A novel modification of the Low Z plasty (NM-Low Z) technique for bilateral sagittal split osteotomy was recently proposed. The osteotomy line was modified more inferiorly than in the conventional Hunsuck-Epker (HE) approach. The NM-Low Z technique enhances the mandibular setback distance and degree of rotation in severe skeletal discrepancies. This study aimed to investigate the biomechanical behavior under simulated forces, and to compare the NM-Low Z and HE techniques on the mandible with Class III skeletal deformity at 1 week, 3 weeks, and 6 weeks post-operation. Physiological muscular and occlusal loads were simulated using the finite element (FE) method. Stresses on the miniplate, screws, and bone were observed and compared between the two models. The elastic strain at the fracture site was observed for the optimal bone-healing capacity. The NM-Low Z model exhibited a lower stress than the HE model at every stage post-operation. Both models demonstrated elastic strains within the normal range for bone healing. In summary, the biomechanical behavior of the NM-Low Z technique is comparable to that of the conventional EH technique. NM-Low Z could facilitate post-operation skeletal stability by reducing the stress on fixation materials during bone healing.
Keywords: BSSO; Bilateral sagittal split osteotomy; Hunsuck/Epker; angle class III; finite element analysis; low Z plasty; malocclusion; mandibular osteotomy; modified BSSO; orthognathic surgery; osteotomy; prognathism; sagittal split ramus.