Effect of Inferior Border and Lingual Vertical Osteotomy Line Length on Splitting Mechanics in Bilateral Sagittal Split Ramus Osteotomy: A Biomechanical Study

Effect of Inferior Border and Lingual Vertical Osteotomy Line Length on Splitting Mechanics in Bilateral Sagittal Split Ramus Osteotomy: A Biomechanical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Inferior Border and Lingual Vertical Osteotomy Line Length on Splitting Mechanics in Bilateral Sagittal Split Ramus Osteotomy: A Biomechanical Study Wen Ma, Zixian Xu, Yong Wu, Almira Ada Diken Turksayar, Jiang Fu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9236308/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Bilateral sagittal split ramus osteotomy (BSSRO) is a widely used technique for mandibular correction; however, controlling fracture propagation and preventing unfavorable splits remain major challenges. Adjunctive osteotomy lines, including inferior border cuts and lingual vertical cuts, have been proposed to improve predictability, yet their optimal design and dimensions remain controversial. This study aimed to evaluate how variations in the length of the inferior border cut (fourth osteotomy line) and lingual vertical osteotomy line (fifth osteotomy line) influence splitting mechanics and fracture outcomes during BSSRO. Methods Cone beam computed tomography (CBCT) data from patients with three mandibular angle types (ectropion, upright, and involution) were imported into a 3D segmentation software. Virtual mandibular models were reconstructed and fabricated via additive manufacturing, yielding 33 models (11 per type). 15 freshly isolated porcine mandibles were used for validation. A custom stainless steel test rig with fixed and movable fixtures was designed to standardize the splitting process. A digital torque gauge attached to a chisel continuously recorded real-time torque during osteotomy. Additional osteotomy lines were created: inferior border cuts (fourth line, 5–20 mm) and lingual vertical cuts (fifth line, 5–10 mm). Both sides of each mandible served as self-controls. Torque values, fracture patterns, and “bad split” incidence were analyzed using two-way analysis of variance, t-tests, and Cochran–Mantel–Haenszel tests, with significance set at p < 0.05. Results Application and incremental lengthening of the additional osteotomy lines significantly reduced the torque required for mandibular splitting (from 1.608 to 0.461 Nm, p < 0.01) and decreased the incidence of “bad splits.” No significant association was observed between mandibular angle type and torque requirements. Conclusions Extending the inferior border cut up to 20 mm improves the predictability and safety of BSSRO by reducing torque demands and minimizing unfavorable fractures. Trial registration: not applicable. Bilateral sagittal split ramus osteotomy (BSSRO) Split patterns Hunsuck Bad split Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Bilateral sagittal split ramus osteotomy (BSSRO) remains one of the most frequently used surgical techniques for correcting mandibular deformities and achieving stable occlusal relationships [ 1 ]. Despite its long history of refinement, controlling lingual fracture lines and avoiding unfavorable splits continue to pose challenges [ 2 ]. Traditional BSSRO relies on the classic Obwegeser–Dal Pont or Hunsuck modifications, which involve horizontal, vertical, and sagittal osteotomies to separate the mandibular segments [ 3 – 5 ]. However, intraoperative variations in bone morphology and density often lead to unpredictable fracture propagation, excessive torque, and complications such as nerve injury or segmental instability [ 6 ]. To address these limitations, additional osteotomy lines—most notably the inferior border cut have been proposed [ 7 ]. These modifications aim to facilitate controlled splitting of the mandible, enlarge the bony contact area between segments, and reduce the mechanical force required for separation [ 8 ]. Clinically, such improvements may decrease the incidence of “bad splits,” minimize nerve involvement, and enhance postoperative stability. Nevertheless, the optimal configuration (the lingual vertical cut) — and length of these additional osteotomy lines remain controversial [ 9 – 11 ]. Differences in mandibular anatomy among patients make it difficult to standardize the surgical approach or predict mechanical outcomes using in-vivo data alone. With the rapid development of digital technology in oral and maxillofacial surgery, computer-assisted design and additive manufacturing now enable the creation of high-fidelity, patient-specific 3D mandibular models [ 12 ]. Through CBCT-based three-dimensional reconstruction and stereolithographic (SLA) printing, surgeons can reproduce diverse mandibular morphologies and simulate osteotomy procedures under controlled laboratory conditions. Such standardized experiments provide a reproducible platform for analyzing the biomechanical behavior of different osteotomy designs while eliminating confounding factors such as inter-patient variability. However, the application of 3D-printed models in investigating the splitting mechanics during BSSRO surgery has not been reported. In addition, resin-based 3D-printed models cannot perfectly replicate the anisotropic properties of human bone [ 13 , 14 ]. Their fracture toughness, elasticity, and stress distribution under load differ from those of natural cortical and cancellous bone, limiting their ability to reflect true clinical behavior [ 15 ]. To overcome these limitations and enhance external validity, porcine mandibles—which closely resemble human mandibles in density and structural composition—were incorporated as biological comparators are necessary. Therefore, by integrating both synthetic (3D-printed) and biological (porcine) models, this present study is designed to investigate the effect of the inferior border cut (fourth osteotomy line) and the lingual vertical osteotomy line (fifth osteotomy line) and their associated length on splitting mechanics and fracture outcomes during BSSRO. The null hypothesis was that applying different lengths of additional osteotomy lines of the inferior border of the mandibular and the lower end of the horizontal and vertical osteotomy would not significantly affect the bone split patterns and torsion. Methods Ethical approval was obtained from the Ethics Review Committee of the Stomatological Hospital Affiliated to Kunming Medical University (Approval No: KYKQ2024MEC0012) in accordance with the Declaration of Helsinki [ 16 ]. Written informed consent was obtained from all patients whose CBCT data were included, with detailed explanation regarding radiation exposure and data usage. CBCT datasets of patients with complete dentition representing three mandibular angle types (ectropion, upright, and involution) were selected. The Digital Imaging and Communications in Medicine (DICOM) files were imported into Mimics 21.0 software (Materialise, Belgium) to generate three-dimensional mandibular models. A total of 33 mandibular models (11 per mandibular angle type) were fabricated using SLA 3D-printing technology and used for BSSRO. To validate the findings from the 3D-printed models, 15 freshly isolated porcine mandibles (approximately 28 weeks old) were obtained post-mortem from a slaughterhouse, and no live animals were used in this study. Each mandible was sectioned along the midline, and both hemimandibles were treated independently during the splitting procedure, serving as bilateral controls. A custom stainless-steel test rig was constructed to standardize the splitting procedure. The apparatus consisted of a rigid fixation unit on one side and a three-dimensional movable fixation unit on the other, each secured with six screws to stabilize the mandible. A chisel holder equipped with a digital torque gauge allowed precise and reproducible alignment between the osteotome and the mandibular specimen (Fig. 1 ). All 3D-printed and porcine mandibles underwent horizontal, vertical, and sagittal osteotomies according to the standardized Hunsuck modification of BSSRO. The split procedure was randomly assigned to either the standard Obwegeser–Dal Pont technique or the modified technique incorporating additional osteotomy lines. The same surgical protocol was performed bilaterally for self-control comparison. A single operator (Wen Ma) performed the additional osteotomy lines and all splitting procedures across experimental groups, A total of 66 cases were obtained from 33 postoperative resin mandibular models. For the porcine specimens, 30 cases were obtained from 15 porcine mandibles. Based on the Hunsuck modification, additional osteotomy lines were created as follows: an inferior border extension (fourth osteotomy line) was added to the lower end of the vertical osteotomy line at lengths of 5, 10, 15, or 20 mm; a lingual vertical osteotomy (fifth osteotomy line), perpendicular to the horizontal osteotomy line, was added at lengths of 5 or 10 mm. In combined modification groups, a 5 mm or 10 mm lingual vertical extension was created first, followed by inferior border extensions of 5, 10, 15, or 20 mm (Fig. 2 ; Table 1 – 2 ). All additional osteotomies were performed using a 0.8-mm diameter fissure bur. Table 1 Mandibular model groups and surgical techniques Group Surgical technique 1 Hunsuck osteotomy 2 Hunsuck osteotomy + 5 mm osteotomy line at the lower end of the vertical osteotomy line 3 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the