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Specialized Implants and Instruments for Orthognathic Surgery

MatrixORTHOGNATHICTM Plating SystemSurgical Technique

MatrixORTHOGNATHICTM Plating System Surgical Technique DePuy Synthes 1

TABLE OF CONTENTS

INTRODUCTION

SURGICAL TECHNIQUE

PRODUCT INFORMATION

REFERENCE

MatrixORTHOGNATHIC Plating System 2

Features and Benefits 4 MatrixORTHOGNATHIC Plate and Screw Color‑Coding 6

AO Principles 7

Indications 8

LeFort I Fixation 9

Sagittal Split Fixation 12

Sagittal Split Plate with Adjustable Slider (optional) 15

Genioplasty Fixation 20

Implants 22

Instruments 26

Trocar System 29

Modules and Accessories 30

MatrixORTHOGNATHIC Plating System 32 References 36

MR Information The MatrixORTHOGNATHIC Plating System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the MatrixORTHOGNATHIC Plating System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

2 DePuy Synthes MatrixORTHOGNATHICTM Plating System Surgical Technique

MatrixORTHOGNATHICTM PLATING SYSTEMSpecialized implants and instruments for orthognathic surgery

The aim of surgical fracture treatment is to reconstruct thebony anatomy and restore its function. According to the AO, internal fixation is distinguished by anatomical reduction,stable fixation, preservation of blood supply, and early, active mobilization.1,2 Plate and screw osteosynthesis has been established and clinically recognized for some time.

Keeping the AO philosophy at its core, the Matrix Family is the new plating platform for internal fixation of the craniomaxillofacial skeleton–addressing neuro, craniofacial, mandibular, and orthognathic surgery. The Matrix Family is a simple, yet comprehensive, system that offers flexibility and ease of use.

Simple• All screws work with all plates within each Matrix Family• One screwdriver for all screws within each Matrix Family• Color‑coding by strength for easy identification

Effective• Low plate‑screw profile, where applicable• Self‑retaining screws/blades• Rounded edges on plates

Efficient• Standardized instrumentation• Reduced inventory for hospitals, without

compromising clinical solutions

INTRODUCTION


MatrixORTHOGNATHIC Plating SystemSpecialized implants and instruments for orthognathic surgery

One screw diameter for all orthognathic indications

Reversible L-plates

Simple yet comprehensive system for orthognathic surgery


MatrixORTHOGNATHIC Screws• One standard screw diameter – 1.85 mm screws (LeFort I, BSSO, genioplasty) – 2.1 mm screws serve as emergency screws• Screw designs include – Self‑drilling (purple) – Self‑tapping (blue) – Emergency (pink)• Screw lengths/thread pitch include – 4 mm–8 mm / 0.6 mm thread pitch – 10 mm–18 mm / 1.0 mm thread pitch• Screw recess designed for – Self‑retention on screwdriver blades – Reduced screwdriver blade cam‑out – Easy screw/blade re‑engagement• Titanium alloy (Ti‑6Al‑7Nb)

Notes: • A 1.55 mm diameter MatrixMIDFACETM Screw is

compatible with the MatrixORTHOGNATHIC Plating System.

• See page 14 for limitations regarding mandibular applications.

FEATURES AND BENEFITS

MatrixORTHOGNATHICTM Plating System• MatrixORTHOGNATHIC is a simple yet comprehensive

system that offers precise implants and instruments for orthognathic surgery

• One standard screw diameter for all orthognathic indications in the midface and mandible

• Reversible plates allow reduced inventory (where applicable)

• Etched lines, in 1 mm increments, on implants provide a visual aid for plate bending (where applicable)

