Complications of the mandibular sagittal split ramus

osteotomy associated with the presence or absence of third

molars******
Author links open overlay panelPushkarMehraBDS, DMD,*VanessaCastroDDS,†Rogerio
Z.FreitasDDS,‡Larry M.WolfordDMD,§
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https://doi.org/10.1053/joms.2001.25013Get rights and content

Abstract
Purpose: This study compared the number of unfavorable fractures after sagittal
split osteotomies (SSOs) of the mandible when third molars were present or
absent. Patients and Methods: The treatment records of 262 patients (500 SSOs)
were retrospectively evaluated. Group 1 consisted of 250 SSOs and concomitant
removal of impacted mandibular third molars and group 2 consisted of 250 SSOs with
absence of third molars. A modified SSO technique with inferior border cuts was used
on all patients, and the third molars, when present, were removed after separation of
the proximal and distal segments. Rigid fixation was applied using bicortical bone
screws. Bone plates with monocortical screws were additionally used to secure the free
bony segments of the proximal segment in cases with unfavorable
fracture. Results: There were 11 (2.2%) unfavorable fractures in 500 SSO procedures.
The incidence of unfavorable splits was 3.2% in group 1 and 1.2 % in group 2. In group
1, all fractures occurred in teenagers, with 7 of 8 fractures extending through the
extraction socket in the distal segment. Six of the 8 fractures were associated with
completely impacted third molars, and 2 involved partially impacted teeth. All 3 fractures
in group 2 occurred in the proximal segment. No significant difference was seen in the
amount of relapse in patients with unfavorable or favorable splits. Conclusions: The
occurrence of unfavorable splits is uncommon when using a modification of the SSO
that includes an inferior border osteotomy. Although more unfavorable fractures
occurred in teenage patients with third molars, this had no impact on the stability of the
final result. © 2001 American Association of Oral and Maxillofacial Surgeons