vertical osteotomy line 4 Hunsuck osteotomy + 15 mm osteotomy line at the lower end of the vertical osteotomy line 5 Hunsuck osteotomy + 20 mm osteotomy line at the lower end of the vertical osteotomy line 6 Hunsuck osteotomy + 5 mm osteotomy line at the lower end of the horizontal osteotomy line 7 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the horizontal osteotomy line 8 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the horizontal osteotomy line and 5 mm osteotomy line at the lower end of the vertical osteotomy line 9 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the horizontal osteotomy line and 10 mm osteotomy line at the lower end of the vertical osteotomy line 10 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the horizontal osteotomy line and 15 mm osteotomy line at the lower end of the vertical osteotomy line 11 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the horizontal osteotomy line and 20 mm osteotomy line at the lower end of the vertical osteotomy line Table 2 Porcine mandibles groups and surgical techniques Group Surgical technique 1 Hunsuck osteotomy 2 Hunsuck osteotomy + 5 mm osteotomy line at the lower end of the vertical osteotomy line 3 Hunsuck osteotomy + 10 mm osteotomy line at the lower end of the vertical osteotomy line 4 Hunsuck osteotomy + 15 mm osteotomy line at the lower end of the vertical osteotomy line 5 Hunsuck osteotomy + 20 mm osteotomy line at the lower end of the vertical osteotomy line For splitting, a 16-mm-wide osteotome was positioned distal to the last molar at a 45° angle to the base of the mandible. The osteotome was rotated clockwise in a controlled manner until fracture completion. The torque applied during the splitting maneuver was continuously recorded, and the maximum torque required to complete the split was documented. Torque measurements were obtained using a digital torque gauge (HTG2-10N, Yinuo Electronics, Taiwan) with a measurement range of 0–10 Nm, accuracy of ± 0.5%, and a sampling rate of 1000 Hz. The device was connected to a computer for real-time graphical recording and data processing using ZLINK 3 software (IMADA). The torque was measured using a calibrated device (original unit: kgf·cm) and converted to SI units (N·m) for analysis. Lingual split patterns were recorded and classified according to the Plooij classification system (Types I–IV). Type I fractures passed through or posterior to the mandibular foramen toward the inferior border; Type II fractures followed the posterior border of the ramus between the inner and outer cortical plates; Type III fractures propagated along the mandibular canal; and Type IV included all other unfavorable patterns, such as buccal plate fractures (Fig. 3 ). For more detailed analysis, The fracture line was divided using a horizontal reference line at the level of the inferior border of the mandibular foramen, parallel to the occlusal plane. The segment from the horizontal osteotomy line to the inferior border of the mandibular foramen was defined as the initial segment, and the segment from the inferior border of the mandibular foramen to the inferior border of the mandible was defined as the extended segment. Types I–III were further subdivided (a–d) according to the direction of the extended fracture line: (a) along the mandibular canal; (b) between the mandibular canal and posterior ramus border; (c) along the posterior border between cortical plates; and (d) crossing to the buccal side (Fig. 4 ). Fracture patterns involving propagation along the mandibular canal and/or unintended fractures (Types III, I-a, II-a, and IV) were classified as “bad splits,” whereas all remaining patterns were considered favorable splits. Torque values, fracture patterns, and the incidence of bad splits were analyzed using two-way analysis of variance (ANOVA), independent t-tests, and Cochran–Mantel–Haenszel tests. Statistical significance was set at α < 0.05. Results For both synthetic and biological models, maximum splitting torque and fracture patterns were documented (Tables 3 – 4 ) and categorized as favorable or bad (Tables 5 – 6 ). Two-way ANOVA revealed that the modified techniques with different osteotomy significantly affected maximum splitting torque ( p < 0.01), while mandibular angle type showed no significant effect ( p = 0.34) (Table 7 ). Table 3 The maximum torsion force (Nm) and fracture patterns in mandibular models Experimental group Mandibular angle types Ectropion Upright Involution 1 Torque value 1.353 1.540 1.530 1.569 1.579 1.530 Fracture pattern 1b 2d 1a 3a 1b 1a 2 Torque value 1.265 1.442 1.304 1.500 1.461 1.196 Fracture pattern 1a 1a 1a 3a 1d 3b 3 Torque value 1.118 1.118 1.187 1.275 1.265 1.000 Fracture pattern 3a 3a 1b 3a 1a 1d 4 Torque value 0.716 0.745 0.873 1.030 0.971 0.814 Fracture pattern 3a 1b 2d 1b 1a 1b 5 Torque value 0.667 0.461 0.520 0.628 0.677 0.559 Fracture pattern 3b 1b 3b 1b 1b 1b 6 Torque value 2.246 2.157 1.608 1.442 1.549 1.363 Fracture pattern 4 4 2c 2d 1b 1d 7 Torque value 1.177 1.393 0.990 1.451 1.245 1.285 Fracture pattern 1b 1b 1b 1a 3a 1b 8 Torque value 1.098 1.373 0.902 1.304 1.138 1.020 Fracture pattern 1a 1d 1a 2d 3a 1a 9 Torque value 0.902 1.069 0.843 1.138 1.010 0.971 Fracture pattern 1d 1d 1b 1a 1b 1b 10 Torque value 0.667 0.873 0.686 0.726 0.765 0.706 Fracture pattern 1b 1b 3b 1a 1b 3b 11 Torque value 0.569 0.667 0.628 0.647 0.677 0.539 Fracture pattern 1b 3a 1b 1b 3b 1c Table 4 The maximum torsion force (Nm) and fracture patterns in Porcine mandible Experimental group 1 Torque value 5.188 5.502 6.531 5.717 5.806 5.658 Fracture pattern 1b 3b 4 3a 3b 3a 2 Torque value 4.894 4.688 4.727 4.521 4.560 4.923 Fracture pattern 1a 1b 3b 2b 1b 3a 3 Torque value 4.040 4.275 4.345 4.187 4.364 4.010 Fracture pattern 1b 1d 3a 1a 3a 1b 4 Torque value 3.206 3.834 3.932 3.648 3.472 3.265 Fracture pattern 1b 3a 2b 1b 1c 1b 5 Torque value 2.500 2.618 2.560 2.687 2.922 2.452 Fracture pattern 1b 1c 1b 1c 3b 1b Table 5 Distribution of bad split by various surgical procedures in 3D printed model Surgical procedure Favorable Split Bad Split Group 1 3 3 Group 2 1 5 Group 3 2 4 Group 4 4 2 Group 5 4 2 Group 6 4 2 Group 7 4 2 Group 8 2 4 Group 9 5 1 Group 10 3 3 Group 11 4 2 Table 6 Distribution of unfavorable splits by surgical procedures in porcine mandible Surgical Procedure Favorable Split Bad Split Group 1 1 5 Group 2 3 3 Group 3 3 3 Group 4 5 1 Group 5 5 1 Table 7 Two-factor analysis of variance results Variable Df Sum of Squares Mean Square F p Surgical procedure 10 849.0 84.90 46.933 < 0.001 Mandibular angle type 2 4.1 2.03 1.125 0.3368 Residuals 33 59.7 1.81 In the 3D-printing models, extending the osteotomy 5 mm apically from the terminal depth of the horizontal osteotomy did not significantly affect the maximum insertion torque. ( p >0.05) (Fig. 5 a). In contrast, splitting torque decreased progressively with increasing length of the osteotomy extension along the inferior mandibular border. Each incremental extension of the inferior border cut (5, 10, 15, and 20 mm) significantly reduced splitting torque compared to controls (all p < 0.01), with the 20-mm extension demonstrating the greatest reduction (Fig. 5 a). Biological validation using porcine mandibles confirmed the progressive torque reduction observed in synthetic models (Fig. 5 b). Neither Cochran-Mantel-Haenszel test nor ordinal logistic regression revealed a significant association between surgical technique and fracture pattern ( p > 0.05; Additional file 1–3). However, as the osteotomy extension along the inferior mandibular border increased, there was a trend toward fewer adverse fractures in the resin mandible models. Discussion The study evaluated the effect of the osteotomy line added to the inferior mandibular border (fourth line) and the vertical osteotomy line added to the posterior ramus (fifth line) in BSSRO on the maximum torsion force required for mandibular separation and the resulting split patterns. These were examined both in 3D models and in fresh porcine mandibles. The data obtained demonstrated a consistent trend in both study models. While the lengthening of the inferior border osteotomy line reduced torque, the length of the vertical osteotomy line was found to have no significant effect on torque. Consequently, the null hypothesis of the study was partially rejected. The study concluded that as the length of the osteotomy line added to the inferior border increased, the maximum torque required to separate the mandible decreased significantly. As the incision line was extended from the shortest to the longest, progressively lower torque values were observed in 3D-printed models, which is consistent with the data reported by Bockmann et al. [ 17 ] in their study using pig models. Specifically, the 20 mm osteotomy line, which exhibited the lowest force requirement, may create a preferential stress pathway along the inferior border, thereby facilitating controlled crack propagation. The inferior border extension likely modifies the stress concentration zone and redirects crack propagation away from the mandibular canal, thereby reducing the torque required for separation. The findings are supported by a similar study that previously reported that modified osteotomy lines reduce splitting force [ 10 ]. Moreover, the majority of pig mandibles exhibited type III and subtype a splitting patterns. The variation in torque may be related to differences in pig breed, slaughter age, and mandibular size. Compared to data without an