• Color‑coding by strength for easy identification


MatrixORTHOGNATHIC Plates

Maxillary Plates• L‑Plates – Reversible design – Etched lines, in 1 mm increments, to help determine

advancement – Bar width increases as bar length increases – 0.5 mm thick plates (blue) – 0.7 mm thick plates (pink) – 0.8 mm thick plates (gold)• Pre‑bent maxillary plates with 2 mm to 10 mm

advancements are 0.8 mm thick (gold)• Adaption plates in 0.5 mm (blue), 0.7 mm (pink),

and 0.8 mm (gold) thicknesses• I‑Plates in 0.5 mm (blue) and 0.7 mm (pink) thickness• Low profile • Commercially pure titanium

Note: The Maxillary Module will hold up to two thicknesses of L-plates. – 0.5 mm and 0.7 mm thicknesses – 0.5 mm and 0.8 mm thicknesses – 0.7 mm and 0.8 mm thicknesses

Sagittal Split Plates• Adjustable slider plate – Double‑strut design with a low profile – Slider allows intraoperative correction of

occlusion during plate fixation – 0.7 mm thick (pink)• Curved and straight BSSO plates – 6 mm to 12 mm bar lengths – Etched lines, in 1 mm increments, to help

determine advancement – 1.0 mm thick (gold)• Commercially pure titanium

Genioplasty Plates• Pre‑bent chin plates with 4 mm to 10 mm advancements• Etched midline for easy centering • 0.7 mm thick (pink)• Commercially pure titanium

Features and Benefits


The color‑coding of implants in the MatrixORTHOGNATHIC Plating System helps to identify the level of strength. The color‑coding scale for plates and screws conforms to the Matrix Family strength color‑coding scheme.

MatrixORTHOGNATHIC Platesn Blue = 0.5 mm thick plates n Pink = 0.7 mm thick plates n Gold = 0.8 mm thick and greater plates

Note: The Maxillary Module will hold up to two thicknesses of L-plates. – 0.5 mm and 0.7 mm thicknesses – 0.5 mm and 0.8 mm thicknesses – 0.7 mm and 0.8 mm thicknesses

MatrixORTHOGNATHIC Screwsn Blue = 1.85 mm diameter self‑tapping screws n Purple = 1.85 mm diameter self‑drilling screwsn Pink = 2.1 mm diameter self‑tapping emergency screws

Also available: n Silver = 1.55 mm diameter MatrixMIDFACE

Self‑Drilling Screws n Bronze = 1.55 mm diameter MatrixMIDFACE

Self‑Tapping Screws

Note: A 1.55 mm diameter MatrixMIDFACE Screw is compatible with the MatrixORTHOGNATHIC Plating System. See page 14 for limitations regarding mandibular applications.

MatrixORTHOGNATHIC PLATE AND SCREW COLOR‑CODING

0.5 mm 0.7 mm 0.8 mm –1.0 mm

1.3 mm System/ 1.5 mm/2.0 mm System Malleable

1.5 mm System/ 2.0 mm System

+2.0 mm System

MatrixORTHOGNATHIC 1.85 mm ScrewsScrew diameter Lengths Thread pitch Drill bit diameter

1.85 mm 4 mm–8 mm 0.6 mm 1.4 mm

1.85 mm 10 mm–18 mm 1.0 mm 1.4 mm

MatrixORTHOGNATHIC 2.1 mm Screws (emergency)Screw diameter Lengths Thread pitch

2.1 mm 4 mm–8 mm 0.6 mm

2.1 mm 10 mm–18 mm 1.0 mm

MatrixMIDFACE 1.55 mm ScrewsScrew diameter Lengths Thread pitch Drill bit diameter

1.55 mm 4 mm–8 mm 0.6 mm 1.1 mm

1.55 mm 10 mm–12 mm 0.6 mm 1.25 mm

Comparable to the Orthognathic Modular Fixation System


AO PRINCIPLES

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4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1,2

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer‑Verlag; 1991.

2. Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme; 2007.


