J Oral Maxillofac Surg

63:1317-1324, 2005

A Biomechanical Evaluation of
Bilateral Sagittal Ramus Osteotomy
Fixation Techniques
Gilman P. Peterson, DMD,* Richard H. Haug, DDS,† and
Joseph Van Sickels, DDS‡

Objectives: The purpose of this investigation was to evaluate and compare the biomechanical behavior
of various rigid internal fixation plates designed to aid in the condylar positioning of bilateral sagittal
ramus osteotomies, to positional screws in an inverted-L pattern, and a control.
Materials and Methods: Fifty polyurethane synthetic mandible replicas (Synbone, Laudquart, Swit-
zerland) were used in this investigation. Five controls and 5 each of 4 different fixation modalities (3
bicortical positional screws in an inverted-L pattern, monocortical 4-hole straight plates, monocortical
6-hole curved plates, and monocortical adjustable 4-hole slide plates) were subjected to vertical loading
at the incisal edge and torsional loading at the molar region by an Instron 1331 (Instron, Canton, MA)
servohydraulic mechanical testing unit. Mechanical deformation data within a 0 to 900 N range were
recorded. Yield load, yield displacement, and stiffness were determined. Means and standard deviations
were derived and compared for statistical significance using a Fisher’s Protected Least Significant
Differences Test with a confidence level of 95% (P ⬍ .05). Second-order polynomial best-fit curves were
also created for each group to further evaluate mechanical behavior.
Results: For incisal edge loading, statistically significant differences were noted between the control
group and all other groups for yield load and stiffness, and between the control group and straight,
curved, and slide plates for yield displacement. Differences were also noted between the inverted-L and
straight, strut, and slide plates for yield load; and inverted-L and straight, curved, and slide, as well as
straight and slide for yield displacement. For molar loading, statistically significant differences were noted
between the control group and all other groups for yield load and stiffness. Differences were noted
between the slide and straight, curved, and control; as well as between the inverted-L and straight and
strut plates for yield displacement. Lastly, differences were noted between the straight and curved plates,
and the slide and straight, curved, and inverted-L for stiffness.
Conclusion: In this in vitro study, differences were noted between the control and all experimental groups
in their abilities to resist loads under all of the conditions tested. Differences were also noted among specific
experimental groups. Yet when placed in the context of functional parameters, only the bicortical positional
screws in an inverted-L pattern met the requirements for both molar loading and incisal edge loading.
© 2005 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 63:1317-1324, 2005

The bilateral sagittal ramus osteotomy (BSRO) has

Received from the University of Kentucky College of Dentistry,
Lexington, KY.
*Resident in Oral and Maxillofacial Surgery.
†Professor of Oral and Maxillofacial Surgery, Executive Associate
Dean.
‡Division and Program Director.
Address correspondence and reprint requests to Dr Haug: Uni-
versity of Kentucky College of Dentistry, 800 Rose St, Room D508,
Lexington, KY 40536-0297; e-mail: rhhaug2@pop.uky.edu
© 2005 American Association of Oral and Maxillofacial Surgeons
0278-2391/05/6309-0011$30.00/0
doi:10.1016/j.joms.2005.05.301
been used for the correction of mandibular skeletal
deformities since the late 1950s.1,2 Since that time,
numerous modifications have been promoted to
decrease morbidity, improve surgical convenience,
and provide stability.3-9 With the advent of titanium
plates and screws, rigid fixation of the BSRO has
become the standard because it improves stability,
affords a more rapid return to presurgical function,
enhances nutritional support, provides for easier
airway maintenance, and reduces relapse. Histori-
cally, the biomechanical research regarding BSRO
fixation that has been performed over the past few
decades has focused on the stability of osteotomy

1317
1318 EVALUATION OF BSRO FIXATION TECHNIQUES

FIGURE 1. Simulated BSRO, advanced, and fixated with 3 2.0-mm
outer thread diameter, 16.0 mm long, self-tapping bicortical screws
(Synthes Maxillofacial; 401.366) in an inverted-L pattern.
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
Techniques. . J Oral Maxillofac Surg 2005.
FIGURE 2. Simulated BSRO, advanced, and fixated with a 4-hole,
narrow, straight monocortical plate (Synthes Maxillofacial; 401.366),
secured with 4 2.0-mm outer thread diameter, 6.0-mm long monocor-
tical screws (Synthes Maxillofacial; 401.356).
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
Techniques. . J Oral Maxillofac Surg 2005.

