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Comparison of the stability and cost effectiveness of 3 bicortical screws with adjustable plate and 2 bicortical screws in the fixation of BSSRO

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In 1957, Trauner and Obwegeser reported on the first correction of the jaw deformity using the sagittal split technique. Dal Pont, a student of Obwegeser, made a modification of the latter technique in 1961 to further improve the precision and accuracy of movement of both proximal distal segments. His technique is widespread. He changed the lower horizontal cut to a vertical cut off the buccal cortex between the first and second molars, giving a wider bone contact. In 1968, Hunsuck modified the technique to reduce the soft tissue section; he advocated a shorter horizontal medial cut. Epker modified the technique in various ways in 1977 to reduce swelling and manipulation of the neurovascular bundle and bleeding, his modification including minimal stripping of the masseter muscle and medial dissection. BSSRO is the most common procedure for moving the lower jaw forward today. It is a bilateral sagittal split osteotomy. There are many different methods of holding the lower jaw in place, such as: B. the use of intraosseous wiring combined with intermaxillary fixation (IWF) that has had significant relapse and patient dissatisfaction, this is called non-fixed fixation. Another type of lower jaw fixation is the three-point fixation with positioning screws, known as rigid fixation. Rigid Internal restraint was introduced by Spiessel in 1976 to promote healing, restore function early and reduce relapse. The introduction of an internal rigid fixation method instead of 5-6 weeks intermaxillary fixation had the additional benefit of shorter hospital stays and patient comfort. 'Minimal or no jaw immobilization allows patients to function sooner, resume daily activities and return to work sooner. In a relatively short period of time, the use of the rigid fixation of bone segments in orthognathic surgery had become a standard of care. A major concern in surgically correcting a patient with anteroposterior mandibular deficiency is potential postoperative relapse. Clinical studies have shown a variety of successful techniques for securing segments. Three inverted L-shaped bicortical screws have become the gold standard for stabilizing bilateral sagittal split advancement. However, various problems have arisen. This shows that the stability necessary for stabilizing an osteotomy site cannot be directly compared to that of a fracture. Other problems included difficulty in positioning the fragments in new locations, resulting in misalignment of the condyle. This led to the term "immediate post-operative relapse". In addition, pain and dysfunction of the temporomandibular joint (TMJ) complicated the treatment and made the goal of long-term stability difficult to achieve. In this current study, a comparison was made between 3 position screws compared to the one patient group used an adjustable plate in conjunction with 2 position screws who suffer from retrognathy and are treated by BSSRO, therefore the investigators are taking advantage of the inherent adjustability of the plate intraoperatively with the Good fixation and stability of the bicortical screws. Short-term stability. This will be evaluated both clinically and cephalometrically.