additional osteotomy line, our results showed a significant decrease in torque after adding an osteotomy line at the inferior border of the mandible. Schoen [ 9 ] used an osteotomy line positioned more distally than in our study, resulting in a lower required torque for splitting, a longer auxiliary osteotomy line, and a similarly significant decrease in torque values. The splitting patterns also improved, with only 25% of pig mandibles splitting along the nerve canal after the modification, a result consistent with our findings. In addition to reducing the force needed to split the mandible, the addition of an auxiliary osteotomy line at the inferior border of the mandible also increases the controllability of the splitting pattern. Furthermore, in a clinical study involving 32 patients, Topan et al. [ 11 ] observed that the implementation of the split procedure was associated with a substantial reduction in operative time. They also found a significant enhancement in neurosensory recovery of the inferior alveolar nerve following this approach. Furthermore, the study noted that the type I lingual split rate exhibited a tendency to increase in the group that underwent inferior border osteotomy; however, this increase did not reach statistical significance. These clinical findings are consistent with the trend that has been observed in both the 3D model and porcine mandible experiments, namely "lower torque and a more predictable split pattern with extended inferior border osteotomy." In addition, the modified sagittal split osteotomy (SSO) technique described by Kumaran et al. [ 18 ] suggests that safer surgical access to areas adjacent to the inferior alveolar nerve can reduce pressure on the nerve. The clinical observations presented here serve to reinforce the biological and surgical rationale for controlled stress direction in the ramus with inferior border osteotomy. Therefore, these biomechanical findings may have clinical relevance; however, prospective clinical validation is required before routine implementation. An alternative evaluation criterion, the additional vertical osteotomy line, yielded divergent results from the osteotomy line added to the inferior border line. The study concluded that the length of the vertical osteotomy line (fifth line) had no significant effect on the torque generated, as measured in 3D models or in fresh porcine mandibles. This result suggests that the vertical osteotomy line does not create a decisive stress path during the split process. Furthermore, it should be considered that a vertically osteotomy line that is unnecessarily long for clinical purposes may cause some potential risks, such as increasing the likelihood of bleeding and prolonging the procedure time. The study established that the three distinct mandibular angle types analysed (ectropion, upright, involution) did not have a significant impact on torque values or split patterns. This finding suggests that morphological variations of the mandible alone play a limited role in determining split force. However, the increased incidence of split along the canal in the ectropion-type model may be indicative of a decrease in cortical thickness in this type. However, it should be noted that the results are not statistically conclusive. In this study, it was observed that the ectropion-type mandibular model was more prone to separation along the mandibular canal compared to the upright and involution types, leading to type III or subclass a separations. Furthermore, two cases of unfavorable splitting occurred in the ectropion-type mandibular model group, but this difference was not statistically significant. Future studies incorporating cortical thickness measurements or microstructural analysis may clarify whether bone architecture, rather than angular morphology alone, influences split behavior. Moreover, the comparable torque trends observed in both experimental models support the internal validity of the mechanical findings. This suggests that inferior border modification represents the primary mechanical determinant of torque reduction, whereas posterior vertical extension appears biomechanically redundant. Extension of the inferior border osteotomy significantly reduced poor split rates and promoted a more controlled fracture trajectory, particularly at 20 mm. This likely reflects stress redistribution toward the inferior border, reducing unintended canal or buccal plate fractures. However, further studies on patients are required to fully translate these results into clinical practice. Another key finding of the study is the observation that the results of porcine mandibles and 3D printed models show similar trends. While this supports the use of 3D printed models as a viable alternative for studying split mechanics, careful interpretation is required as they may not fully reflect the biomechanical properties of living tissues. This study has some limitations. The 3D-printed mandible models and fresh porcine mandibles used may not fully reflect the biomechanical properties of the actual human mandible. Furthermore, while the split procedure was evaluated with a single-axis torque application, the multidirectional forces, soft tissue, and muscle effects seen in the clinic were not included in this model. Further research could be conducted using finite element analysis to test this hypothesis. In addition, further studies are required to validate the results obtained in clinical practice. These should evaluate the effect of different levels of surgical experience, the proximity of the osteotomy line to the inferior alveolar nerve canal, and the effect of the osteotomy line on healing and postoperative stability. Conclusion This controlled biomechanical study establishes that inferior border osteotomy line extension significantly reduces splitting torque and enhances fracture predictability in BSSRO. Specifically: A reduction in splitting torque was observed with increasing inferior border cut length, with the 20-mm extension demonstrating superior biomechanical efficiency and minimal risk of unfavorable fractures. Splitting mechanics were independent of mandibular angle morphology and lingual vertical osteotomy line length, indicating that inferior border extension is universally applicable. Abbreviations Table 8 The list of abbreviations used in the text Abbreviation Definition BSSRO Bilateral sagittal split ramus osteotomy CBCT Cone beam computed tomography SLA stereolithographic DICOM Digital Imaging and Communications in Medicine SSO The sagittal split osteotomy Declarations Ethics approval and consent to participate This study was approved by the Ethics Review Committee of the Stomatological Hospital Affiliated to Kunming Medical University (Approval No: KYKQ2024MEC0012) in strict accordance with the principles of the Declaration of Helsinki. All patients undergoing CBCT scans provided written informed consent, which included detailed information regarding radiation risks, data usage. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Authors' information 1 Yunnan Key Laboratory of Stomatology & Department of Oral Digital Center, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming 650106, China 2 Yunnan Key Laboratory of Stomatology & Department of The First Outpatient, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming 650106, China 3 Yunnan Key Laboratory of Stomatology & Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming 650106, China 4 Department of Prosthodontics, Faculty of Dentistry, Biruni University, İstanbul, Turkey; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Biruni University, İstanbul, Turkey 5 Department of Prosthodontics, Geriatric Dentistry & Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin & Humboldt-Universität zu Berlin, Aßmannshauser Str. 4–6, 14197 Berlin, Germany Funding The Science Research Foundation of Department of Education in Yunnan Province (2024J0272), the Kumning Medical University Team for Diagnosis and Treatment of Complex Craniofacial Malformations (2024XKTDTS08), Yunnan Provincial Clinical Medical Center Research Project (2024YNLCYXZX0227, 2024YNLCYXZX0229), Yunnan Clinical Research Center for Oral Diseases (202505AJ310001), the Yunnan Province High Level Talent Training Support Plan (YNWR-MY-2020-086), the Multi-stage and Multidisciplinary treatment technology innovation team for deformities of Kunming Medical University (CXTD202213). Author Contribution WM and ZX contributed equally to this work. WM and ZX conceived and designed the study, performed the experiments, collected the data, carried out the statistical analyses, and drafted the manuscript. YW and JF contributed to study design and data interpretation. LW contributed to data collection and critically revised the manuscript. AADT and ZM revised and edited the final version of the manuscript. FZ contributed to methodology, provided critical revision, and coordinated the study. ML supervised the study and finalized the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. Data Availability All data generated or analysed during this study are included in this published article (and its supplementary information files). References Kumar S, Prasad V, Pradhan H, Siddiqui R, Ali I. Bilateral sagittal split osteotomy a versatile approach for correction of facial deformity: A review literature. Natl J Maxillofac Surg. 2021;12(1):8. Dreiseidler T, Bergmann J, Zirk M, Rothamel D, Zoller J, Kreppel M. Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg. 2016;45(11):1452–8. Trauner R, Obwegeser H. 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(7):677 – 89; contd. Dal Pont G. Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv. 1961;19:42–7. Hunsuck EE. A modified intraoral sagittal splitting technic for correction of mandibular prognathism. J Oral Surg. 1968;26(4):250–3. Kasahara K, Sugahara K, Koyachi M, Nishiyama A, Yamamoto M, Iwamoto M, et al. Bad Split in Bilateral Sagittal Split Ramus Osteotomy: A Retrospective Study of 745 Patients for Evading Bad Split. IJOMS. 2021;20(1):50–6. Böckmann R, Meyns J, Dik E, Kessler P. The Modifications of the Sagittal Ramus Split Osteotomy. PRS Global Open. 2014;2(12):e271. Wolford LM, Davis WM. The mandibular inferior border split: a modification in the sagittal split osteotomy. J Oral Maxillofac Surg. 1990;48(1):92–4. Schoen P, Frotscher M, Eggeler G, Kessler P, Wolff KD, Boeckmann R. Modification of the bilateral sagittal split osteotomy (BSSO) in a study using pig mandibles. Int J Oral Maxillofac Surg. 2011;40(5):516–20. Al-Dawoody A, Hamad S, Kheder Khrwatany K, Saleem T. Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy? HEAD FACE MED. 2023;19(1):49. Topan C, Bilge S, Demirbas AE. Does the modified inferior border osteotomy improve the surgical outcomes in bilateral sagittal split osteotomy? J Stomatol Oral Maxillofac Surg. 2025;126(4):102122. Msallem B, Sharma N, Cao S, Halbeisen FS, Zeilhofer H-F, Thieringer FM. Evaluation of the Dimensional Accuracy of 3D-Printed Anatomical Mandibular Models Using FFF, SLA, SLS, MJ, and BJ Printing Technology. J CLIN MED. 2020;9(3):817. Schwartz-Dabney CL, Dechow PC. Variations in cortical material properties throughout the human dentate mandible. Am J Phys Anthropol. 2003;120(3):252–77. Ling L, Lai T, Malyala R. Mechanical Properties and Degree of Conversion of a Novel 3D-Printing Model Resin. POLYMERS-BASEL. 2024;16(24):3562. Wang X, Shujaat S, Shaheen E, Jacobs R. Quality and haptic feedback of three-dimensionally printed models for simulating dental implant surgery. J Prosthet Dent. 2024;131(4):660–7. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. Bockmann R, Schon P, Frotscher M, Eggeler G, Lethaus B, Wolff K. Pilot study of modification of the bilateral sagittal split osteotomy (BSSO) in pig mandibles. J Craniomaxillofac Surg. 2011;39(3):169–72. Satish P, Kumaran P, Manikandan G, Anuradha V, BalaMurugan R, Kumar A. A novel modification of the sagittal split osteotomy as an access osteotomy. Ann Maxillofac Surg. 2020;10(2):463. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.xlsx Additional file 1: File name: Additional file 1. File format:.xls. Title: Cochran–Mantel–Haenszel test statistics for surgical procedure and split pattern in mandibular models. Description: Excel spreadsheet reporting Cochran–Mantel–Haenszel test statistics assessing the association between surgical procedure and split pattern in mandibular models. Additionalfile2.xlsx Additional file 2: File name: Additional file 2. File format: .xls.Title: Ordinal logistic regression of surgical procedures 1–5 and maximum torque for split pattern. Description: Excel spreadsheet reporting ordinal logistic regression results assessing the association between surgical procedures 1–5 and maximum torque with split pattern. Additionalfile3.xlsx Additional file 3: File name: Additional file 3. File format: .xls.Title: Ordinal logistic regression of surgical procedures 7–11 and maximum torque for split pattern. Description: Excel spreadsheet reporting ordinal logistic regression results assessing the association between surgical procedures 7–11 and maximum torque with split pattern. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9236308","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616612846,"identity":"c8be450b-1f90-47c4-bd10-7b2363cb42dd","order_by":0,"name":"Wen Ma","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Ma","suffix":""},{"id":616612848,"identity":"793ca39a-7d23-4d7a-b07c-af928e60425d","order_by":1,"name":"Zixian Xu","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zixian","middleName":"","lastName":"Xu","suffix":""},{"id":616612855,"identity":"56d34e46-a29f-4f51-b9b6-dd2d321602f7","order_by":2,"name":"Yong Wu","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Wu","suffix":""},{"id":616612856,"identity":"e822cf06-1f5a-4287-a0d8-e57b89076b04","order_by":3,"name":"Almira Ada Diken Turksayar","email":"","orcid":"","institution":"Biruni University","correspondingAuthor":false,"prefix":"","firstName":"Almira","middleName":"Ada Diken","lastName":"Turksayar","suffix":""},{"id":616612859,"identity":"ef3c4ad3-6acb-447d-8cb6-3bb5e00806d4","order_by":4,"name":"Jiang Fu","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiang","middleName":"","lastName":"Fu","suffix":""},{"id":616612860,"identity":"e0ee26c3-768f-4748-97b5-65adbcd881b1","order_by":5,"name":"Lidong Wang","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lidong","middleName":"","lastName":"Wang","suffix":""},{"id":616612861,"identity":"549ecdba-b304-43a1-8cf2-3b9cc19ff392","order_by":6,"name":"Fangqian Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIie3RsWsCMRTH8XcEMgVufeFE/4WAkA76x7wg9BYLneQGoYJFB3FX9I9wEldJyZTut/VcnC2UcmN7U7e7GwvmM2TKd3j8AILgP8LqGUKXgz0XlE3bJo/QjyM3UoV37ROznXstL6+suejt5tfLFw2ig/M6MzMO8XJFtUm0dw/9DqVMeTfJzakD6N8PtQlD0oksLVe5PebGc1D4VJ9wTL8TJCvUR6GfzYI1JwLHWt7Iopy9aWiVII4nCVCqYnAjJO9E4y29TXqUJQ1eFr9TfpbZtBsv1/VJhQn4m0M0fq9EJbRYMAiC4H79ACn1S4hwAzmVAAAAAElFTkSuQmCC","orcid":"","institution":"Kunming Medical University","correspondingAuthor":true,"prefix":"","firstName":"Fangqian","middleName":"","lastName":"Zhang","suffix":""},{"id":616612862,"identity":"32d6a318-1db1-45ad-ac53-90ab4a9ffba8","order_by":7,"name":"Ming Li","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Li","suffix":""},{"id":616612863,"identity":"2e74dec7-2788-48ab-8b1b-e8946e214aec","order_by":8,"name":"Zhen Mao","email":"","orcid":"","institution":"Charité-Universitätsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Mao","suffix":""}],"badges":[],"createdAt":"2026-03-26 16:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9236308/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9236308/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106189779,"identity":"9e8e5d02-6529-4366-889f-1dbbe72835a6","added_by":"auto","created_at":"2026-04-05 17:11:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13268333,"visible":true,"origin":"","legend":"\u003cp\u003eResin mandibular models and porcine mandibles were prepared and mounted on a custom-made holding stand fixed to the mandibular model. The osteotome was positioned in place and connected to an HTG2-10N digital torque gauge.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/3e8d93269676e11806af409b.png"},{"id":106402603,"identity":"1bb5c667-eea6-493b-965e-5acdf5042d65","added_by":"auto","created_at":"2026-04-08 09:12:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6844416,"visible":true,"origin":"","legend":"\u003cp\u003eOsteotomy procedures of varying lengths and at different locations were performed on the 3D-printed models and porcine mandibles.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/96ee6ce67e2b494084daf6d1.png"},{"id":106189782,"identity":"9c358fe5-c4a3-4ea3-90ed-91050da548bc","added_by":"auto","created_at":"2026-04-05 17:11:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5870074,"visible":true,"origin":"","legend":"\u003cp\u003eIn this study, the Plooij classification of BSSRO mandibular fracture patterns was used as the primary framework: panel (a) shows Type I, panel (b) shows Type II, panel (c) shows Type III, and panel (d) shows Type IV. The yellow dashed line indicates the mandibular canal, and the red solid line represents the fracture line.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/76a3bf9af7d7fc0e7daba3f3.png"},{"id":106403090,"identity":"b9ba7d66-7863-4465-b7a8-f2ab34e568e5","added_by":"auto","created_at":"2026-04-08 09:13:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":6092790,"visible":true,"origin":"","legend":"\u003cp\u003eOur novel classification extends the Plooij system by adding subtypes that differentiate osteotomy-line patterns from the inferior margin of the mandibular foramen to the inferior mandibular border. Panel (a) shows Subtype 1, in which the extension follows the mandibular canal to the inferior border. Panel (b) shows Subtype 2, in which the extension reaches the inferior border between the mandibular canal and the posterior ramus border. Panel (c) shows Subtype 3, in which the extension courses along the posterior ramus border between the medial and lateral cortices and reaches the inferior border. Panel (d) shows Subtype 4, in which the extension crosses the posterior ramus border and deviates buccally\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/929e4c5ec5ef9672ea884e91.png"},{"id":106189785,"identity":"5fe1a404-9957-4b33-837e-e915b7fe5ace","added_by":"auto","created_at":"2026-04-05 17:11:10","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":589412,"visible":true,"origin":"","legend":"\u003cp\u003eEffects of different osteotomy techniques on maximum torque in mandibular models and porcine mandibles. (a) Maximum torque values for mandibular model techniques 1–11 (Table 1). (b) Maximum torque values for porcine mandible techniques 1–5 (Table 2). The x-axis indicates technique number and the y-axis indicates maximum torque (*\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05; **\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.01; ***\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/27cc7b047461eb5b74a63f0f.png"},{"id":107409778,"identity":"357c59ad-b74e-45b4-b877-23e596676ae5","added_by":"auto","created_at":"2026-04-21 08:57:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":30842849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/894d7407-f7b2-4892-a01f-6874d7703b91.pdf"},{"id":106189780,"identity":"95ebcb08-c0e9-4338-b8ca-58ec37e1f021","added_by":"auto","created_at":"2026-04-05 17:11:10","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":9022,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 1\u003c/strong\u003e: \u003cstrong\u003eFile name:\u003c/strong\u003e Additional file 1. \u003cstrong\u003eFile format:\u003c/strong\u003e.xls. \u003cstrong\u003eTitle:\u003c/strong\u003e Cochran–Mantel–Haenszel test statistics for surgical procedure and split pattern in mandibular models. \u003cstrong\u003eDescription:\u003c/strong\u003e Excel spreadsheet reporting Cochran–Mantel–Haenszel test statistics assessing the association between surgical procedure and split pattern in mandibular models.