{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:40:21Z","timestamp":1785404421106,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico (CNPq)\u2014Brazil, PIBIC program","doi-asserted-by":"publisher","award":["518"],"award-info":[{"award-number":["518"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"award":["518"],"award-info":[{"award-number":["518"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The selection of an appropriate fixation system is critical for maintaining postoperative stability after sagittal split ramus osteotomy (SSRO), especially in cases involving large mandibular advancements and counterclockwise rotation, where mechanical stresses may compromise treatment outcomes. This in vitro study evaluated the biomechanical stability of five fixation systems following sagittal split ramus osteotomy (SSRO) under two mandibular advancement conditions. Fifty polyurethane hemimandibles were allocated into two experimental groups: Group 1, submitted to 10-mm linear advancement, and Group 2, submitted to 10-mm advancement associated with 20\u00b0 counterclockwise rotation. Each group was further divided into five subgroups according to the fixation design employed: (A) conventional straight plate, (B) angled plate, (C) sagittal plate, (D) 10-hole miniplate, and (E) two 4-hole miniplates. Biomechanical performance was assessed by compression testing using a universal testing machine. Complementary analyses were performed using strain gauges and digital image correlation. Group 1 in fixation B, C and D demonstrated higher biomechanical resistance than Group 2, however without significance difference. Among the evaluated configurations, subgroup E exhibited the highest resistance values in both experimental conditions. Statistically significant differences were observed among fixation systems within each group (p &lt; 0.05). The fixation systems using two miniplates demonstrated superior biomechanical stability, particularly in mandibular advancements associated with counterclockwise rotational movements. These findings suggest that this fixation strategy may contribute to enhanced postoperative stability in orthognathic surgery involving large mandibular advancements and complex rotational movements.<\/jats:p>","DOI":"10.3390\/bioengineering13070745","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:57Z","timestamp":1782463437000},"page":"745","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Counterclockwise Rotation Affect Fixation Stability? An In Vitro Biomechanical Study of Large Mandibular Advancements"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4274-2833","authenticated-orcid":false,"given":"Beethoven Estev\u00e3o","family":"Costa","sequence":"first","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2483-8695","authenticated-orcid":false,"given":"Ma\u00edsa","family":"Pereira-Silva","sequence":"additional","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Tiemi Uehara","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5275-9241","authenticated-orcid":false,"given":"Gustavo Batista Grolli","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, S\u00e3o Leopoldo Mandic, Campinas 13045-755, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celso Fernando","family":"Palmieri Junior","sequence":"additional","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"},{"name":"Department of Oral and Maxillofacial Surgery, Louisiana State University Health Shreveport (LSUHS), Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Oreadi","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana Ferreira","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Matheus Honda","family":"Tavares","sequence":"additional","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Domingos","family":"Ribeiro Junior","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Santa Casa de Jahu, Ja\u00fa 17201-340, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvaldo","family":"Magro Filho","sequence":"additional","affiliation":[{"name":"Department of Diagnosis and Surgery, School of Dentistry, S\u00e3o Paulo State University (UNESP), Ara\u00e7atuba 16010-380, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","unstructured":"Proffit, W.R., White, R.P., and Sarver, D.M. (2003). Contemporary Treatment of Dentofacial Deformity, Mosby."},{"key":"ref_2","unstructured":"Reyneke, J.P. (2010). Essentials of Orthognathic Surgery, Quintessence Publishing. [2nd ed.]."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/0889-5406(93)70076-Z","article-title":"A redefinition of bilateral sagittal osteotomy (BSO) advancement relapse","volume":"104","author":"Arnett","year":"1993","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2528","DOI":"10.1016\/j.joms.2009.06.022","article-title":"Malocclusions resulting from loss of fixation after sagittal split ramus osteotomies","volume":"67","author":"Ellis","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ijom.2004.02.003","article-title":"Stabilisation of sagittal split advancement osteotomies with miniplates: A prospective, multicentre study with two-year follow-up. Part I. Clinical parameters","volume":"33","author":"Borstlap","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ijom.2004.01.015","article-title":"Stabilisation of sagittal split advancement osteotomies with miniplates: A prospective, multicentre study with two-year follow-up. Part II. Radiographic parameters","volume":"33","author":"Borstlap","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.joms.2008.11.009","article-title":"An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: Advancement surgery","volume":"67","author":"Brasileiro","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/j.ijom.2014.11.019","article-title":"In vitro biomechanical comparison of six different fixation methods following 5-mm sagittal split advancement osteotomies","volume":"44","author":"Oguz","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.joms.2009.07.018","article-title":"In vitro biomechanical evaluation of the use of conventional and locking miniplate\/screw systems for sagittal split ramus