Does Angular Sagittal Split Osteotomy of the Mandibular Ramus Alter Fracture Patterns Compared With the Modifications of Posnick, Wolford, and Hunsuck/Epker?

OBJECTIVES: To evaluate the torque required to perform sagittal split osteotomy using the angular osteotomy technique compared with the Posnick, Wolford, and Hunsuck/Epker techniques, and to assess associated fracture patterns and inferior alveolar nerve (IAN) visibility. MATERIALS AND METHODS: A laboratory-based experimental study was conducted using 52 porcine mandibles. After dissection, sagittal osteotomies were performed in a blinded and randomized manner according to the assigned technique. The primary outcomes were the torque required to complete the osteotomy and the resulting fracture pattern. Secondary analysis included IAN visibility following osteotomy. Statistical analysis was performed using analysis of variance with Tukey post hoc testing for torque comparisons and Pearson χ2 or Fisher exact tests for categorical variables. Statistical significance was set at P<0.05. RESULTS: The angular osteotomy technique required significantly less torque (110±0.07N) compared with the Posnick, Wolford, and Hunsuck/Epker techniques (P<0.001). In addition, the angular technique demonstrated a higher frequency of favorable fracture patterns and reduced IAN visibility, suggesting a lower potential risk of nerve injury. The Hunsuck/Epker technique required the highest torque and was associated with less favorable fracture outcomes. CONCLUSIONS: Within the limitations of this ex vivo porcine model, the angular sagittal split osteotomy technique demonstrated greater mechanical efficiency, requiring lower torque and producing more homogeneous fracture patterns with reduced IAN exposure. These findings provide a comparative biomechanical assessment of different osteotomy designs and may contribute to understanding force distribution during sagittal splitting. However, direct clinical extrapolation should be made with caution, and further studies in human models are necessary to determine the implications for surgical outcomes and neurosensory recovery.