INDICATIONS

The DePuy Synthes Companies MatrixORTHOGNATHIC Plating System is intended for use in selective trauma of the midface and craniofacial skeleton, craniofacial surgery, reconstructive procedures, and selective orthognathic surgery of the maxilla, mandible, and chin in adolescents* (greater than 12 to 21 years of age) and adults.

Specific Indications for Use:• Fractures of the midface and craniofacial skeleton• LeFort I osteotomies, sagittal split osteotomies,

and genioplasties• Orthognathic surgery including reconstructive procedures

Warnings:• Using an internal fixation system on patients with

active or latent infection may cause potential risks which may include construct failure and deteriora-tion of infection. It is at the physician’s discretion to evaluate the patient’s medical conditions and select a fixation device most appropriate for the individual patient. It is also at the physician’s discretion to con-sider all other necessary treatment methods to effec-tively manage the infection.

• Confirm the quality of bone at the selected plate posi-tion. Using an internal fixation system on patients with insufficient quantity or quality of bone may cause potential risks which may include device loos-ening and construct failure. It is at the physician’s discretion to evaluate the patient’s medical condi-tions and select a fixation device most appropriate for the individual patient.

• While the surgeon must make the final decision on implant removal, we recommend that whenever possible and practical for the individual patient, fixation devices should be removed once their service as an aid to healing is accomplished. Implant removal should be followed by adequate postoperative management to avoid refracture.

• These devices can break during use (when subjected to excessive forces or outside the recommended surgical technique). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the patient, the broken part should be removed.

• Take care to remove all fragments that are not fixated during the surgery.

• Steel may elicit an allergic reaction in patients with hypersensitivity to nickel.

• Instruments and screws may have sharp edges or moving joints that may pinch or tear user’s glove or skin.

Precautions:• Important considerations in achieving quality out-

comes for orthognathic surgery in growing patients include accurate diagnosis, proper treatment plan-ning, and appropriate age sequencing of procedures.3

• Physicians should inform their patients about the implant’s load restrictions and develop a plan for postoperative behavior and increasing physical loads.

• Confirm that plate positioning, drill bit, and screw length allow for adequate clearance of the nerves, tooth buds, and/or tooth roots, and the edge of the bone.

• Confirm the quality of bone at the selected plate position.

• Predrilling is recommended in fractures with dense bone.

• Drill rate should never exceed 1800 RPM. Higher rates can result in thermal necrosis of the bone, soft tissue burns, and an oversized hole to be drilled. The adverse effects of an oversized hole include reduced pullout force, increased ease of the screws stripping in bone, and/or suboptimal fixation.

• Always irrigate during drilling, ensure hole is drilled concentric to plate, and bone debris is removed.

• Avoid drilling over nerve or tooth roots.• Take care while drilling to not damage, entrap, or

tear a patient’s soft tissue or damage critical structures. Be sure to keep drill clear of loose surgical materials.

• Handle devices with care and dispose of worn bone cutting instruments in a sharps container.

• Use the appropriate amount of screws to achieve stable fixation. Stable fixation requires a minimum of 2 screws per segment.

• Tighten screws in a controlled manner. Applying too much torque to the screws may cause screw/plate deformation, or bone stripping.

• Surgical implants must never be reused. An explanted metal implant must never be reimplanted. Even though the device appears undamaged, it may have small defects and internal stress patterns which could lead to breakage.

• After implant placement is complete, irrigate and apply suction for removal of debris potentially generated during implantation.

• Check instruments periodically for wear or damage. Replace worn or damaged instruments prior to use.


LEFORT I FIXATION

1Select plate design

Instrument

03.511.003 Plate Holder for Reversible Matrix Plates

After the osteotomy has been performed and the new position of the maxilla has been established, select the plate shape, quantity, and thickness that best suits the bony anatomy, treatment objective, and quantity and quality of bone.

Oblique L‑plates, 90° L‑plates, and I‑plates are recommended for both medial and lateral buttress fixation.

Pre‑bent maxillary plates are recommended for medial buttress fixation.

