TY - JOUR
T1 - Comparison between 2- and 4-plate fixation in Le Fort I osteotomy
T2 - a mixed methods systematic review
AU - Grillo, Ricardo
AU - Reis, Bruno Alvarez Quinta
AU - Lima, Bernardo Correia
AU - Pinto, Leonardo Augustus Peral Ferreira
AU - Melhem-Elias, Fernando
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/9/16
Y1 - 2024/9/16
N2 - Objective: Achieving postsurgical skeletal stability is crucial for successful outcomes and patient satisfaction. Precision maxillofacial surgery, which integrates precision techniques with minimally invasive approaches, is increasingly recognized for its potential to enhance long-term stability and reduce surgical risks and complications. This study aimed to comprehensively evaluate the impact of fixation techniques (2 vs 4 plates) during Le Fort I osteotomy in orthognathic surgery on skeletal stability. The main focus was to compare the stability achieved and potential risks of relapse between these two fixation methods. Material and Methods: A mixed-methods approach was employed, combining a systematic review, in silico analysis, and in vitro studies. The systematic review adhered to Joanna Briggs Institute methodology and Good Reporting of A Mixed Methods Study guidelines, focusing on comparative studies that evaluated skeletal stability as the primary outcome measure. In silico and in vitro analyses were conducted to assess the biomechanical principles and relapse risks associated with maxillary advancement using different fixation techniques. Results: The systematic review included three clinical trials, four finite element analysis studies, and two in vitro analyses. The meta-analysis revealed no significant difference in skeletal stability between the 2- and 4-plate fixation methods. However, biomechanical analysis showed an atypical increase in relapse risk with 2-plate fixation at 3 mm maxillary advancement, compared to a 10 mm advancement for 4-plate fixation. Conclusions: While both 2- and 4-plate fixation methods are viable, the findings suggest that 4-plate fixation offers superior stability, particularly in cases of significant maxillary advancement, where 2-plate fixation showed an increased risk of relapse. Future research with larger sample sizes and addressing the biases identified in this study is needed to validate these findings and effectively guide clinical practice.
AB - Objective: Achieving postsurgical skeletal stability is crucial for successful outcomes and patient satisfaction. Precision maxillofacial surgery, which integrates precision techniques with minimally invasive approaches, is increasingly recognized for its potential to enhance long-term stability and reduce surgical risks and complications. This study aimed to comprehensively evaluate the impact of fixation techniques (2 vs 4 plates) during Le Fort I osteotomy in orthognathic surgery on skeletal stability. The main focus was to compare the stability achieved and potential risks of relapse between these two fixation methods. Material and Methods: A mixed-methods approach was employed, combining a systematic review, in silico analysis, and in vitro studies. The systematic review adhered to Joanna Briggs Institute methodology and Good Reporting of A Mixed Methods Study guidelines, focusing on comparative studies that evaluated skeletal stability as the primary outcome measure. In silico and in vitro analyses were conducted to assess the biomechanical principles and relapse risks associated with maxillary advancement using different fixation techniques. Results: The systematic review included three clinical trials, four finite element analysis studies, and two in vitro analyses. The meta-analysis revealed no significant difference in skeletal stability between the 2- and 4-plate fixation methods. However, biomechanical analysis showed an atypical increase in relapse risk with 2-plate fixation at 3 mm maxillary advancement, compared to a 10 mm advancement for 4-plate fixation. Conclusions: While both 2- and 4-plate fixation methods are viable, the findings suggest that 4-plate fixation offers superior stability, particularly in cases of significant maxillary advancement, where 2-plate fixation showed an increased risk of relapse. Future research with larger sample sizes and addressing the biases identified in this study is needed to validate these findings and effectively guide clinical practice.
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U2 - 10.1016/j.oooo.2024.09.002
DO - 10.1016/j.oooo.2024.09.002
M3 - Review article
AN - SCOPUS:85212447553
SN - 2212-4403
JO - Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
JF - Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
ER -