Modification of the Bilateral Sagittal Split Osteotomy (BSSO) Technique: Increased Predictability, with Oblique Bone Cut in the Mandibular Basal Cortex - A Technical Note
Elio Hitoshi Shinohara1, Irineu Gregnanin Pedron2*, Ilan Hudson Gomes de Santana3, Denis Zangrando4, Fernando Kendi Horikawa5
1DDS, PhD. Assistant Surgeon, Department of Oral and Maxillofacial Surgery, Hospital Regional de Osasco (SUS/SP). OMF Residency Program and ColosSUS Bucal, Osasco, Brazil.
2DDS, MDS. Professor, Department of Periodontics and Integrated Clinic, School of Dentistry, Centro Universitário Braz Cubas, Mogi das Cruzes, Brazil.
3Undergraduation Student, School of Dentistry, Universidade Federal da Paraíba, João Pessoa, Brazil.
4DDS, MDS. Assistant Surgeon, Department of Oral and Maxillofacial Surgery, Hospital Regional de Osasco (SUS/SP). OMF Residency Program and ColosSUS Bucal, Osasco, Brazil.
5Head. Department of Oral and Maxillofacial Surgery, Hospital Regional de Osasco (SUS/SP). OMF Residency Program and ColosSUS Bucal, Osasco, Brazil.
*Corresponding Author: Irineu Gregnanin Pedron, DDS, MDS. Professor, Department of Periodontics and Integrated Clinic, School of Dentistry, Centro Universitário Braz Cubas, Mogi das Cruzes, Brazil.
https://doi.org/10.58624/SVOADE.2026.07.004
Received: December 29, 2025
Published: January 23, 2026
Citation: Shinohara EH, Pedron IG, Gomes de Santana IH, Zangrando D, Horikawa FK. Modification of the Bilateral Sagittal Split Osteotomy (BSSO) Technique: Increased Predictability, with Oblique Bone Cut in the Mandibular Basal Cortex - A Technical Note. SVOA Dentistry 2026, 7:1, 17-19. doi: 10.58624/SVOADE.2026.07.004
Abstract
Bilateral sagittal split osteotomy (BSSO) is one of the established procedures in orthognathic surgery. Although its original design has been improved over time with the aim of making this technique more predictable and reproducible. Combining several osteotomies in the ramus, angle, and body of the mandible, the BSSO technique is subject to several complications, such as those that alter the sensitivity of the inferior alveolar nerve and unwanted fractures. The literature cites that the latter can occur between 0.2 and 11.4% on each side of the osteotomy. In this group, buccal plate fracture was the most commonly found. Caution is needed when performing corticotomy on the lower edge of the mandible to minimize the risk of unwanted fracture. This technical note suggests a modification to the basal cortical osteotomy, proposing an oblique buccal-lingual cut. In our hands, this modification to the basal osteotomy has become more predictable and safer.
Keywords: Bilateral Sagittal Split Osteotomy; Orthognathic Surgery; Mandible; Fixation; Miniplates.