Anatomic L‑plates are recommended for lateral buttress fixation.

2Select and form the bending template (optional)

Instruments

03.511.360 – Bending Templates for Matrix Anatomic 03.511.362 L‑plates, 3x3 holes

03.511.363 – Bending Templates for Matrix Oblique 03.511.365 L‑plates, 3x3 holes

03.511.366 – Bending Templates for Matrix 90° L‑Plates, 03.511.368 2x2 holes

Select the appropriate shape and length of bending template according to the plate selection and form it to the bony anatomy.

Precaution: Bending templates should not be used as an implant or drill guide for surgical planning.


3Adapt plate to bone

Instruments

03.503.035 In‑plane Plate Bender for Midface Plates

03.503.038 Plate Bender for Midface Plates (2 required)

03.503.039 Plate Cutter for Midface Plates

Cut and contour the plate according to the bending template and the bony anatomy using the Plate Cutters (03.503.039) and the Plate Benders (03.503.038, 03.503.035) respectively. Bend the plate between the holes as necessary. Ensure the plate is passively adapted to the bone.

Note: • Etched lines, in 1 mm increments, to facilitate bending

and placement.

Precautions: • Damage to developing tooth roots may result in

dento-osseous ankylosis and localized dentoalveolar growth impairment.4

• Confirm that plate positioning, drill bit and screw length allow for adequate clearance of nerves, tooth buds and/or tooth roots, and the edge of the bone.

• Cut the implant adjacent to the screw holes.• Take care to protect soft tissue from trimmed edges.

Warnings: • Do not excessively bend or reverse bend the plates as

it may produce internal stresses which may become the focal point for eventual breakage of the implant.

• Do not alter the bend in the pre-bent plates to achieve more than a 1 mm adjustment in either direction.

LeFort I Fixation


4Fixate plate to bone

Insert proper length 1.85 mm MatrixORTHOGNATHIC Screws to fixate the plate to the underlying bone.

If pilot hole is desired, select the appropriate 1.4 mm diameter drill bit length to allow for the adequate clearance of nerves, tooth buds, and/or tooth roots.

Engage the screw on the blade, align the blade over the cruciform recess, and slowly rotate it counterclockwise until the blade drops into the recess. Firmly press the blade to fully seat it into the screw.

Confirm drill bit length matches screw length.

Note: Self-drilling and self-tapping screws are available.

Precautions: • Confirm that plate positioning, drill bit and screw

length allow for adequate clearance of nerves, tooth buds and/or tooth roots, and the edge of the bone.

• Drill speed rate should never exceed 1,800 rpm, particularly in dense, hard bone.

• Higher drill speed rates can result in: – thermal necrosis of the bone – soft tissue burns – an oversized hole, which can lead to reduced

pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws.

• Always irrigate during drilling to avoid thermal damage to the bone.

• After implant placement is complete, irrigate and apply suction for removal of debris potentially generated during implantation or removal.

• Avoid drilling over nerve or tooth roots. • Take care while drilling to not damage, entrap, or

tear a patient’s soft tissue or damage critical structures. • Be sure to keep drill clear of loose surgical materials. • Handle devices with care and dispose of worn bone

cutting instruments in an approved sharps container. • Use the appropriate amount of screws to achieve

stable fixation for fractures. Stable fixation requires a minimum of two screws per bone segment for osteotomies.

LeFort I Fixation

Warning: Instruments and screws may have sharp edges or moving joints that may pinch or tear user’s glove or skin.


SAGITTAL SPLIT FIXATION


Instrument


After the sagittal split osteotomy, adjust the occlusion and the joint‑bearing segment, and stabilize by intermaxillary fixation.

Select a plate shape that best suits the bony anatomy, treatment objective, and the quantity and quality of bone.

Straight and curved sagittal split plates are available for monocortical screw placement.

The Sagittal Split Plate with Adjustable Slider is also available if intraoperative occlusal adjustments are necessary (see page 15 for technique).

