Skeletal Stability After Mandibular Counterclockwise Rotational Advancement for Correction of Skeletal Class II Deformity—A Systematic Review and Meta-analysis

Objectives: The aim of this systemic review was to compare surgical and postsurgical changes in the mandible after bilateral sagittal split osteotomy (BSSO) with counterclockwise (CCW) rotational advancement. A review of the current available dental literature regarding skeletal stability after mandibular CCW rotational advancement for skeletal Class II deformity was performed using a qualitative and quantitative analysis (meta-analysis). Material and Methods: Five databases were searched: PubMed, MEDLINE (Ovid), Science Direct, Scopus, and Web of Science. The systematic review and meta-analysis addressed the stability of BSSO CCW rotational advancement and the effect of the amount of CCW rotation on skeletal stability after BSSO advancement. Meta-analysis was performed only for studies reporting point B position in mm or mandibular plane angle in degrees before and after surgery and at follow-up. Results: The database search resulted in 284 articles after removal of duplicates, and an additional 3 articles were included from hand searches of the bibliographies of the selected articles and relevant reviews. Eight studies were included in the systematic review; all were retrospective case series, and all used rigid fixation. Only 1 study was of medium quality; all other studies were of low quality. Meta-analysis of 3 studies revealed a mean forward movement of 7.6 mm at point B (95% confidence interval [CI], 4.07 to 11.4), a mean downward movement of 2.6 mm (95% CI, −0.66 to 5.84), and a mean CCW rotation of mandibular plane of 4.3° (95% CI, −6.34 to −2.19) during surgery. After surgery, point B showed a mean backward movement of −0.18 mm (95% CI, −1.30 to 1.14), a mean upward movement of −0.5 mm (95% CI, −3.00 to 1.98), and a mean clockwise rotation of 0.1° (95% CI, −1.76 to 1.91). Conclusions: Meta-analysis showed mandibular CCW rotational advancement is a stable procedure, both horizontally and vertically. However, the conclusions are far from robust due to the small sample size and poor quality of the reviewed studies.