Digitally Fabricated Interocclusal Wafer Versus Wafer-Less Distal Segment Repositioning for Bilateral Sagittal Split Osteotomy (BSSO) in Skeletal Mandibular Deformities (Randomized Controlled Trial)

Objective: This study aimed to compare the accuracy of condylar positioning between 2 computer-guided orthognathic surgical protocols: a waferless screw hole plate locating (WSL-CPD) technique versus an occlusal splint with distal extending arms (OWDA-CPD) approach. Materials and Methods: Twenty-four patients requiring mandibular orthognathic surgery (class II or III deformities) were randomly allocated into 2 groups (n=12 each). Group I underwent a waferless protocol utilizing 3D-printed osteotomy and screw hole locating guides, while group II received an occlusal splint with distal extensions for condylar positioning. Preoperative and postoperative cone-beam computed tomography (CBCT) scans were used to assess condylar displacement in linear (anteroposterior, mediolateral, vertical) and angular (rotational) dimensions. Statistical analysis was performed using the Mann-Whitney U test. Results: No statistically significant differences were observed between the 2 groups in linear or angular condylar deviations. Median linear deviations in the WSL-CPD group were 0.45 mm (mediolateral), 0.3 mm (anteroposterior), and 0.35 mm (vertical), while the OWDA-CPD group showed 0.35 mm, and 0.2 mm, respectively (all P values>0.05). Angular deviations were also comparable, with median rotational changes below 1 degree in both groups. Conclusion: Both waferless and occlusal splint-based condylar positioning techniques demonstrated similar accuracy in maintaining condylar position postoperatively. The findings suggest that either method can be effectively utilized in orthognathic surgery, with no significant superiority of one approach over the other. Further standardization in measurement protocols is recommended to enhance future comparative studies.