Notes: • For bicortical screw placement, 1.85 mm diameter

MatrixORTHOGNATHIC Screws are available in lengths up to 18 mm (position screws). Predrill using 1.4 mm diameter drill bit without stop.

• The 10 mm to 18 mm length screws have a larger head diameter for better visibility and force transmission.

2Select and form the bending template

Instruments

03.511.369 – Bending Template for Matrix Curved 03.511.372 Sagittal Split Plate

03.511.373 – Bending Template for Matrix Straight 03.511.376 Sagittal Split Plate

Select the appropriate shape and length of bending template according to the plate selection and form it to the bony anatomy.

Precaution: Bending templates should not be used as an implant or drill guide for surgical planning.


3Adapt plate to the bone

Instrument


Contour the plate according to the bending template and make final adjustments to match the bony anatomy using the Bending pliers (03.503.038). Bend the plate between the holes as necessary. Ensure the plate is passively adapted to the bone.

Note: Etched lines, in 1 mm increments, to facilitate bending and placement.




• Cut the implant adjacent to the screw holes.• Take care to protect soft tissue from trimmed edges.

Warning: • Do not excessively bend or reverse bend the plates,

which can produce internal stress which may become the focal point for eventual breakage of the implant.

Sagittal Split Fixation


Sagittal Split Fixation

1

4Fixate plate to the bone

Select the appropriate 1.4 mm diameter drill bit length to allow for the adequate clearance of nerves, tooth buds, and/or tooth roots. Insert the appropriate length 1.85 mm MatrixORTHOGNATHIC Screws to fixate the plate to the underlying bone.


Confirm drill bit length matches screw length.

Precautions: • The 1.55 diameter MatrixMIDFACE Screw is not

recommended for sagittal split fixation.• Confirm that plate positioning, drill bit, and screw




pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws


• After implant placement is complete, irrigate, and apply suction for removal of debris potentially generated during implantation or removal.

• Avoid drilling over nerve or tooth roots. • Take care while drilling to not damage, entrap, or tear

a patient’s soft tissue or damage critical structures. • Be sure to keep drill clear of loose surgical materials. • Handle devices with care and dispose of worn bone

cutting instruments in an approved sharps container. • Use the appropriate amount of screws to achieve

stable fixation for fractures. Stable fixation requires a minimum of two screws per bone segment for osteotomies.



2Select and form the bending template (optional)

Instruments

03.511.377 – Bending Template for Sagittal Split Plate, 03.511.378 with adjustable slider

Select the appropriate length of bending template according to the plate selection and form it to the bony anatomy.

Precaution: Bending templates are not to be used as an implant or drill guide for surgical planning.

SAGITTAL SPLIT PLATE WITH ADJUSTABLE SLIDER (optional)


Instrument


After the sagittal split osteotomy, adjust the occlusion and the joint‑bearing segment, and stabilize by intermaxillary fixation.

Select the appropriate Sagittal Split Plate with Adjustable Slider that best suits the bony anatomy, treatment objective, and the quantity and quality of bone.


3Adapt plate to the bone

Instrument


Contour the plate according to the bending template and bony anatomy using the bending pliers (03.503.038). Bend the plate between the holes as necessary. Ensure the plate is passively adapted to the bone.

Notes: • Etched lines, in 1 mm increments, provide a visual

guide for bending.• Since the slider will not slide in the contoured

section, the plate should be contoured as far proximally as possible.




Warning: • Do not excessively bend or reverse bend the plates as

it may produce internal stresses which may become the focal point for eventual breakage of the implant.

Sagittal Split Plate with Adjustable Slider (optional)


4Primary plate fixation

Select the appropriate 1.4 mm drill bit length to allow for the adequate clearance of nerves, tooth buds, and/or tooth roots.