\u003c/p\u003e","description":"","filename":"Additionalfile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/89ec4a0308c28c0d05889190.xlsx"},{"id":106402356,"identity":"30413ce2-e016-494a-b53a-21e4d2f8f0d9","added_by":"auto","created_at":"2026-04-08 09:11:49","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":9384,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 2: File name: \u003c/strong\u003eAdditional file 2.\u003cstrong\u003e File format: \u003c/strong\u003e.xls.\u003cstrong\u003eTitle: \u003c/strong\u003eOrdinal logistic regression of surgical procedures 1–5 and maximum torque for split pattern.\u003cstrong\u003e Description: \u003c/strong\u003eExcel spreadsheet reporting ordinal logistic regression results assessing the association between surgical procedures 1–5 and maximum torque with split pattern.\u003c/p\u003e","description":"","filename":"Additionalfile2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/088bc57fe3cf496bf8f6790d.xlsx"},{"id":106402437,"identity":"a5555ac2-a960-4918-a450-bd9b5226f990","added_by":"auto","created_at":"2026-04-08 09:12:01","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":9373,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 3: File name: \u003c/strong\u003eAdditional file 3.\u003cstrong\u003e File format: \u003c/strong\u003e.xls.\u003cstrong\u003eTitle: \u003c/strong\u003eOrdinal logistic regression of surgical procedures 7–11 and maximum torque for split pattern.\u003cstrong\u003e Description: \u003c/strong\u003eExcel spreadsheet reporting ordinal logistic regression results assessing the association between surgical procedures 7–11 and maximum torque with split pattern.\u003c/p\u003e","description":"","filename":"Additionalfile3.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9236308/v1/4399b7596bd85c32e728305b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Inferior Border and Lingual Vertical Osteotomy Line Length on Splitting Mechanics in Bilateral Sagittal Split Ramus Osteotomy: A Biomechanical Study","fulltext":[{"header":"Background","content":"\u003cp\u003eBilateral sagittal split ramus osteotomy (BSSRO) remains one of the most frequently used surgical techniques for correcting mandibular deformities and achieving stable occlusal relationships [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite its long history of refinement, controlling lingual fracture lines and avoiding unfavorable splits continue to pose challenges [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Traditional BSSRO relies on the classic Obwegeser\u0026ndash;Dal Pont or Hunsuck modifications, which involve horizontal, vertical, and sagittal osteotomies to separate the mandibular segments [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, intraoperative variations in bone morphology and density often lead to unpredictable fracture propagation, excessive torque, and complications such as nerve injury or segmental instability [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address these limitations, additional osteotomy lines\u0026mdash;most notably the inferior border cut have been proposed [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These modifications aim to facilitate controlled splitting of the mandible, enlarge the bony contact area between segments, and reduce the mechanical force required for separation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Clinically, such improvements may decrease the incidence of \u0026ldquo;bad splits,\u0026rdquo; minimize nerve involvement, and enhance postoperative stability. Nevertheless, the optimal configuration (the lingual vertical cut) \u0026mdash; and length of these additional osteotomy lines remain controversial [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Differences in mandibular anatomy among patients make it difficult to standardize the surgical approach or predict mechanical outcomes using in-vivo data alone.\u003c/p\u003e \u003cp\u003eWith the rapid development of digital technology in oral and maxillofacial surgery, computer-assisted design and additive manufacturing now enable the creation of high-fidelity, patient-specific 3D mandibular models [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Through CBCT-based three-dimensional reconstruction and stereolithographic (SLA) printing, surgeons can reproduce diverse mandibular morphologies and simulate osteotomy procedures under controlled laboratory conditions. Such standardized experiments provide a reproducible platform for analyzing the biomechanical behavior of different osteotomy designs while eliminating confounding factors such as inter-patient variability. However, the application of 3D-printed models in investigating the splitting mechanics during BSSRO surgery has not been reported. In addition, resin-based 3D-printed models cannot perfectly replicate the anisotropic properties of human bone [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Their fracture toughness, elasticity, and stress distribution under load differ from those of natural cortical and cancellous bone, limiting their ability to reflect true clinical behavior [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To overcome these limitations and enhance external validity, porcine mandibles\u0026mdash;which closely resemble human mandibles in density and structural composition\u0026mdash;were incorporated as biological comparators are necessary.\u003c/p\u003e \u003cp\u003eTherefore, by integrating both synthetic (3D-printed) and biological (porcine) models, this present study is designed to investigate the effect of the inferior border cut (fourth osteotomy line) and the lingual vertical osteotomy line (fifth osteotomy line) and their associated length on splitting mechanics and fracture outcomes during BSSRO. The null hypothesis was that applying different lengths of additional osteotomy lines of the inferior border of the mandibular and the lower end of the horizontal and vertical osteotomy would not significantly affect the bone split patterns and torsion.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eEthical approval\u0026nbsp;was obtained from the Ethics Review Committee of the Stomatological Hospital Affiliated to Kunming Medical University (Approval No: KYKQ2024MEC0012) in accordance with the Declaration of Helsinki [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Written informed consent was obtained from all patients whose CBCT data were included, with detailed explanation regarding radiation exposure and data usage.\u003c/p\u003e\n\u003cp\u003eCBCT datasets of patients with complete dentition representing three mandibular angle types (ectropion, upright, and involution) were selected. The Digital Imaging and Communications in Medicine (DICOM) files were imported into Mimics 21.0 software (Materialise, Belgium) to generate three-dimensional mandibular models. A total of 33 mandibular models (11 per mandibular angle type) were fabricated using SLA 3D-printing technology and used for BSSRO.\u003c/p\u003e\n\u003cp\u003eTo validate the findings from the 3D-printed models, 15 freshly isolated porcine mandibles (approximately 28 weeks old) were obtained post-mortem from a slaughterhouse, and no live animals were used in this study. Each mandible was sectioned along the midline, and both hemimandibles were treated independently during the splitting procedure, serving as bilateral controls.\u003c/p\u003e\n\u003cp\u003eA custom stainless-steel test rig was constructed to standardize the splitting procedure. The apparatus consisted of a rigid fixation unit on one side and a three-dimensional movable fixation unit on the other, each secured with six screws to stabilize the mandible. A chisel holder equipped with a digital torque gauge allowed precise and reproducible alignment between the osteotome and the mandibular specimen (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAll 3D-printed and porcine mandibles underwent horizontal, vertical, and sagittal osteotomies according to the standardized Hunsuck modification of BSSRO. The split procedure was randomly assigned to either the standard Obwegeser\u0026ndash;Dal Pont technique or the modified technique incorporating additional osteotomy lines. The same surgical protocol was performed bilaterally for self-control comparison. A single operator (Wen Ma) performed the additional osteotomy lines and all splitting procedures across experimental groups, A total of 66 cases were obtained from 33 postoperative resin mandibular models. For the porcine specimens, 30 cases were obtained from 15 porcine mandibles. Based on the Hunsuck modification, additional osteotomy lines were created as follows: an inferior border extension (fourth osteotomy line) was added to the lower end of the vertical osteotomy line at lengths of 5, 10, 15, or 20 mm; a lingual vertical osteotomy (fifth osteotomy line), perpendicular to the horizontal osteotomy line, was added at lengths of 5 or 10 mm. In combined modification groups, a 5 mm or 10 mm lingual vertical extension was created first, followed by inferior border extensions of 5, 10, 15, or 20 mm (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). All additional osteotomies were performed using a 0.8-mm diameter fissure bur.