Abstract
The aim of this systematic review and meta-analysis was to assess whether the presence
of inferior third molars during sagittal split mandibular ramus osteotomy increases
the risk of intraoperative and postoperative complications. The PRISMA protocol was
followed in this study, and the review was registered in the PROSPERO database (CRD42020147642).
A search was conducted in the MEDLINE (PubMed), Web of Science, Cochrane Central,
and Scopus databases on November 1, 2021. Nineteen articles were included, and the
variables analysed were unfavourable fractures, infection, neurosensory disturbance,
removal of osteosynthesis material, and duration of surgery. Meta-analyses were performed
for the variables unfavourable fractures (risk ratio (RR) 0.95, 95% confidence interval
(CI) 0.58–1.57, P = 0.84), infection (RR 0.75, 95% CI 0.48–1.18, P = 0.21), and neurosensory disturbance (RR 1.55, 95% CI 0.61–3.91, P = 0.35); no statistically significant difference in the risk of these variables was
found between the groups with and without third molars. The third molars did not increase
the need to remove fixation material, but increased the surgery time. The presence
of the third molar during sagittal split mandibular ramus osteotomy appears not to
increase the risk of intraoperative and postoperative complications. The results presented
here must be interpreted with caution due to the heterogeneity presented by the observational
studies included.
Keywords
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References
- Nasal deformities associated with orthognathic surgery: analysis, prevention, and correction.J Craniofac Surg. 2007; 18: 734-739
- Ein Beitrag zur chirurgischen Kieferorthopädie unter Berücksichtigung ihrer Bedeutung für die Behandlung angeborener under worbener Kieferdeformitaten bie Soldaten.Dtsch Zahn Mund Kieferhk. 1942; 9: 73-89
- The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin.Oral Surg Oral Med Oral Pathol. 1957; 10: 677-689
- Retromolar osteotomy for the correction of prognathism.J Oral Surg Anesth Hosp Dent Serv. 1961; 19: 42-47
- Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars.Int J Adult Orthodon Orthognath Surg. 1998; 13: 183-187
- Biologic basis for maxillary osteotomies.Am J Phys Anthropol. 1973; 38: 279-289
- Posterior maxillary anatomy: implications for Le Fort I osteotomy.Int J Oral Maxillofac Surg. 1998; 27: 346-351
- Influence of third molars in Le Fort 1 osteotomy.Ann Maxillofac Surg. 2011; 1: 136-144
- Complications associated with orthognathic surgery.J Korean Assoc Oral Maxillofac Surg. 2017; 43: 3-15
- Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal-split osteotomies.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 362-365
- Postoperative fractures of the lingual plate after bilateral sagittal split osteotomies.Br J Oral Maxillofac Surg. 2006; 44: 296-300
- Concomitant removal of mandibular third molars during sagittal split osteotomy minimizes neurosensory dysfunction.J Oral Maxillofac Surg. 2012; 70: 2153-2163
- Infections after sagittal split osteotomy: a retrospective analysis of 336 patients.J Oral Maxillofac Surg. 2015; 73: 158-161
- Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars.J Oral Maxillofac Surg. 2001; 59: 854-858
- Age as a factor in the complication rate after removal of unerupted/impacted third molars at the time of mandibular sagittal split osteotomy.J Oral Maxillofac Surg. 2002; 60: 654-659
- Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up Part I. Clinical parameters.Int J Oral Maxillofac Surg. 2004; 33: 433-441
- Risk factors for a bad split during sagittal split osteotomy.Br J Oral Maxillofac Surg. 2008; 46: 177-179
- Presence of mandibular third molars during bilateral sagittal split osteotomy increases the possibility of bad split but not the risk of other post-operative complications.J Craniomaxillofac Surg. 2014; 42: 359-363
- Comparison of skeletal stability after sagittal split ramus osteotomy with and without extraction of the third molar in patients with mandibular prognathism.J Craniomaxillofac Surg. 2015; 43: 1104-1108
- Simultaneous removal of third molars and completion of a sagittal split osteotomy: effects of age and presence of third molars.Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 121: 468-473
- Occurrence of a ‘bad’ split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients.Int J Oral Maxillofac Surg. 2016; 45: 1187-1194
- Does simultaneous third molar extraction increase intraoperative and perioperative complications in orthognathic surgery?.J Craniofac Surg. 2016; 27: 923-926
- Surgical and social implications of extraction of mandibular third molars as a separate procedure before bilateral sagittal split osteotomy.Br J Oral Maxillofac Surg. 2017; 55: 937-939
- The presence of mandibular third molars during sagittal split osteotomies does not increase the risk of complications.J Oral Maxillofac Surg. 2012; 70: 1935-1943
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.J Clin Epidemiol. 2009; 62: 1-34
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Benzodiazepine use and risk of dementia in the elderly population: a systematic review and meta-analysis.Neuroepidemiology. 2016; 47: 181-191
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Principles of and procedures for systematic reviews.in: Egger M. Smith G.D. Altman A.G. Systematic Reviews in Health Care: Meta-Analysis in Context. BMJ Books, 2003: 23-42
- What are the effects of age and presence of third molars on the occurrence of unfavorable splits during sagittal split osteotomy?.J Oral Maxillofac Surg. 2021; 79: 226.e1-226.e8
- Risk factors for bad splits during sagittal split ramus osteotomy: a retrospective study of 964 cases.Br J Oral Maxillofac Surg. 2021; 59: 678-682
- Surgical site infections following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study.J Oral Maxillofac Surg. 2017; 75: 584-595
- Antibiotics in orthognathic surgery: a retrospective analysis and identification of risk factors for postoperative infection.Int J Oral Maxillofac. Surg. 2021; 50: 643-648
- Terceiros molares impactados em osteotomias sagitais divididas em prognatismo mandibular e micrognatia.Ann Maxillofac Surg. 2014; 4: 39-44
- Nerve manipulation during bilateral sagittal split osteotomy increases neurosensory disturbance and decreases patient satisfaction.J Oral Maxillofac Surg. 2014; 72: 2052e1-2052e5
- Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93: 736-742
- Risk factors of nerve injury during mandibular sagittal split osteotomy.Int J Oral Maxillofac Surg. 2002; 31: 33-39
- Evaluation of factors affecting recovery period in lower lip hypoesthesia after sagittal split ramus osteotomy in mandibular prognathism patients.J Craniomaxillofac Surg. 2014; 42: 1748-1752
- Risk factors for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis.J Craniomaxillofac Surg. 2016; 44: 1170-1180
Article info
Publication history
Published online: August 04, 2022
Accepted:
July 6,
2022
Identification
Copyright
© 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