fixation. Bilateral positional screws have been the

most critically evaluated of BSRO rigid internal fix- secured to the proximal segment, used as a handle for
ation techniques because they are relatively simple condylar positioning and then temporarily fixated
to place and are quite stable.10-22 While bilateral with a monocortical screw and washer. After release
positional screws in an inverted-L pattern (Fig 1) of maxillomandibular fixation, the occlusion can be
have become the “gold standard” by which other verified. If minor modifications are required, they can
fixation techniques have been compared, other pat- be made by adjusting the slide screw, and then finally
terns of screw placement and varying types of permanent fixation can be accomplished with mono-
plates have been the subject of recent biomechani- cortical screws in the distal segment.
cal investigations.23,24 Yet the focus of these inves- The purpose of this investigation was to evaluate
tigations was related solely to the stability of the and compare the biomechanical behavior of a sam-
fixation, without regard to other surgical consider- pling of plate fixation modalities designed to aid in
ations. One such consideration is the ease and abil- condyle positioning during BSSO, to bicortical invert-
ity to appropriately seat the condyles intraopera-
tively, and then to apply fixation accurately,
precisely, and consistently. It has been the experi-
ence of our group that on more than 1 occasion,
after fixation and subsequent release of maxillo-
mandibular fixation, occlusal discrepancies have
occurred because of inaccurate or imprecise fixa-
tion placement.
Recent developments in plate design have provided
for new techniques that have the potential to conve-
niently aid in condylar seating in a 1-step fashion. One
such technique is the use of a monocortical straight
plate. Once monocortically secured to the proximal
segment, the plate can be used as a handle to position
the condyle and then be secured monocortically to
the distal segment (Fig 2). An improvement over that
design has been a curved shape that permits more FIGURE 3. Simulated BSRO, advanced, and fixated with a 6-hole
anatomic adaptation, additional screw holes for stabil- curved, low profile sagittal split plate, with an 8.0-mm bar (Synthes
Maxillofacial; 447.034), secured with 6 2.0-mm outer thread diam-
ity, and graduated marking on the shaft in millimeter eter, 6.0-mm long monocortical screws (Synthes Maxillofacial;
increments to assist in accurate positioning (Fig 3). 401.356).
One last modification is the sagittal split plate with Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
adjustable slider (Fig 4). This particular plate can be Techniques. . J Oral Maxillofac Surg 2005.
PETERSON, HAUG, AND VAN SICKELS 1319

FIGURE 4. Simulated BSRO, advanced, and fixated with a 33.0-mm

long sagittal split plate with adjustable slider (Synthes Maxillofacial;
447.114) secured with 4 2.0-mm outer thread diameter, 6.0-mm long
monocortical screws (Synthes Maxillofacial; 401.356).
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
Techniques. . J Oral Maxillofac Surg 2005.
FIGURE 5. Second order polynomial best-fit curves of load/displace-
ment data for incisal edge loading.
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
Techniques. . J Oral Maxillofac Surg 2005.

