POLİÜRETAN ALT ÇENELERİN İLERLETİLMESİNDE İKİ CERRAHİ TEKNİĞİN BİKORTİKAL VİDA VE MİNİPLAKLARIN BİYOMEKANİK DAYANIMINDAKİ ETKİSİNİN KARŞILAŞTIRILMASI

Abstract

Amaç: Bu çalışmanın amacı Obwegeser-DalPont (ODP) ya da Hunsuck-Epker (HE) cerrahi kesi yöntemleri kullanılarak bilateral sagital split osteotomi uygulanan poliüretan alt çenelerde miniplak ve bikortikal vida fiksasyonlarının biyomekanik dayanımını karşılaştırmaktır. Gereç ve Yöntem: Bu çalışmada bir hastanın tomografik görüntüsünden elde edilen verilerle üretilen 32 adet (N=32) poliüretan alt çene modeli kullanılmıştır. Bu modellerde ODP ve HE kesi teknikleri kullanılarak 4mm ilerletme yapılmıştır. Fiksasyon için 1 mm kalınlığında, 4 delikli, 9mm ara lıklı 2 adet düz titanyum mini plak ve 8 adet 2mm çapında, 5mm uzunlu ğunda titanyum vidalar ya da 2mm çapında 6 adet bikortikal vida kullanıl mıştır. Çalışmada kesi ve fiksasyon tekniklerine göre her birinde 8 (n=8) alt çene olan 4 grup oluşturulmuştur. Bunlar sırasıyla M-EPKER, M-DALPONT, B-EPKER ve B-DALPONT olarak isimlendirilmiştir. Fikse edilmiş modeller bir evrensel test cihazına yerleştirilerek kesiciler bölgesinden doğrusal, devamlı ve giderek artan kuvvet uygulanmıştır. Deney arayüzünün 1 mm, 3mm, 5mm yer değiştirme değerlerine ulaşması için gereken Newton (N) cinsinden kuvvet büyüklükleri ölçülmüş ve istatistiksel olarak karşılaştırılmıştır. Bulgular: Deney modellerinin 1 mm yer değiştirme seviyesine ulaşması için B-EPKER grubunda M-EPKER grubuna göre daha yüksek kuvvet büyük lüğü gerekli olmuştur (p<0,05). 3mm seviyesinde ise B-DALPONT grubu M-DALPONT grubuna göre daha yüksek kuvvet değerlerine dayanım gös termiştir (p<0,05). Aynı seviyede B-EPKER grubu M-EPKER grubuna göre daha yüksek kuvvet değerlerine ulaşmıştır (p<0,05). 5mm seviyesinde ise her iki kesi tekniğinde de bikortikal kullanılan grup, miniplak kullanılan gruba göre daha yüksek değerlere ulaşmıştır (p<0,05). Sonuç: Bu deneysel çalışmanın sınırları dâhilinde, alt çene ilerletmesi yapılan poliüretan modellerde cerrahi teknik fark etmeksizin bikortikal vida ile yapılan fiksasyon işlemlerinin miniplak ile yapılanlara göre daha dayanıklı olduğu söylenebilir.

Keywords

• Epker
• DalPont
• miniplak
• bikortikal vida
• ortognatik cerrahi

Project Number

2021/04

COMPARISON OF THE EFFECT OF TWO SURGICAL TECHNIQUES ON THE BIOMECHANICAL STRENGTH OF BICORTICAL SCREWS AND MINIPLATES IN THE ADVANCEMENT OF POLYURETHANE MANDIBLES

Abstract

Objective: This study aims to compare the biomechanical strength of miniplate and bicortical screw fixation in polyurethane mandibles with bilateral sagittal split osteotomy using either the Obwegeser-DalPont (ODP) or Hunsuck-Epker (HE) surgical cutting techniques. Materials and Method: Thirty-two (N=32) polyurethane mandible models were created from data obtained from a tomographic image of a patient. In these models, 4mm advancements were made using ODP and HE cutting techniques. For fixation, 1mm thick, 4-hole, 9mm spaced straight titanium mini plates and 8 titanium screws, 2mm in diameter and 5mm in length, or 6 bicortical screws, 2mm in diameter, were used. Based on the cutting and fixation techniques, four groups were formed, each with 8 (n=8) mandible models. These groups were named M-EPKER, M-DALPONT, B-EPKER, and B-DALPONT, respectively. Fixed models were placed in a universal testing machine, and linear, continuous, and progressively increasing forces were applied from the cutting region. Force magnitudes required to reach displacement values of 1mm, 3mm, and 5mm for the test interface were measured in Newtons (N) and statistically compared. Results: To reach the 1mm displacement level of the test models, the B-EPKER group required a higher force magnitude than the M-EPKER group (p<0.05). At the 3mm level, the B-DALPONT group demonstrated higher force values compared to the M-DALPONT group (p<0.05). Similarly, at the same level, the B-EPKER group reached higher force values than the M-EPKER group (p<0.05). At the 5mm level, both groups using bicortical screws achieved higher values compared to the group using mini plates (p<0.05). Conclusion: Within the limitations of this experimental study, it can be concluded that fixation procedures with bicortical screws in polyurethane models with mandibular advancement, regardless of the surgical technique, are more durable than those with mini plates.

