Skeletal stability after mandibular advancement with rigid versus wire fixation

• Published in: Journal of oral and maxillofacial surgery Vol. 58; no. 11; pp. 1219 - 1227
• Main Authors: Dolce, Calogero, Van Sickels, Joseph E., Bays, Robert A., Rugh, John D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2000
• Subjects: Adult; Bone Screws; Cephalometry; Dentistry; Female; Humans; Immobilization; Jaw Fixation Techniques - instrumentation; Male; Malocclusion, Angle Class II - surgery; Mandibular Advancement - methods; Prospective Studies; Secondary Prevention; Statistics, Nonparametric; Treatment Outcome
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1053/joms.2000.16617

Purpose: This study examined the stability of skeletal changes after mandibular advancement surgery with rigid or wire fixation up to 2 years postoperatively. Patients and Methods: Subjects for this multisite, prospective, clinical trial received rigid (n = 78) or wire (n = 49) fixation. The rigid cases were fixed with three 2-mm bicortical position screws and 1 to 2 weeks of skeletal maxillomandibular fixation with elastics, and the wire fixation subjects were fixed with inferior border wires and had 6 weeks of skeletal maxillomandibular fixation with 24-gauge wires. Cephalometric radiographs were obtained before orthodontics, immediately before surgery, and at 1 week, 8 weeks, 6 months, 1 year, and 2 years after surgery. Linear cephalometric changes were referenced to a cranial base coordinate system. Results: Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. Mean anterior sagittal advancement of the mandibular symphysis was 4.92 ± 3.01 mm in the rigid group and 5.11 ± 3.09 mm in the wire group, and the inferior vertical displacement was 3.37 ± 2.44 in the rigid group and 2.85 ± 1.78 in the wire group. The vertical changes were similar in both groups. Two years postsurgery, the wire group had 30% sagittal relapse of the mandibular symphysis, whereas there was no change in the rigid group (P <.001). Both groups experienced changes in the orientation and configuration of the mandible. Conclusions: Rigid fixation is a more stable method than wire fixation for maintaining mandibular advancement after sagittal split ramus osteotomy.