Mandibular sagittal split osteotomy vs mandibular distraction osteogenesis in treatment of non-syndromic skeletal class II patients
More details
Hide details
Maxillofacial Reconstructive and Esthetic Surgery Department and Maxillofacial Center for Children and Young Adults, Specialist Children's Hospital in Olsztyn, Poland
Submission date: 2014-12-31
Acceptance date: 2015-12-17
Online publication date: 2016-01-26
Publication date: 2020-03-23
Corresponding author
Krzysztof Dowgierd   

Maxillofacial Reconstructive and Esthetic Surgery Department and Maxillofacial Center for Children and Young Adults, Specialist Children's Hospital in Olsztyn, Żołnierska 18a, 10-563 Olsztyn, Poland. Tel.: +48 604436411.
Pol. Ann. Med. 2016;23(1):21-25
Mandibular retrognathia is a common skeletal congenital dysgnathia. In many cases of skeletal class II patients require the surgical operation. Orthognatic surgery offers mandibular bilateral sagittal split osteotomy (BSSO) as the most common procedure to make the advancement of the mandible. However, the alternative, mandibular distraction osteogenesis (MDO), is prevalent nowadays and beneficial in particular cases.

The purpose of this study is to show the effect of MDO and BSSO done on 20 patients at Specialist Children's Hospital in Olsztyn, Poland between 2011 and 2013, performed by the same surgeon – KD. Authors would like to present the details of treatment planning and management of these methods as well as the protocol of usage of the distraction device.

Material and methods:
The sample consisted of 74 lateral cephalometric X-rays. Criteria for cephalometric comparison were angular cephalometric variables: SNB and SN/GoGn (Steiner analysis). The criteria for inclusion into this study were as follows: males and females with skeletal class II pattern plus dentofacial and dental abnormalities like skeletal open bite. The mean age of the subjects was 17.9 years.

Results and discussion:
Our comparison study showed that there was no statistically significant difference between results of BSSO postoperatively and MDO post-distraction. However, there is a need of long-term data on stability of both methods.

Study shows that MDO may offer another option for treatment of skeletal class II malocclusions in growing patients and after growth spurt.