ed-L positional screw fixation, and a control, using the systems tested to further evaluate and compare
polyurethane synthetic mandible replicas under the differences in mechanical behavior.
benchtop conditions that resembled clinical function.
These synthetic replicas (Synbone, Laudquart, Swit-
zerland) were chosen to eliminate many of the vari- Materials and Methods
ables associated with human cadaveric and animal A total of 50 synthetic polyurethane mandibles
mandibles and have previously been used for biome- (Synbone) were used in this study. To minimize vari-
chanical research.25-30 The polyurethane replicas ables in this investigation, all monocortical screws
have been created from exactly matched human anat- used (Synthes Maxillofacial, West Chester, PA,
omy in all dimensions and proportions.25,26 The mod- 401.356) were 2.0 mm in outer thread diameter, 6.0
els are constructed with a dense outer layer resem- mm in length, fabricated of titanium, and were self-
bling cortical bone, and a porous inner core that tapping. All bicortical screws (Synthes Maxillofacial;
mimics cancellous bone.25,26 The uniformity of these 401.366) were 2.0 mm in outer thread diameter, 16.0
synthetic replicas provides more consistent sampling mm in length, fabricated of titanium, and self-tapping.
than cadaver bone, with a similar modulus of elastic-
ity.31-34 Their use as human bone substitutes has been
evaluated for these types of biomechanical investiga-
tions and has been verified as being acceptable alter-
natives.34 While direct inference to the clinical situa-
tion cannot be made when using human bone
substitutes, experimental trends can be identified.
The parameters evaluated in this investigation were
yield load, yield displacement, and stiffness. Yield
load is that stress at which permanent deformation of
the system begins. Yield displacement is that strain at
which permanent deformation begins. Stiffness is de-
fined as the rate of change of stress as a function of
strain (slope of the load/displacement curve). Each of
these parameters was evaluated under conditions that
simulated function—incisal edge loading (vertical
loads) and molar loading (torsional loads). Data were
gathered, means and standard deviations derived and FIGURE 6. Second order polynomial best-fit curves of load/displace-
then compared for statistical significance. Finally, sec- ment data for molar loading.
ond order polynomial best-fit curves of the load/dis- Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
placement data (Figs 5 and 6) were created for each of Techniques. . J Oral Maxillofac Surg 2005.
1320
Table 1. A DESCRIPTION OF FIXATION TECHNIQUES
FOR CATEGORIES AND GROUPS
Group Fixation Technique
Control No osteotomy or fixation
Inverted-L Three, 2.0 mm outer thread diameter, 16.0
mm long, self-tapping bicortical screws
(Synthes Maxillofacial, West Chester, PA;
401.366) in an inverted-L pattern
Straight Four-hole, narrow, straight monocortical
plate (Synthes Maxillofacial; 401.366),
secured with four, 2.0 mm outer thread
diameter, 6.0 mm long monocortical
screws (Synthes Maxillofacial; 401.356)
Curved Six-hole curved, low profile sagittal split
plate, with an 8.0 mm bar (Synthes
Maxillofacial; 447.034), secured with six,
2.0 mm outer thread diameter, 6.0 mm
long monocortical screws (Synthes
Maxillofacial; 401.356)
Slide 33.0 mm long sagittal split plate with
adjustable slider (Synthes Maxillofacial;
447.114) secured with four 2.0 mm
outer thread diameter, 6.0 mm long
monocortical screws (Synthes
Maxillofacial; 401.356)
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation
Techniques. J Oral Maxillofac Surg 2005.
SAMPLE PREPARATION
Ten uncut mandible replicas were reserved as con-
trol models; 5 for incisal edge (vertical) loading and 5
for molar (torsional) loading. Forty synthetic mandi-
bles were selected for the experimental groups. Each
experimental mandible had bilateral sagittal split os-
teotomies created by a single investigator. Sagittal
cuts were made using a Stryker TPS reciprocation saw
(Stryker Instruments, Kalamazoo, MI) extending from
superior to the lingual into the first molar region. All
transverse osteotomies were made using a single right
or left stone jig. Following the osteotomies the distal
segments were advanced 7 mm. A stone jig was used
to ensure consistent positioning of proximal and dis-
tal segments. The experimental groups were recon-
structed as follows (Table 1): fixation by 3 2.0-mm
outer thread diameter, 16.0-mm long, self-tapping bi-
cortical screws (Synthes Maxillofacial; 401.356) in an
inverted-L pattern (inverted-L group) (Fig 1); a 2.0-
mm, 4-hole, narrow, straight monocortical plate (Syn-
thes Maxillofacial; 401.366), secured with 4 2.0-mm
outer thread diameter, 6.0-mm long monocortical
screws (Synthes Maxillofacial; 401.356) (straight
group) (Fig 2); a curved, low profile sagittal split
plate, with an 8.0-mm bar (Synthes Maxillofacial;
447.034) (curved group) (Fig 3), secured with 6
2.0-mm outer thread diameter, 6.0-mm long monocor-
tical screws (Synthes Maxillofacial; 401.356); and a
33.0-mm long sagittal split plate with adjustable slider
EVALUATION OF BSRO FIXATION TECHNIQUES
(Synthes Maxillofacial; 447.114) (slide group) (Fig 4)
secured with 4 2.0-mm outer thread diameter, 6.0-mm
long monocortical screws (Synthes Maxillofacial;
401.356). The 30 plates and 340 screws were placed
by a single investigator.
INCISAL EDGE LOADING
The first portion of this investigation consisted of
anterior loading at the mandibular incisal edges.
Synthetic mandibles (N ⫽ 25) were prepared by
placing jig receiver holes into the coronoid/ramus
region in a uniform manner using a standardized jig
created from dental stone. Each mandibular replica
was tested only once. Five uncut mandibles served
as controls to define limitations of the substrate
(synthetic mandible replica). Five advanced and
fixated mandibles were used from each of the ex-
perimental groups. All samples were placed in a
custom-fabricated jig similar to that described by
Dichard and Klotch28 permitting incisal edge load-
ing. Resistance to proximal segment rotation was
provided by a stainless steel rod, 5.0 mm in diam-
eter, placed through 3 eyelets in the jig and the
coronoid/ramus regions of each mandible. Vertical
loads were created and measured with an Instron
1331 (Instron Corp, Canton, MA) mechanical test-
ing unit. This servohydraulic materials testing unit
developed a liner displacement at a rate of 5.0 mm
per minute, and a 13.34 kN load cell measured the
resultant force. Data were acquired at a rate of 10
Hz and were stored through the use of Instron
software. Loading was continued up to mechanical
failure or the displacement limits of the servohy-
draulic testing unit (50.0 mm). The behavior of the
constructs was evaluated within a 0 to 900 N range.
Means and standard deviations were derived and
compared for statistical significance within the fix-
ation categories shown in Table 1 using a Fisher’s
Protected Least Significant Differences Test. A P ⬍
.05 was considered significant. Second order poly-
nomial best-fit curves were then created for each
group to further evaluate and compare the mechan-
ical behavior within and among fixation categories.
MOLAR LOADING
The second portion of this investigation consisted
of posterior loading at the left mandibular molars. All
mandibles (N ⫽ 25) were prepared by creating a 1.0
cm activating arm receptacle fossa between the left
first and second molars. Coronoid/ramus receiver
holes were created as previously described. Each
model was tested only once. Five uncut mandibles
were used as controls. The remaining 5 mandibles
from each of the experimental groups were then used
in this experimental section. The same testing jig
described for incisal edge loading was used to secure
PETERSON, HAUG, AND VAN SICKELS 1321