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMandibular model groups and surgical techniques\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSurgical technique\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;5 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;15 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;20 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;5 mm osteotomy line at the lower end of the horizontal osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the horizontal osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the horizontal osteotomy line and 5 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the horizontal osteotomy line and 10 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the horizontal osteotomy line and 15 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the horizontal osteotomy line and 20 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePorcine mandibles groups and surgical techniques\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSurgical technique\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;5 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;10 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;15 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHunsuck osteotomy\u0026thinsp;+\u0026thinsp;20 mm osteotomy line at the lower end of the vertical osteotomy line\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFor splitting, a 16-mm-wide osteotome was positioned distal to the last molar at a 45\u0026deg; angle to the base of the mandible. The osteotome was rotated clockwise in a controlled manner until fracture completion. The torque applied during the splitting maneuver was continuously recorded, and the maximum torque required to complete the split was documented.\u003c/p\u003e\n\u003cp\u003eTorque measurements were obtained using a digital torque gauge (HTG2-10N, Yinuo Electronics, Taiwan) with a measurement range of 0\u0026ndash;10 Nm, accuracy of \u0026plusmn;\u0026thinsp;0.5%, and a sampling rate of 1000 Hz. The device was connected to a computer for real-time graphical recording and data processing using ZLINK 3 software (IMADA). The torque was measured using a calibrated device (original unit: kgf\u0026middot;cm) and converted to SI units (N\u0026middot;m) for analysis.\u003c/p\u003e\n\u003cp\u003eLingual split patterns were recorded and classified according to the Plooij classification system (Types I\u0026ndash;IV). Type I fractures passed through or posterior to the mandibular foramen toward the inferior border; Type II fractures followed the posterior border of the ramus between the inner and outer cortical plates; Type III fractures propagated along the mandibular canal; and Type IV included all other unfavorable patterns, such as buccal plate fractures (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFor more detailed analysis, The fracture line was divided using a horizontal reference line at the level of the inferior border of the mandibular foramen, parallel to the occlusal plane. The segment from the horizontal osteotomy line to the inferior border of the mandibular foramen was defined as the initial segment, and the segment from the inferior border of the mandibular foramen to the inferior border of the mandible was defined as the extended segment. Types I\u0026ndash;III were further subdivided (a\u0026ndash;d) according to the direction of the extended fracture line: (a) along the mandibular canal; (b) between the mandibular canal and posterior ramus border; (c) along the posterior border between cortical plates; and (d) crossing to the buccal side (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFracture patterns involving propagation along the mandibular canal and/or unintended fractures (Types III, I-a, II-a, and IV) were classified as \u0026ldquo;bad splits,\u0026rdquo; whereas all remaining patterns were considered favorable splits.\u003c/p\u003e\n\u003cp\u003eTorque values, fracture patterns, and the incidence of bad splits were analyzed using two-way analysis of variance (ANOVA), independent t-tests, and Cochran\u0026ndash;Mantel\u0026ndash;Haenszel tests. Statistical significance was set at \u003cem\u003e\u0026alpha;\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFor both synthetic and biological models, maximum splitting torque and fracture patterns were documented (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) and categorized as favorable or bad (Tables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Two-way ANOVA revealed that the modified techniques with different osteotomy significantly affected maximum splitting torque (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), while mandibular angle type showed no significant effect (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.34) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe maximum torsion force (Nm) and fracture patterns in mandibular models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eExperimental group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e \u003cp\u003eMandibular angle types\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eEctropion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eUpright\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eInvolution\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe maximum torsion force (Nm) and fracture patterns in Porcine mandible\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eExperimental group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTorque value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFracture pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1b\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of bad split by various surgical procedures in 3D printed model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFavorable Split\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBad Split\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of unfavorable splits by surgical procedures in porcine mandible\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Procedure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFavorable Split\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBad Split\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTwo-factor analysis of variance results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSum of Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e849.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandibular angle type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.3368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResiduals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the 3D-printing models, extending the osteotomy 5 mm apically from the terminal depth of the horizontal osteotomy did not significantly affect the maximum insertion torque. (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea).\u003c/p\u003e \u003cp\u003eIn contrast, splitting torque decreased progressively with increasing length of the osteotomy extension along the inferior mandibular border. Each incremental extension of the inferior border cut (5, 10, 15, and 20 mm) significantly reduced splitting torque compared to controls (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with the 20-mm extension demonstrating the greatest reduction (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea). Biological validation using porcine mandibles confirmed the progressive torque reduction observed in synthetic models (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNeither Cochran-Mantel-Haenszel test nor ordinal logistic regression revealed a significant association between surgical technique and fracture pattern (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Additional file 1\u0026ndash;3). However, as the osteotomy extension along the inferior mandibular border increased, there was a trend toward fewer adverse fractures in the resin mandible models.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study evaluated the effect of the osteotomy line added to the inferior mandibular border (fourth line) and the vertical osteotomy line added to the posterior ramus (fifth line) in BSSRO on the maximum torsion force required for mandibular separation and the resulting split patterns. These were examined both in 3D models and in fresh porcine mandibles. The data obtained demonstrated a consistent trend in both study models. While the lengthening of the inferior border osteotomy line reduced torque, the length of the vertical osteotomy line was found to have no significant effect on torque. Consequently, the null hypothesis of the study was partially rejected.