Comparison between 2- and 4-plate fixation in Le Fort I osteotomy: a mixed methods systematic review

Ricardo Grillo; Bruno Alvarez Quinta Reis; Bernardo Correia Lima; Leonardo Augustus Peral Ferreira Pinto; Fernando Melhem-Elias

doi:10.1016/j.oooo.2024.09.002

Comparison between 2- and 4-plate fixation in Le Fort I osteotomy: a mixed methods systematic review

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Sep 16:S2212-4403(24)00463-2. doi: 10.1016/j.oooo.2024.09.002. Online ahead of print.

Authors

Ricardo Grillo¹, Bruno Alvarez Quinta Reis², Bernardo Correia Lima³, Leonardo Augustus Peral Ferreira Pinto⁴, Fernando Melhem-Elias⁵

Affiliations

¹ Oral and Maxillofacial Surgery Training Program, Foundation of Dentistry-Fundecto, University of São Paulo, São Paulo, Brazil. Electronic address: [email protected].
² Oral and Maxillofacial Surgery Training Program, Foundation of Dentistry-Fundecto, University of São Paulo, São Paulo, Brazil.
³ Oral Diagnosis, Dental Radiology and Imaging Postgraduate Program, School of Dentistry, University of São Paulo, São Paulo, Brazil.
⁴ Department of Oral and Maxillofacial Surgery, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
⁵ Oral and Maxillofacial Surgery Training Program, Foundation of Dentistry-Fundecto, University of São Paulo, São Paulo, Brazil; Oral Diagnosis, Dental Radiology and Imaging Postgraduate Program, School of Dentistry, University of São Paulo, São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, São Paulo, Brazil.

PMID: 39701862
DOI: 10.1016/j.oooo.2024.09.002

Abstract

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.

Publication types

Review