Table 2. SUMMARY OF RESULTS (MEAN ⴞ STANDARD DEVIATION)

Incisal Edge Loading Contralateral Molar Loading

Yield Displacement Yield Displacement
Group Yield Load (N) (mm) Stiffness (N/mm) Yield Load (N) (mm) Stiffness (N/mm)

Control 517.9 ⫾ 162.19 8.2 ⫾ 2.6 65.7 ⫾ 8.3 890.8 ⫾ 310.4 6.6 ⫾ 1.7 164.4 ⫾ 9.9
Inverted-L 143.3 ⫾ 19.93 5.2 ⫾ 2.1 15.4 ⫾ 2.8 352.4 ⫾ 81.5 9.3 ⫾ 3.9 47.2 ⫾ 11.6
Straight 43.93 ⫾ 9.3 5.2 ⫾ 2.1 10.1 ⫾ 3.7 220.8 ⫾ 46.8 6.2 ⫾ 1.5 44.9 ⫾ 7.6
Curved 48.0 ⫾ 10.7 3.9 ⫾ 2.2 16.1 ⫾ 11.6 210.0 ⫾ 69.1 4.7 ⫾ 1.7 57.7 ⫾ 6.9
Slide 27.7 ⫾ 10.3 1.9 ⫾ 1.2 17.4 ⫾ 10.1 345.2 ⫾ 122.6 11.3 ⫾ 1.4 28.5 ⫾ 4.5
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation Techniques. J Oral Maxillofac Surg 2005.

the condyle/coronoid regions of the mandible repli-
cas. A curved stainless steel rod, 10.0 mm in diameter,
was secured to the Instron activator, engaged in the
right molar region, and used to create loads as in the
first portion of the investigation. The Instron unit
developed a liner displacement at a rate of 1 mm per
minute, and measured the resultant force. Data were
acquired at a rate of 10 Hz and were stored through
the use of Instron software. Loading was continued
up to mechanical failure or the displacement limits of
the servohydraulic testing unit (50.0 mm). The me-
chanics of the constructs for molar loading were eval-
uated within a 0 to 900 N range. The same mechanical
evaluation parameters and statistical analysis were
performed as described in the incisal loading section.
Second order polynomial best fit curves were created
to evaluate biomechanical failure.
Results
From among the 50 synthetic mandibles, 30
plates, and 340 screws used in this investigation,
some very exciting information was obtained and
observations made. For incisal edge loading, statis-
tically significant differences were noted between
the control group and all other groups for yield load
and stiffness, and between the control group and
straight, curved, and slide plates for yield displace-
ment (Tables 2 and 3). Differences were also noted
between the inverted-L and straight, curved, and
slide plates for yield load; and inverted-L and
straight, curved, and slide, as well as straight and
slide for yield displacement.
For molar loading, statistically significant differ-
ences were noted between the control group and all
other groups for yield load and stiffness. Differences
were noted between the slide and straight, curved,
and control, as well as between the inverted-L and
straight and curved plates for yield displacement.
Lastly, differences were noted between the straight
and strut plates, and the slide and straight, curved,
and inverted-L for stiffness.
The second order polynomial best fit curves
showed remarkably similar patterns of mechanical
behavior between experimental groups for both in-
cisal edge and molar loading (Figs 5 and 6). For both