Fixate the Sagittal Split Plate with Adjustable Slider to the bone by drilling and inserting the proper length 1.85 mm MatrixORTHOGNATHIC Screws in the specified sequence as shown (1–3) (Figure 1). Screws should be placed monocortically.


Precautions: • Confirm that plate positioning, drill bit and screw







• Avoid drilling over nerve or tooth roots. • Take care while drilling to not damage, entrap, or

tear a patient’s soft tissue or damage critical structures. • The 1.5 mm MatrixMIDFACE Screw is not

recommended for sagittal split fixation. • The 2.1 mm self-tapping screw is not recommended

for slider fixation. • Be sure to keep drill clear of loose surgical materials.

Figure 1


23 1

• Handle devices with care and dispose of worn bone cutting instruments in an approved sharps container.

• Use the appropriate amount of screws to achieve stable fixation for fractures. Stable fixation requires a minimum of two screws per bone segment for osteotomies.



5Operative correction of occlusion

Release the intermaxillary fixation and inspect the occlusion.If the occlusion needs adjustment, loosen the screw (3) in the slider plate (Figure 2).

The distal bone segment can now be shifted horizontally and vertically until the occlusion has been corrected.

Retighten the screw (3) in the slider.

The process can be repeated if necessary.

Precaution: Ensure the desired condylar positioning has been achieved.

Figure 2

3



6Final plate fixation

Using the 1.4 mm diameter drill bit to drill, insert the remaining proper length 1.85 mm MatrixORTHOGNATHIC Screws in holes (4) and (5) (Figure 3).


Remove the screw (3) and the slider plate component. Ensure fixation of the mandible is adequate to withstand the sagittal forces.

Warnings:• The slider is strictly for intraoperative use only;

do not leave in-situ.• Previous changes in tempromandibular joint may

affect surgical outcome.• Instruments and screws may have sharp edges or

moving joints that may pinch or tear user’s glove or skin.

Precautions: • Drill speed rate should never exceed 1,800 rpm,

particularly in dense, hard bone. • Higher drill speed rates can result in: – thermal necrosis of the bone – soft tissue burns – an oversized hole, which can lead to reduced




• Avoid drilling over nerve or tooth roots. • Take care while drilling to not damage, entrap,

or tear a patient’s soft tissue or damage critical structures.

• Be sure to keep drill clear of loose surgical materials.

354

Figure 3


• Handle devices with care and dispose of worn bone cutting instruments in an approved sharps container.



2Adapt plate to bone

Instrument


Contour the selected plate to the bone, using the plate benders. Bend the plate between the holes as necessary. Ensure the plate is passively adapted to the bone.

Note: The etched centerline helps with plate alignment on the bone.




Warnings: • Do not excessively bend or reverse bend the plate,

which can produce internal stresses which may become the focal point for eventual breakage of the implant.

• Do not alter the bend in the pre-bent plates to achieve more than a 1 mm adjustment in either direction.

GENIOPLASTY FIXATION


Instrument


After the osteotomy has been performed and the advancement of the distal segment has been established, select the plate design that best suits the bony anatomy, treatment objective, and the quantity and quality of the bone.

The chin plates are available in 4 mm to 10 mm offsets.


3Fix plate to bone

Use a 1.4 mm drill bit to drill, and insert the proper length 1.85 mm diameter MatrixORTHOGNATHIC Screws to fixate the plate to the bone.


Precautions: • Confirm that plate positioning, drill bit, and screw






• After implant placement is complete, irrigate, and apply suction for removal of debris potentially generated during implantation or removal.

• Avoid drilling over nerve or tooth roots. • Take care while drilling to not damage, entrap,

or tear a patient’s soft tissue or damage critical structures.

• The 1.5 mm MatrixMIDFACE Screw is not recommended for genioplasty fixation.

• Be sure to keep drill clear of loose surgical materials. • Handle devices with care and dispose of worn

bone cutting instruments in an approved sharps container.