\u003c/p\u003e \u003cp\u003eThe study concluded that as the length of the osteotomy line added to the inferior border increased, the maximum torque required to separate the mandible decreased significantly. As the incision line was extended from the shortest to the longest, progressively lower torque values were observed in 3D-printed models, which is consistent with the data reported by Bockmann et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in their study using pig models. Specifically, the 20 mm osteotomy line, which exhibited the lowest force requirement, may create a preferential stress pathway along the inferior border, thereby facilitating controlled crack propagation. The inferior border extension likely modifies the stress concentration zone and redirects crack propagation away from the mandibular canal, thereby reducing the torque required for separation. The findings are supported by a similar study that previously reported that modified osteotomy lines reduce splitting force [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, the majority of pig mandibles exhibited type III and subtype a splitting patterns. The variation in torque may be related to differences in pig breed, slaughter age, and mandibular size. Compared to data without an additional osteotomy line, our results showed a significant decrease in torque after adding an osteotomy line at the inferior border of the mandible. Schoen [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] used an osteotomy line positioned more distally than in our study, resulting in a lower required torque for splitting, a longer auxiliary osteotomy line, and a similarly significant decrease in torque values. The splitting patterns also improved, with only 25% of pig mandibles splitting along the nerve canal after the modification, a result consistent with our findings. In addition to reducing the force needed to split the mandible, the addition of an auxiliary osteotomy line at the inferior border of the mandible also increases the controllability of the splitting pattern. Furthermore, in a clinical study involving 32 patients, Topan et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] observed that the implementation of the split procedure was associated with a substantial reduction in operative time. They also found a significant enhancement in neurosensory recovery of the inferior alveolar nerve following this approach. Furthermore, the study noted that the type I lingual split rate exhibited a tendency to increase in the group that underwent inferior border osteotomy; however, this increase did not reach statistical significance. These clinical findings are consistent with the trend that has been observed in both the 3D model and porcine mandible experiments, namely \"lower torque and a more predictable split pattern with extended inferior border osteotomy.\" In addition, the modified sagittal split osteotomy (SSO) technique described by Kumaran et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] suggests that safer surgical access to areas adjacent to the inferior alveolar nerve can reduce pressure on the nerve. The clinical observations presented here serve to reinforce the biological and surgical rationale for controlled stress direction in the ramus with inferior border osteotomy. Therefore, these biomechanical findings may have clinical relevance; however, prospective clinical validation is required before routine implementation. An alternative evaluation criterion, the additional vertical osteotomy line, yielded divergent results from the osteotomy line added to the inferior border line. The study concluded that the length of the vertical osteotomy line (fifth line) had no significant effect on the torque generated, as measured in 3D models or in fresh porcine mandibles. This result suggests that the vertical osteotomy line does not create a decisive stress path during the split process. Furthermore, it should be considered that a vertically osteotomy line that is unnecessarily long for clinical purposes may cause some potential risks, such as increasing the likelihood of bleeding and prolonging the procedure time.\u003c/p\u003e \u003cp\u003eThe study established that the three distinct mandibular angle types analysed (ectropion, upright, involution) did not have a significant impact on torque values or split patterns. This finding suggests that morphological variations of the mandible alone play a limited role in determining split force. However, the increased incidence of split along the canal in the ectropion-type model may be indicative of a decrease in cortical thickness in this type. However, it should be noted that the results are not statistically conclusive. In this study, it was observed that the ectropion-type mandibular model was more prone to separation along the mandibular canal compared to the upright and involution types, leading to type III or subclass a separations. Furthermore, two cases of unfavorable splitting occurred in the ectropion-type mandibular model group, but this difference was not statistically significant. Future studies incorporating cortical thickness measurements or microstructural analysis may clarify whether bone architecture, rather than angular morphology alone, influences split behavior. Moreover, the comparable torque trends observed in both experimental models support the internal validity of the mechanical findings. This suggests that inferior border modification represents the primary mechanical determinant of torque reduction, whereas posterior vertical extension appears biomechanically redundant.\u003c/p\u003e \u003cp\u003eExtension of the inferior border osteotomy significantly reduced poor split rates and promoted a more controlled fracture trajectory, particularly at 20 mm. This likely reflects stress redistribution toward the inferior border, reducing unintended canal or buccal plate fractures. However, further studies on patients are required to fully translate these results into clinical practice.\u003c/p\u003e \u003cp\u003eAnother key finding of the study is the observation that the results of porcine mandibles and 3D printed models show similar trends. While this supports the use of 3D printed models as a viable alternative for studying split mechanics, careful interpretation is required as they may not fully reflect the biomechanical properties of living tissues.\u003c/p\u003e \u003cp\u003eThis study has some limitations. The 3D-printed mandible models and fresh porcine mandibles used may not fully reflect the biomechanical properties of the actual human mandible. Furthermore, while the split procedure was evaluated with a single-axis torque application, the multidirectional forces, soft tissue, and muscle effects seen in the clinic were not included in this model. Further research could be conducted using finite element analysis to test this hypothesis. In addition, further studies are required to validate the results obtained in clinical practice. These should evaluate the effect of different levels of surgical experience, the proximity of the osteotomy line to the inferior alveolar nerve canal, and the effect of the osteotomy line on healing and postoperative stability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis controlled biomechanical study establishes that inferior border osteotomy line extension significantly reduces splitting torque and enhances fracture predictability in BSSRO. Specifically:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e A reduction in splitting torque was observed with increasing inferior border cut length, with the 20-mm extension demonstrating superior biomechanical efficiency and minimal risk of unfavorable fractures.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSplitting mechanics were independent of mandibular angle morphology and lingual vertical osteotomy line length, indicating that inferior border extension is universally applicable.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eTable 8\u0026nbsp;\u003c/strong\u003eThe list of abbreviations used in the text\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"549\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAbbreviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDefinition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBSSRO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral sagittal split ramus osteotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCBCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCone beam computed tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003estereolithographic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDICOM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDigital Imaging and Communications in Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSSO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eThe sagittal split osteotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Ethics Review Committee of the Stomatological Hospital Affiliated to Kunming Medical University (Approval No: KYKQ2024MEC0012) in strict accordance with the principles of the Declaration of Helsinki. All patients undergoing CBCT scans provided written informed consent, which included detailed information regarding radiation risks, data usage.