Table 3. STATISTICAL ANALYSIS SUMMARY USING FISHER’S PROTECTED LEAST SIGNIFICANT DIFFERENCES

Statistical
Categories Test Significance Between Groups P Value

Incisal edge loading Yield load Yes Control and all fixation techniques P ⬍ .0001
Inverted-L and Straight, Slide P ⫽ .0219, .045
Yield displacement Yes Control and Straight, Curved, Slide P ⫽ .0359, .038, .0001
Inverted-L and Straight, Curved,
Slide P ⫽ .0032, .003, .001
Straight and Slide P ⫽ .0205
Stiffness Yes Control and all fixation techniques P ⬍ .0001
Molar loading Yield load Yes Control and all fixation techniques P ⬍ .0001
Yield displacement Yes Slide and Control, Straight, Curved P ⫽ .0036, .0018,
.0001
Inverted-L and Straight, Curved P ⫽ .0394, .0036
Stiffness Yes Control and all fixation techniques P ⬍ .0001
Slide and Inverted-L, Straight, and P ⫽ .0022, .0061,
Curved ⬍ .0001
Straight and Curved P ⫽ .0262
Peterson, Haug, and Van Sickels. Evaluation of BSRO Fixation Techniques. J Oral Maxillofac Surg 2005.
1322
forms of loading, the control behaved in a dissimilar
fashion. For each experimental group, load was re-
sisted logarithmically along a straight slope until the
yield point was reached after which data recorded on
the graph were discontinued.
Lastly, some interesting observations were made
regarding the fixation systems when failure was
reached. For the inverted-L positional screws, at fail-
ure, the fixation/substrate (polyurethane mandible)
interface shattered. Screws did not bend. For each of
the plate fixation systems, the plates bent and de-
formed at their respective shafts. The slide plate re-
sisted more torsion before failure than the straight or
curved plates.
Discussion
From among the 50 synthetic mandibles, 30 plates,
and 340 screws used in this investigation, some very
exciting information was obtained, observations
made, and conclusions drawn. First, a comparison of
the second order polynomial best fit curves (Figs 5
and 6) showed some very similar mechanical behavior
among the experimental groups. A first order polyno-
mial would take the form: x ⫽ y ⫹ z, a second order
would take the form x2 ⫽ y ⫹ z, a third order would
take the form x3 ⫽ y ⫹ z, and so on. Thus, for a
straight line second order polynomial best fit curve,
the experimental groups resisted load logarithmically
in relation to the distances displaced. It was interest-
ing that this trend was true for both the bicortical
positional screw system and all of the monocortical
plate and screw systems, for both vertical and tor-
sional loading. Yield points (discontinuance of the
line on the graph) did differ among the groups tested.
A review of the statistical comparisons (Table 3)
showed differences among the experimental groups
in their abilities to resist loads. Yet, a review of the
loads resisted (Table 2), coupled with the patterns of
behavior showed some interesting but understand-
able findings. The loads resisted by the positional
screws in an L-pattern were the greatest for both
molar and incisal edge loading. They resisted both
vertical and torsional forces consistently. The plate
fixation groups resisted vertical loads (incisal edge
loading) in a consistently poor fashion (Table 3). The
straight and curved systems were virtually equal with
the slide plate performing the worst. This could be
explained by the similarities in the lengths of the
shafts of the straight and curved plates, and more than
twice the length of the shaft for the slide plate. The
lever arm that was created resulted in instability. The
longer the lever arm, the less stable. Molar loading
(torsion), however, resulted in a different trend. This
time, the positional screws in an inverted-L pattern
and the slide plate system resisted the most torque,
EVALUATION OF BSRO FIXATION TECHNIQUES
while the straight and curved plate systems resisted
the least. This could be explained by the 2 shafts of
the slide plate providing more resistance to torsion
than the single shaft systems. As has been reported in
prior investigations, the positional screws in an L-
pattern performed the best of all of the groups
tested.11-14,22,24,26
Our investigation evaluated the biomechanical be-
havior of several rigid internal fixation techniques
used in reconstructing BSROs. We used both a sub-
strate that resembled natural tissue in shape, geome-
try, and anatomic dimension, yet was synthetic. While