osteotomy","volume":"68","author":"Shastri","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.ijom.2017.05.016","article-title":"Biomechanical evaluation of different osteosynthesis methods after mandibular sagittal split osteotomy in major advancements","volume":"46","author":"Klein","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.ijom.2012.07.008","article-title":"In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate","volume":"42","author":"Iamashita","year":"2013","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ijom.2010.09.026","article-title":"Miniplate osteosynthesis with four different systems in sheep","volume":"40","author":"Gutwald","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.bjoms.2009.11.014","article-title":"Comparison of stability of 2.0mm standard and 2.0mm locking miniplate\/screws for the fixation of sagittal split ramus osteotomy on sheep mandibles","volume":"49","author":"Oguz","year":"2011","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_14","first-page":"280","article-title":"Biomechanical stability of an internal mini-fixation-system in maxillofacial osteosynthesis","volume":"37","author":"Gutwald","year":"1999","journal-title":"Med. Biol. Eng. Comp."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.joms.2006.03.027","article-title":"Failure strength of 2.0 locking versus 2.0 conventional Synthes mandibular plates: A laboratory model","volume":"64","author":"Chiodo","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2302\/kjm.52.21","article-title":"Principle and stability of locking plates","volume":"52","author":"Gutwald","year":"2003","journal-title":"Keio J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.4317\/medoral.27625","article-title":"Biomechanical assessment of ten fixation techniques after sagittal split ramus osteotomy for significant mandibular advancement","volume":"31","author":"Silva","year":"2026","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_18","first-page":"157","article-title":"Modifications in the sagittal osteotomy of the mandible","volume":"35","author":"Epker","year":"1977","journal-title":"J. Oral Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.ijom.2004.01.018","article-title":"Stabilisation of sagittal split advancement osteotomies with miniplates: A prospective, multicenter study with two-year follow-up. Part III\u2014Condylar remodelling and resorption","volume":"33","author":"Borstlap","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.joms.2009.09.004","article-title":"Comparative biomechanical and photoelastic evaluation of different fixation techniques of sagittal split ramus osteotomy in mandibular advancement","volume":"68","author":"Sato","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_21","first-page":"147","article-title":"In vitro comparison of screw versus plate fixation in the sagittal split osteotomy","volume":"7","author":"Foley","year":"1992","journal-title":"Int. J. Adult Orthodon. Orthognath. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1053\/joms.2001.20492","article-title":"Preliminary investigation of the biomechanics of internal fixation of sagittal split osteotomies with miniplates using a newly designed In vitro testing model","volume":"59","author":"Armstrong","year":"2001","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/j.ijom.2016.04.021","article-title":"Are bicortical screw and plate osteosynthesis techniques equal in providing skeletal stability with the bilateral sagittal split osteotomy when used for mandibular advancement surgery? A systematic review and meta-analysis","volume":"45","year":"2016","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.1016\/j.tripleo.2011.08.027","article-title":"A comparative evaluation of the hybrid technique for fixation of the sagittal split ramus osteotomy in mandibular advancement by mechanical, photoelastic, and finite element analysis","volume":"114","author":"Sato","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.joms.2005.05.301","article-title":"A biomechanical evaluation of bilateral sagittal ramus osteotomy fixation techniques","volume":"63","author":"Peterson","year":"2005","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1016\/j.jcms.2013.08.012","article-title":"Comparison of postoperative stability of three rigid internal fixation techniques after sagittal split ramus osteotomy for mandibular advancement","volume":"42","author":"Sato","year":"2014","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_27","first-page":"485","article-title":"Which type of method shows the best mechanical behavior for internal fixation of bilateral sagittal split osteotomy in major advancements with clockwise rotation? Comparison of four methods","volume":"24","author":"Carvalho","year":"2020","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e104","DOI":"10.4317\/medoral.27600","article-title":"Evaluation of five fixation methods for mandibular sagittal split osteotomy in a significant advancement with counterclockwise rotation: A finite element study","volume":"31","author":"Mendes","year":"2026","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105245","DOI":"10.1016\/j.jdent.2024.105245","article-title":"Accuracy of a new photometric jaw tracking system in the frontal plane at different recording distances: An in-vitro study","volume":"148","author":"Valenti","year":"2024","journal-title":"J. Dent."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s00784-024-05772-6","article-title":"Mechanical and biological properties of polymer materials for oral appliances produced with additive 3D printing and subtractive CAD-CAM techniques compared to conventional methods: A systematic review and meta-analysis","volume":"28","author":"Valenti","year":"2024","journal-title":"Clin. Oral Investig."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/7\/745\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:32:53Z","timestamp":1782469973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/7\/745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["bioengineering13070745"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13070745","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}