A comparative study of bicortical screws and suspension wires versus bicortical screws in large mandibular advancements

Relapse with large mandibular advancements treated by bicortical position screws has been documented in the literature. This study compares stability seen with two groups of patients; one treated with bicortical position screws and allowed to function, the second treated with bicortical position screws, skeletal wires, and 1 week of maxillomandibular fixation. Both groups had large advancements. The screw group was advanced an average of 10.9 mm, whereas the screw and wire group was advanced 12.2 mm. The screw group relapsed an average of 2 mm in the first 6 weeks, with further relapse occurring after that point. In contrast, the screw and wire group relapsed an average of 0.6 mm in the first 6 weeks, followed by a small advancement in the long term. Differences between the two groups were significant in the first 6 weeks and from the initial postoperative period to the long-term examination point. While stability was markedly improved with up to 13 mm of advancement in the group with screws and wires, relapse was noted after that amount of advancement. Methods to keep larger advancements stable are reviewed.