Keywords

• Epker
• DalPont
• mini plate
• bicortical screw
• orthognathic surgery

Project Number

2021/04

References

1. Arcuri F, Giarda M, Stellin L, Gatti A, Nicolotti M, Brucoli M, et al. Basic and advanced operative techniques in orthognathic surgery. A textbook of advanced oral and maxillofacial surgery. IntechOpen Rijeka 2013;697-718. google scholar
2. Sato FR, Asprino L, Consani S, de MM. Comparative biomechanical and photoelastic evaluation of different fixation techniques of sagittal split ramus osteotomy in mandibular advancement. J Oral Maxillofac Surg 2010;68(1):160-6. google scholar
3. Patel PK, Novia MV. The surgical tools: the LeFort I, bilateral sagittal split osteotomy of the mandible, and the osseous genioplasty. Clin Plast Surg 2007;34(3):447-75. google scholar
4. Ylikontiola L. Neurosensory disturbance after bilateral sagittal split osteotomy. Doctoral thesis, University of Oulu Faculty of Dentistry, Oulu Finlandiya 2002. google scholar
5. Teltzrow T, Kramer FJ, Schulze A, Baethge C, Brachvogel P. Perioperative complications following sagittal split osteotomy of the mandible. J Cran Maxillofac Surg 2005;33(5):307-13. google scholar
6. Al-Moraissi EA, Ellis E. Stability of bicortical screw versus plate fixation after mandibular setback with the bilateral sagittal split osteotomy: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016;45(1):1-7. google scholar
7. Kuik K, De Ruiter M, De Lange J, Hoekema A. Fixation methods in sagittal split ramus osteotomy: a systematic review on in vitro biomechanical assessments. Int J Oral Maxillofac Surg 2019;48(1):56-70. google scholar
8. Rughubar V, Vares Y, Singh P, Filipsky A, Creanga A, Iqbal S, et al. Combination of rigid and nonrigid fixation versus nonrigid fixation for bilateral mandibular fractures: a multicenter randomized controlled trial. J Oral Maxillofac Surg 2020;78(10):1781-94. google scholar

9. Ellis E 3rd, Miles BA. Fractures of the mandible: a technical perspective. Plast Reconstr Surg 2007;120(7 Suppl 2):76S-89S. google scholar
10. Pandey V, Bhuti O, Nagori SA, Seith A, Roychoudhury A. Management of mandibular angle fractures using a 1.7 mm 3-dimensional strut plate. J Oral Biol Craniofac Res 2016;6(1):35-40. google scholar
11. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Meth 2009;41(4):1149-60. google scholar
12. Ribeiro-Junior PD, Magro-Filho O, Shastri KA, Papageorge MB. In vitro evaluation of conventional and locking miniplate/screw systems for the treatment of mandibular angle fractures. Int J Oral Maxillofac Surg 2010;39(11):1109-14. google scholar
13. Throckmorton GS, Buschang PH, Ellis E, III. Improvement of maximum occlusal forces after orthognathic surgery. J Oral Maxillofac Surg 1996;54(9):1080-6. google scholar
14. Gerlach KL, Schwarz A. Bite forces in patients after treatment of mandibular angle fractures with miniplate osteosynthesis according to Champy. Int J Oral Maxillofac Surg 2002;31(4):345-8. google scholar
15. Harada K, Watanabe M, Ohkura K, Enomoto S. Measure of bite force and occlusal contact area before and after bilateral sagittal split ramus osteotomy of the mandible using a new pressuresensitive device: a preliminary report. J Oral Maxillofac Surg 2000;58(4):370-3. google scholar
16. Joss CU, Vassalli IM. Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg 2009;67(2):301-13. google scholar
17. Proffit WR, Philips C, Turvey TA. Stability following superior repositioning of the maxilla. Am J Orthod Dentofacial Orthop 1987;92(2):151-61. google scholar
18. Pepersack WJ, Chausse JM. Long-term follow-up of the sagittal splitting technique for correction of mandibular prognathism. J Maxillofac Surg 1978;6(2):117-40. google scholar
19. Dolanmaz D, Uckan S, Isik K, Saglam H. Comparison of stability of absorbable and titanium plate and screw fixation for sagittal split ramus osteotomy. Br J Oral Maxillofac Surg 2004;42(2):127-32. google scholar
20. Oguz Y, Saglam H, Dolanmaz D, Uckan S. Comparison of stability of 2.0 mm standard and 2.0 mm locking miniplate/screws for the fixation of sagittal split ramus osteotomy on sheep mandibles. Br J Oral Maxillofac Surg 2011;49(2):135-7. google scholar
21. Ochs MW. Bicortical screw stabilization of sagittal split osteotomies. J Oral Maxillofac Surg 2003;61(12):1477-84. google scholar
22. Armstrong JEA, Lupointe HJ, Hogg NJV, Kwok AD. Preliminary investigation of the biomechanics of internal fixation of sagittal split osteotomies with miniplates using a newly designed in vitro testing model. J Oral Maxillofac Surg 2001;59(2):191-5. google scholar
23. Sarkarat F, Ahmady A, Farahmand F, Fateh A, Kahali R, Nourani A, et al. Comparison of strengths of five internal fixation methods used after bilateral sagittal split ramus osteotomy: An in vitro study. Dent Res J (Isfahan) 2020;17(4):258-265. google scholar
24. Takahashi H, Moriyama S, Furuta H, Matsunaga H, Sakamoto Y, Kikuta T. Three lateral osteotomy designs for bilateral sagittal split osteotomy: biomechanical evaluation with three-dimensional finite element analysis. Head Face Med 2010;26:6:4. google scholar
25. Puricelli E, Fonseca JS, de Paris MF, Sant’Anna H. Applied mechanics of the Puricelli osteotomy: a linear elastic analysis with the finite element method. Head Face Med 2007;3:38. google scholar
26. Sirin Y. SMB, Limani E., Soley S. Effects of two different sagittal split osteotomy techniques on in-vitro biomechanical strength of titanium plates. J Dent Fac Istanb Univ 2011;45:67-73. google scholar