loading at the incisal edge mimicked vertically de-
forming forces and molar loading mimicked torsion-
ally deforming forces that are encountered under clin-
ical circumstances, they cannot completely represent
the complex interaction between the mandible and
musculature in function. Thus, we can only expect to
identify trends in behavior that would be helpful in
making decisions clinically.
When considering function, a review of the bite
force literature shows some very surprising informa-
tion. While this type of information has existed since
1895,35 its communication in the scientific literature
is not uniform, and for the most part relates only
information regarding healthy patients. Occlusal
forces have been classified as swallowing, chewing,
or maximum bite forces. Maximum molar bite forces
have been identified from a low of 1.6 kg to a high of
443 kg (15.7 to 4,341.4 N).36-42 Yet, this magnitude of
force would not be encouraged in the postoperative
setting. Mean molar swallowing forces have ranged
from 1.7 to 30.2 kg (16.7 to 296.0 N).36-38 Mean molar
chewing forces have ranges from 1.6 to 26.7 kg (15.7
to 261.7 N)36-40and are dependent upon the food
source being chewed. Yet each of these recorded
forces involved healthy individuals who have not
been subjected to any surgical intervention.
Ellis et al have indicated that bite forces in the acute
postoperative period are much less than we have
previously recognized both long term postoperative
and also for the non-operated population.43-45 During
an investigation assessing estimated occlusal forces
subsequent to orthognathic surgery, their group sug-
gested that the molar bite force for the non-operated
male was 52.3 kg (512.5 N) and non-operated female
39.0 kg (382.2 N) and of the incisal region 10.6 kg
(103.9 N) and 14.2 kg (139.2 N), respectively.43 Their
estimate immediately postoperatively for molar bite
forces was 13.3 to 19.2 kg (130.3 to 188.2 N) for
females and 21.5 to 48.1 (210.7 to 471.38 N) for
males. Incisal forces were estimated to be about one
quarter of that for molar loads, being 3.1 to 5.3 kg
(30.4 to 51.9 n) for females and 4.4 to 10.0 kg (43.1 to
98.0 N) for males.43 In another investigation by their
group examining the postoperative bite force for
PETERSON, HAUG, AND VAN SICKELS
males who sustained mandibular angle fractures and
who were reconstructed with some form of rigid
internal fixation similar patterns were identified.44
Average incisal bite force during weeks 1 through 6
was 6.4 kg (62.7 N) compared with 12.3 kg (120.5)
after 6 weeks and 15.4 kg (150.9 N) in the control
group.44 Similarly, right and left molar bite forces
were 13.8 and 12.8 kg (135.2 and 125.4 N) respec-
tively (almost twice incisal edge forces), between 1
and 6 weeks, 25.3 and 26.0 kg (247.9 and 254.8 N)
after the sixth postoperative week, and 48.2 and 49.3
(472.36 and 483.1 N) for controls.44A similar bite
force investigation performed by Harada et al investi-
gated orthognathic surgery candidates preoperatively
and postoperatively.46 They noted that preoperative
occlusal forces for males were 293.2 to 162.0 N and
for females 208.5 to 98.8 N. At 2 weeks postoperative,
the occlusal forces were 60.8 to 41.5 N for males and
69.6 to 29.4 N for females, and at 8 weeks 184.7 to
89.0 and 199.1 to 88.5 N, respectively.46 We can
therefore make the assumption that the resistance to
loads in the perioperative period should fall within
the 250 N range for molar loading and within the 125
N range for incisal loading.
Yield load is the most important measure when
considering biomechanical investigations. It is that
load at which permanent deformation begins. Simply
stated, it is the load under which failure of the system
occurs. Although statistically significant differences
were noted among the experimental groups for molar
loading, under the parameters for function just out-
lined, only the inverted-L and slide groups performed
acceptably. For incisal edge loading, only the posi-
tional screws in an inverted-L pattern performed ac-
ceptably. Thus, with the current plate designs and
under the simulated conditions tested none of the
plating systems that were developed to aid in condy-
lar positioning could be considered acceptable for
clinical use. Positional screws in an L-pattern could be
considered.
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