None declared.
Baas EM, Bierenbroodspot F, de Lange J. Bilateral sagittal split osteotomy versus distraction osteogenesis of the mandible: a randomized clinical trial. Int J Oral Maxillofac Surg. 2015;44(2):180–188.
Bell WH, Guerrero CA. Distraction Osteogenesis of the Facial Skeleton. PMPH-USA; 2007.
Vos MD, Baas EM, de Lange J. Stability of mandibular advancement procedures: bilateral sagittal split osteotomy versus distraction osteogenesis. Int J Oral Maxillofac Surg. 2009;38:7–12.
Baas EM, Pijpe J, de Lange J. Long term stability of mandibular advancement procedures: bilateral sagittal split osteotomy versus distraction osteogenesis. Int J Oral Maxillofac Surg. 2012;41(2):137–141.
Ow A, Cheung LK. Bilateral sagittal split osteotomies and mandibular distraction osteogenesis: a randomized controlled trial comparing skeletal stability. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):17–23.
Schreuder WH, Jansma J, Bierman MW, Vissink A. Distraction osteogenesis versus bilateral sagittal split osteotomy for advancement of the retrognathic mandible: a review of the literature. Int J Oral Maxillofac Surg. 2007;36(2):103–110.
Van Strijen PJ, Breuning KH, Becking AG, Perdijk FB, Tuinzing DB. Cost, operation and hospitalization times in distraction osteogenesis versus sagittal split osteotomy. J Craniomaxillofac Surg. 2003;31(1):42–45.
Weber W. A modified mandibular ramus osteotomy for orthognathic surgery. J Oral Maxillofac Surg. 2001;59(2):237–240.
Walker DA. Management of severe mandibular retrognathia in the adult patient using distraction osteogenesis. J Oral Maxillofac Surg. 2002;60(11):1341–1346.
Mensink G, Verweij JP, Frank MD, Eelco Bergsma J, Richard van Merkesteyn JP. Bad split during bilateral sagittal split osteotomy of the mandible with separators: a retrospective study of 427 patients. Br J Oral Maxillofac Surg. 2013;51(6):525–529.
Zhang Q-B, Dong F-S, Zhang Z-Q, Yang B. Design considerations and animal experiment on a new bilateral mandibular distraction device. J Oral Maxillofac Surg Med Pathol. 2012;25(3):210–213.
Kessler P, Neukam FW, Wiltfang J. Effect of distraction forces and frequency of distraction on bony regeneration. Br J Ora Maxillofac Surg. 2005;43(5):392–398.
Breuning KH, van Strijen PJ, Prahl-Andersen B, Tuinzing DB. Outcome of treatment of class II malocclusion by intraoral mandibular distraction. Br J Oral Maxillofac Surg. 2004;42(6):520–525.
Cope JB, Samchukov ML, Cherkashin AM. Mandibular distraction osteogenesis: a historic perspective and future directions. Am J Orthod Dentofacial Orthop. 1999;115(4):448–460.
Williams BE, King GJ, Liu ZJ, Rafferty KL. Sequential histomorphometric analysis of regenerate osteogenesis following mandibular distraction in the rat. Arch Oral Biol. 2005;50(5):497–506.
Zimmerman CE, Thurmüller P, Troulis MJ, Perrott DH, Rahn B, Kaban LB. Histology of the porcine mandibular distraction wound. Int J Oral Maxillofac Surg. 2005;34(4):411–419.
Thongchai N, Wilad S, Surapong V. Mandibular lengthening by distraction osteogenesis: role of periosteum and endosteum. Asian J Oral Maxillofac Surg. 2004;16:21–33.
El-Bialy TH, Razdolsky Y, Kravitz ND, Dessner S, Elgazzar RF. Long-term results of bilateral mandibular distraction osteogenesis using an intraoral tooth-borne device in adult Class II patients. Int J Oral Maxillofac Surg. 2013;42(11):1446–1453.
Djasim UM, Wolvius EB, van Neck JW, van Wamel A, Weinans H, van der Wal KG. Single versus triple daily activation of the distractor: no significant effects of frequency of distraction on bone regenerate quantity and architecture. J Craniomaxillofac Surg. 2008;36(3):143–151.
Cope JB, Yamashita J, Healy S, Dechow PC, Harper RP. Force level and strain patterns during bilateral mandibular osteodistraction. J Oral Maxillofac Surg. 2000;58(2):171–178.
Koide S, Yamashita K, Hirano M, Matsumoto N. Mandibular distraction osteogenesis in an adult with severe mandibular retrognathia with arthrosis deformity: a 10-year follow-up. Orthod Waves. 2013;72(3):119–127.
Ow A, Cheung K. Bilateral sagittal split osteotomies versus mandibular distraction osteogenesis: a prospective clinical trial comparing inferior alveolar nerve function and complications. Int J Oral Maxillofac Surg. 2010;39(8):756–760.
Sidlauskas A, Svalkauskiene V, Sidlauskas M. Assessment of skeletal and dental pattern of Class II division 1 malocclusion with relevance to clinical practice. Stomatologija. 2006;8(1):3–8.
Hamada T, Ono T, Otsuka R, et al. Mandibular distraction osteogenesis in a skeletal Class II patient with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2007;131(3):415–425.
van Strijen PJ, Breuning KH, Becking AG, Tuinzing DB. Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients. J Oral Maxillofac Surg. 2005;62(3):304–307.
Takahashi I, Kawamura H, Takano-Yamamoto T. Combined maxillary and mandibular midline and mandibular ramus distraction osteogenesis for treatment of a Class II patient with implants as orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2010;137(3):412–423.
Triaca A, Minoretti R, Merz B. Treatment of mandibular retrusion by distraction osteogenesis: a new technique. Br J Oral Maxillofac Surg. 2004;42(2):89–95.
Journals System - logo
Scroll to top