofac Surg. 2011; 70(4):779-86. DOI: 10.1016/j.joms.2011.09.034. View

18.

Hernandez-Alfaro F, Guijarro-Martinez R . "Twist technique" for pterygomaxillary dysjunction in minimally invasive Le Fort I osteotomy. J Oral Maxillofac Surg. 2012; 71(2):389-92. DOI: 10.1016/j.joms.2012.04.032. View

19.

Hernandez-Alfaro F, Raffaini M, Paredes-de-Sousa-Gil A, Magri A, Guijarro-Martinez R, Valls-Ontanon A . Three-Dimensional Analysis of Long-Term Stability After Bilateral Sagittal Split Ramus Osteotomy Fixed With a Single Miniplate With 4 Monocortical Screws and 1 Bicortical Screw: A Retrospective 2-Center Study. J Oral Maxillofac Surg. 2017; 75(5):1036-1045. DOI: 10.1016/j.joms.2016.12.041. View

20.

Ellis 3rd E . A method to passively align the sagittal ramus osteotomy segments. J Oral Maxillofac Surg. 2007; 65(10):2125-30. DOI: 10.1016/j.joms.2007.02.005. View