Evaluation of inter-maxillary fixation techniques for multi-piece Le Fort I osteotomies using finite element analysis

Evaluation of inter-maxillary fixation techniques
for multi-piece Le Fort I osteotomies using finite
element analysis

European Review for Medical and Pharmacological Sciences

T. UZEL, Z. CUKUROVA YILMAZ, A. OZE

Institution: Department of Oral and Maxillofacial Surgery, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey

Published: 2023, Volume 27, Issue 4 Suppl, Pages 41-57

Orthognathic surgery, specifically multi-piece Le Fort I osteotomies, presents challenges in achieving a satisfactory postoperative occlusal relationship. This study by T. Uzel, Z. Cukurova Yilmaz, and A. Ozel from Istanbul Medipol University’s Department of Oral and Maxillofacial Surgery, investigates the effectiveness of different inter-maxillary fixation (IMF) techniques in ensuring long-term stability of the jaw relation post-surgery. Utilizing finite element analysis (FEA), the research evaluates tooth-supported, bone-supported, and hybrid IMF techniques across various osteotomy models.

Methodology
The study meticulously designed four distinct models for FEA: three multi-piece Le Fort I scenarios (lateral incisor-canine, central incisor-central incisor, and canine-first premolar) and a single-piece scenario. These models were subjected to simulations that replicated the planned occlusion and applied occlusal forces of 100 N, 300 N, and 800 N to assess force distribution, stress accumulation, and the overall effectiveness of each IMF technique.

Key Findings
Hybrid IMF Technique Superiority: Across all models, the hybrid technique, which combines tooth and bone support, was found to be the most effective in achieving ideal occlusal contact and stability. This suggests a significant advantage in using a mixed approach for postoperative stability.
Performance of Other Techniques: While the hybrid method stood out, tooth-supported and bone-supported techniques also showed varying degrees of effectiveness, depending on the specific osteotomy scenario. The nuanced performance of these methods highlights the complexity of achieving optimal outcomes in orthognathic surgery.
Finite Element Analysis as a Tool: The study underscores the utility of FEA in orthognathic surgery planning, allowing for detailed examination of occlusal forces and stress distributions that are not easily achievable in clinical settings.
Implications and Conclusion
This research brings valuable insights into the planning of orthognathic surgery, particularly in selecting the most suitable IMF technique for multi-piece Le Fort I osteotomies. By demonstrating the superior performance of the hybrid IMF technique, the study paves the way for further clinical trials to explore its benefits and practical applications. The findings advocate for a more nuanced approach to IMF, tailored to the specific needs of the surgery scenario, to ensure the best possible postoperative outcomes.

Future Directions
While the study establishes a strong case for the hybrid IMF method, it also calls for further clinical validation. Real-world applications and longitudinal studies are necessary to fully understand the benefits and potential limitations of each technique in diverse clinical scenarios.

This comprehensive analysis serves as a critical reference for oral and maxillofacial surgeons in optimizing surgical outcomes for patients undergoing complex orthognathic procedures.