Comparative evaluation of stress distribution and transverse displacement of novel designs of miniplates for sagittal split ramus osteotomy in 10 mm advancements: a finite element analysis


      The aim of this study was to evaluate the stress distribution and displacement values of six different miniplate systems in large mandibular advancement after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA). A three-dimensional model of a mandible was created and a 10 mm advancement SSRO was simulated. The model was fixed using a four-hole miniplate, a six-hole miniplate, a newly designed six-hole miniplate and their curved versions. Maximum principal stress values for bone, von Mises stress values for osteosynthesis materials, and the amount of displacement between segments were measured. The highest von Mises value was observed in the curved version of the newly designed six-hole miniplate; the lowest value was detected in the four-hole curved miniplate. The lowest value of maximum principal stress in the bone was found in the curved version of the novel design six-hole miniplate. The least displacements between segments were also recorded in the new design of straight miniplate; therefore, for large mandibular advancement surgery, this novel six-hole miniplate may be a promising option with positive biomechanical characteristics.


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        • Larson B.E.
        • Lee N.K.
        • Jang M.J.
        • et al.
        Comparative evaluation of the sliding plate technique for fixation of a sagittal split ramus osteotomy: finite element analysis.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 123: e148-e152
        • Klein G.B.
        • Mendes G.C.
        • Ribeiro-Junior P.D.
        • et al.
        Biomechanical evaluation of different osteosynthesis methods after mandibular sagittal split osteotomy in major advancements.
        Int J Oral Maxillofac Surg. 2017; 46: 1387-1393
        • Erkmen E.
        • Simşek B.
        • Yücel E.
        • et al.
        Three-dimensional finite element analysis used to compare methods of fixation after sagittal split ramus osteotomy: setback surgery-posterior loading.
        Br J Oral Maxillofac Surg. 2005; 43: 97-104
        • Miloro M.
        • Ghali G.E.
        • Larsen -.
        • Pe.
        Peterson's principles of oral and maxillofacial surgery.
        3rd ed. BC Decker, Hamilton2012
        • Park Y.W.
        Bioabsorbable osteofixation for orthognathic surgery.
        Maxillofac Plast Reconstr Surg. 2015; 37: 6
        • Martis C.S.
        Complications after mandibular sagittal split osteotomy.
        J Oral Maxillofac Surg. 1984; 42: 101-107
        • Sigua-Rodriguez E.A.
        • Caldas R.A.
        • Goulart D.R.
        • et al.
        Comparative evaluation of different fixation techniques for sagittal split ramus osteotomy in 10 mm advancements. Part two: finite element analysis.
        J Cranimaxillofac Surg. 2019; 47: 1015-1109
        • Sato F.R.
        • Asprino L.
        • Noritomi P.Y.
        • et al.
        Comparison of five different fixation techniques of sagittal split ramus osteotomy using three-dimensional finite elements analysis.
        Int J Oral Maxillofac Surg. 2012; 41: 934-941
        • Albougha S.
        • Albogha M.H.
        • Darwich M.A.
        • et al.
        Evaluation of the rigidity of sagittal split ramus osteotomy fixation using four designs of biodegradable and titanium plates—a numerical study.
        Oral Maxillofac Surg. 2015; 19: 281-285
      1. Borcic J, Braut A. Finite Element Analysis in Dental Medicine. InTech, 2012. Available from URL: (last accessed 22 August 2022).

        • Prado F.B.
        • Rossi A.C.
        • Freire A.R.
        • et al.
        The application of finite element analysis in the skull biomechanics and dentistry.
        Indian J Dent Res. 2014; 25: 390-397
        • Budynas R.
        • Nisbett K.J.
        Shigley's mechanical engineering design.
        9th ed. McGraw-Hill Education, 2014
        • Lourenço A.L.
        • Jager N.D.
        • Prochnow C.
        • et al.
        Young’s modulus and Poisson ratio of composite materials: Influence of wet and dry storage.
        Dent Mater J. 2020; 39: 657-663
        • Chang Y.H.
        • Chan M.Y.
        • Hsu J.T.
        • et al.
        Biomechanical analysis of the forces exerted during different occlusion conditions following bilateral sagittal split osteotomy treatment for mandibular deficiency.
        Appl Bionics Biomech. 2019; 2019: 4989013
        • Sung S.J.
        • Baik H.S.
        • Moon Y.S.
        • et al.
        A comparative evaluation of different compensating curves in the lingual and labial techniques using 3D FEM.
        Am J Orthodont Dentofac Orthop. 2003; 123: 441-450
        • Olivera L.B.
        • Manzato A.J.
        • Guerra F.L.
        • et al.
        Biomechanical in vitro evaluation of three stable internal fixation techniques used in sagittal osteotomy of the mandibular ramus: a study in sheep mandibles.
        J Appl Oral Sci. 2012; 20: 419-426
        • Al-Moraissi E.A.
        • Al-Hendi E.A.
        Are bicortical screw and plate osteosynthesis techniques equal in providing skeletal stability with the bilateral sagittal split osteotomy when used for mandibular advancement surgery? A systematic review and meta-analysis.
        Int J Oral Maxillofac Surg. 2016; 45: 1195-1200
        • Blomqvist J.E.
        • Ahlborg G.
        • Isaksson S.
        • et al.
        A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation techniques.
        J Oral Maxillofac Surg. 1997; 55: 568-574
        • Kahnberg K.-E.
        • Kashani H.
        • Owman-Moll P.
        Sagittal split advancement osteotomy: comparison of the tendency to relapse after two different methods of rigid fixation.
        Scand J Plast Reconstr Surg Hand Surg. 2007; 41: 167-172
        • Stringhini D.J.
        • Sommerfeld R.
        • Uetanabaro L.C.
        • et al.
        Resistance and stress finite element analysis of different types of fixation for mandibular orthognathic surgery.
        Braz Dent J. 2016; 27: 284-291
        • Ribeiro-Junior P.D.
        • Magro-Filho O.
        • Shastri K.
        • et al.
        Which kind of miniplate to use in mandibular sagittal split osteotomy? An in vitro study.
        Int J Oral Maxillofac Surg. 2012; 41: 1369-1373
        • Peterson G.P.
        • Haug R.H.
        • Van Sickels J.
        A biomechanical evaluation of bilateral sagittal ramus osteotomy fixation techniques.
        J Oral Maxillofac Surg. 2005; 63: 1317-1324
        • Ribeiro-Junior P.D.
        • Magro-Filho O.
        • Shastri K.A.
        • et al.
        In vitro biomechanical evaluation of the use of conventional and locking miniplate/screw systems for sagittal split ramus osteotomy.
        J Oral Maxillofac Surg. 2010; 68: 724-730
        • Gursoytrak B.
        • Unsal N.
        • Demetoglu U.
        • et al.
        Biomechanical evaluation of hybrid fixation method of sagittal split ramus osteotomy in mandibular advancement.
        J Craniomaxillofac Surg. 2018; 46: 2063-2068
        • Albougha S.
        • Darwich K.
        • Darwich M.
        • et al.
        Assessment of sagittal split ramus osteotomy rigid internal fixation techniques using a finite element method.
        Int J Oral Maxillofac Surg. 2015; 44: 823-829
        • Brasileiro B.F.
        • Grempel R.G.
        • Ambrosano G.M.
        • et al.
        An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: advancement surgery.
        J Oral Maxillofac Surg. 2009; 67: 809-817