Skeletal class III malocclusion and bilateral sagittal osteotomy: a concise systematic review

Introduction: In the context of skeletal class III malocclusion, orthognathic surgery is a standardized procedure used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusions, disease, or trauma. Thus, bilateral sagittal osteotomy of the mandibular ramus is a technique widely used in OS for the correction of mandibular deformities. Objective: the present study evaluated, through a concise systematic review, the main considerations of mandibular advancements through mandibular bilateral sagittal osteotomies in patients with skeletal class III malocclusion. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: A total of 115 articles were found involving “skeletal class III malocclusion". A total of 45 articles were evaluated in full, and 22 were included and discussed in this study. Bilateral sagittal osteotomy (BSO) is the most used technique in mandibular OS, allowing mandibular movements in the sagittal, vertical, and transverse directions. Several studies show good results and few complications. The size of this space is proportional to the mandibular advancement and/or rotation movements required by the patient's maxillomandibular discrepancy. The prevention of inferior mandibular edge defects is an important issue when planning an BSO traditional non-grafted BSO technique produces a large proportion of defects in the lower edge of the mandible. In cases where the advancement is greater than 10 mm and/or the patient is over 30 years old, the risk of the mandibular defect increases significantly. Also, using a bone graft in the intersegmental gap of a sagittal branch osteotomy is considered an effective clinical method to ensure the desirable intersegmental position as it helps to easily maintain the space. Conclusion: The results showed that bilateral sagittal osteotomy is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical, and transverse directions, with good results and few complications. Furthermore, a bone graft can accelerate bone formation in orthognathic surgery.