Does Angular Sagittal Split Osteotomy of the Mandibular Ramus Alter Fracture Patterns Compared With the Modifications of Posnick, Wolford, and Hunsuck/Epker?
Jéferson Martins Pereira Lucena Franco, Tácio Pinheiro Bezerra, Jamile de Melo Casado Pereira, Giovana Radomille TofoliObjectives:
To evaluate the torque required to perform sagittal split osteotomy using the angular osteotomy technique compared with the Posnick, Wolford, and Hunsuck/Epker techniques, and to assess associated fracture patterns and inferior alveolar nerve (IAN) visibility.
Materials and Methods:
A laboratory-based experimental study was conducted using 52 porcine mandibles. After dissection, sagittal osteotomies were performed in a blinded and randomized manner according to the assigned technique. The primary outcomes were the torque required to complete the osteotomy and the resulting fracture pattern. Secondary analysis included IAN visibility following osteotomy. Statistical analysis was performed using analysis of variance with Tukey post hoc testing for torque comparisons and Pearson χ
2
or Fisher exact tests for categorical variables. Statistical significance was set at
Results:
The angular osteotomy technique required significantly less torque (110±0.07N) compared with the Posnick, Wolford, and Hunsuck/Epker techniques (
Conclusions:
Within the limitations of this ex vivo porcine model, the angular sagittal split osteotomy technique demonstrated greater mechanical efficiency, requiring lower torque and producing more homogeneous fracture patterns with reduced IAN exposure. These findings provide a comparative biomechanical assessment of different osteotomy designs and may contribute to understanding force distribution during sagittal splitting. However, direct clinical extrapolation should be made with caution, and further studies in human models are necessary to determine the implications for surgical outcomes and neurosensory recovery.