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthors' information\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003eYunnan Key Laboratory of Stomatology \u0026amp; Department of Oral Digital Center, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming 650106, China\u003c/p\u003e \u003cp\u003e \u003csup\u003e2\u003c/sup\u003eYunnan Key Laboratory of Stomatology \u0026amp; Department of The First Outpatient, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming 650106, China\u003c/p\u003e \u003cp\u003e \u003csup\u003e3\u003c/sup\u003eYunnan Key Laboratory of Stomatology \u0026amp; Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming 650106, China\u003c/p\u003e \u003cp\u003e \u003csup\u003e4\u003c/sup\u003eDepartment of Prosthodontics, Faculty of Dentistry, Biruni University, İstanbul, Turkey; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Biruni University, İstanbul, Turkey\u003c/p\u003e \u003cp\u003e \u003csup\u003e5\u003c/sup\u003eDepartment of Prosthodontics, Geriatric Dentistry \u0026amp; Craniomandibular Disorders, Charit\u0026eacute;-Universit\u0026auml;tsmedizin Berlin, corporate member of Freie Universit\u0026auml;t Berlin \u0026amp; Humboldt-Universit\u0026auml;t zu Berlin, A\u0026szlig;mannshauser Str. 4\u0026ndash;6, 14197 Berlin, Germany\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe Science Research Foundation of Department of Education in Yunnan Province (2024J0272), the Kumning Medical University Team for Diagnosis and Treatment of Complex Craniofacial Malformations (2024XKTDTS08), Yunnan Provincial Clinical Medical Center Research Project (2024YNLCYXZX0227, 2024YNLCYXZX0229), Yunnan Clinical Research Center for Oral Diseases (202505AJ310001), the Yunnan Province High Level Talent Training Support Plan (YNWR-MY-2020-086), the Multi-stage and Multidisciplinary treatment technology innovation team for deformities of Kunming Medical University (CXTD202213).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWM and ZX contributed equally to this work. WM and ZX conceived and designed the study, performed the experiments, collected the data, carried out the statistical analyses, and drafted the manuscript. YW and JF contributed to study design and data interpretation. LW contributed to data collection and critically revised the manuscript. AADT and ZM revised and edited the final version of the manuscript. FZ contributed to methodology, provided critical revision, and coordinated the study. ML supervised the study and finalized the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article (and its supplementary information files).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKumar S, Prasad V, Pradhan H, Siddiqui R, Ali I. Bilateral sagittal split osteotomy a versatile approach for correction of facial deformity: A review literature. Natl J Maxillofac Surg. 2021;12(1):8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDreiseidler T, Bergmann J, Zirk M, Rothamel D, Zoller J, Kreppel M. Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg. 2016;45(11):1452\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrauner R, Obwegeser H. 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(7):677\u0026thinsp;\u0026ndash;\u0026thinsp;89; contd.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDal Pont G. Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv. 1961;19:42\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunsuck EE. A modified intraoral sagittal splitting technic for correction of mandibular prognathism. J Oral Surg. 1968;26(4):250\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKasahara K, Sugahara K, Koyachi M, Nishiyama A, Yamamoto M, Iwamoto M, et al. Bad Split in Bilateral Sagittal Split Ramus Osteotomy: A Retrospective Study of 745 Patients for Evading Bad Split. IJOMS. 2021;20(1):50\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026ouml;ckmann R, Meyns J, Dik E, Kessler P. The Modifications of the Sagittal Ramus Split Osteotomy. PRS Global Open. 2014;2(12):e271.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolford LM, Davis WM. The mandibular inferior border split: a modification in the sagittal split osteotomy. J Oral Maxillofac Surg. 1990;48(1):92\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchoen P, Frotscher M, Eggeler G, Kessler P, Wolff KD, Boeckmann R. Modification of the bilateral sagittal split osteotomy (BSSO) in a study using pig mandibles. Int J Oral Maxillofac Surg. 2011;40(5):516\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Dawoody A, Hamad S, Kheder Khrwatany K, Saleem T. Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy? HEAD FACE MED. 2023;19(1):49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTopan C, Bilge S, Demirbas AE. Does the modified inferior border osteotomy improve the surgical outcomes in bilateral sagittal split osteotomy? J Stomatol Oral Maxillofac Surg. 2025;126(4):102122.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMsallem B, Sharma N, Cao S, Halbeisen FS, Zeilhofer H-F, Thieringer FM. Evaluation of the Dimensional Accuracy of 3D-Printed Anatomical Mandibular Models Using FFF, SLA, SLS, MJ, and BJ Printing Technology. J CLIN MED. 2020;9(3):817.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwartz-Dabney CL, Dechow PC. Variations in cortical material properties throughout the human dentate mandible. Am J Phys Anthropol. 2003;120(3):252\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLing L, Lai T, Malyala R. Mechanical Properties and Degree of Conversion of a Novel 3D-Printing Model Resin. POLYMERS-BASEL. 2024;16(24):3562.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Shujaat S, Shaheen E, Jacobs R. Quality and haptic feedback of three-dimensionally printed models for simulating dental implant surgery. J Prosthet Dent. 2024;131(4):660\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBockmann R, Schon P, Frotscher M, Eggeler G, Lethaus B, Wolff K. Pilot study of modification of the bilateral sagittal split osteotomy (BSSO) in pig mandibles. J Craniomaxillofac Surg. 2011;39(3):169\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatish P, Kumaran P, Manikandan G, Anuradha V, BalaMurugan R, Kumar A. A novel modification of the sagittal split osteotomy as an access osteotomy. Ann Maxillofac Surg. 2020;10(2):463.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bilateral sagittal split ramus osteotomy (BSSRO), Split patterns, Hunsuck, Bad split","lastPublishedDoi":"10.21203/rs.3.rs-9236308/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9236308/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBilateral sagittal split ramus osteotomy (BSSRO) is a widely used technique for mandibular correction; however, controlling fracture propagation and preventing unfavorable splits remain major challenges. Adjunctive osteotomy lines, including inferior border cuts and lingual vertical cuts, have been proposed to improve predictability, yet their optimal design and dimensions remain controversial. This study aimed to evaluate how variations in the length of the inferior border cut (fourth osteotomy line) and lingual vertical osteotomy line (fifth osteotomy line) influence splitting mechanics and fracture outcomes during BSSRO.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eCone beam computed tomography (CBCT) data from patients with three mandibular angle types (ectropion, upright, and involution) were imported into a 3D segmentation software. Virtual mandibular models were reconstructed and fabricated via additive manufacturing, yielding 33 models (11 per type). 15 freshly isolated porcine mandibles were used for validation. A custom stainless steel test rig with fixed and movable fixtures was designed to standardize the splitting process. A digital torque gauge attached to a chisel continuously recorded real-time torque during osteotomy. Additional osteotomy lines were created: inferior border cuts (fourth line, 5\u0026ndash;20 mm) and lingual vertical cuts (fifth line, 5\u0026ndash;10 mm). Both sides of each mandible served as self-controls. Torque values, fracture patterns, and \u0026ldquo;bad split\u0026rdquo; incidence were analyzed using two-way analysis of variance, t-tests, and Cochran\u0026ndash;Mantel\u0026ndash;Haenszel tests, with significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eApplication and incremental lengthening of the additional osteotomy lines significantly reduced the torque required for mandibular splitting (from 1.608 to 0.461 Nm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and decreased the incidence of \u0026ldquo;bad splits.\u0026rdquo; No significant association was observed between mandibular angle type and torque requirements.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eExtending the inferior border cut up to 20 mm improves the predictability and safety of BSSRO by reducing torque demands and minimizing unfavorable fractures.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003enot applicable.\u003c/p\u003e","manuscriptTitle":"Effect of Inferior Border and Lingual Vertical Osteotomy Line Length on Splitting Mechanics in Bilateral Sagittal Split Ramus Osteotomy: A Biomechanical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-05 17:11:05","doi":"10.21203/rs.3.rs-9236308/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af50f9db-598b-4ffc-9167-f04af1fee0f6","owner":[],"postedDate":"April 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T08:54:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-05 17:11:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9236308","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9236308","identity":"rs-9236308","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}