Genioplasty Fixation



IMPLANTS

Titanium MatrixORTHOGNATHIC Screws

1.85 mm Self-tapping Screws (5/pkg.)

Length (mm)

04.511.204.05 4

04.511.205.05 5

04.511.206.05 6

04.511.208.05 8

04.511.210.05 10, coarse pitch

04.511.212.05 12, coarse pitch

04.511.214.05 14, coarse pitch

04.511.216.05 16, coarse pitch

04.511.218.05 18, coarse pitch

1.85 mm Self-drilling Screws (5/pkg.)

Length (mm)

04.511.224.05 4

04.511.225.05 5

04.511.226.05 6

04.511.228.05 8

2.1 mm Emergency Screws, self-tapping (5/pkg.)

Length (mm)

04.511.234.05 4

04.511.235.05 5

04.511.236.05 6

04.511.238.05 8

04.511.240.05 10, coarse pitch

04.511.242.05 12, coarse pitch

04.511.244.05 14, coarse pitch

04.511.246.05 16, coarse pitch

04.511.248.05 18, coarse pitch

Note: Screws are made of titanium alloy (Ti‑6Al‑7Nb).Plates are made of commercially pure titanium.

For single‑pack screws, change .05 to .01 at end of product number.


Titanium MatrixORTHOGNATHIC Plates

90° L-Plates, 2 x 2 holes, reversible

Type Bar length (mm) Thickness (mm)

04.511.301 short 2 0.5

04.511.302 medium 6 0.5

04.511.303 long 11 0.5

04.511.304 short 2 0.7

04.511.305 medium 6 0.7

04.511.306 long 11 0.7

04.511.307 short 2 0.8

04.511.308 medium 6 0.8

04.511.309 long 11 0.8

Oblique L-Plates, 3 x 3 holes, reversible


04.511.321 short 4 0.5

04.511.322 medium 8 0.5

04.511.323 long 13 0.5

04.511.324 short 4 0.7

04.511.325 medium 8 0.7

04.511.326 long 13 0.7

04.511.327 short 4 0.8

04.511.328 medium 8 0.8

04.511.329 long 13 0.8

Oblique L-Plates, 3 x 4 holes, reversible


04.511.331 short 4 0.5

04.511.332 medium 8 0.5

04.511.334 short 4 0.7

04.511.335 medium 8 0.7

Implants


Implants

Anatomic L-Plates, 3 x 3 holes, reversible


04.511.341 short 4 0.5

04.511.342 medium 8 0.5

04.511.343 long 12 0.5

04.511.344 short 4 0.7

04.511.345 medium 8 0.7

04.511.346 long 12 0.7

04.511.347 short 4 0.8

04.511.348 medium 8 0.8

04.511.349 long 12 0.8

I-Plates, 4 holes

Thickness (mm)

04.511.350 0.5

04.511.370 0.7

Pre-bent Maxillary Plates, 0.8 mm thick

Advancement (mm)

04.511.381 left 2

04.511.382 right 2

04.511.383 left 4

04.511.384 right 4

04.511.385 left 6

04.511.386 right 6

04.511.387 left 8

04.511.388 right 8

04.511.389 left 10

04.511.390 right 10

Adaption Plates, 20 holes

Thickness (mm)

04.503.346 0.5 mm

04.503.376 0.7 mm

04.503.396 0.8 mm


Curved Sagittal Split Plates, 6 holes, 1.0 mm thick

Bar (mm)

04.511.401 6

04.511.402 8

04.511.403 10

04.511.404 12

Straight Sagittal Split Plates, 4 holes, 1.0 mm thick

Bar (mm)

04.511.421 6

04.511.422 8

04.511.423 10

04.511.424 12

Sagittal Split Plates with Adjustable Slider, 4 holes, 0.7 mm thick

Length (mm)

04.511.444 33

04.511.445 40

Chin Plates with Double Bend, 5 holes, 0.7 mm thick

Offset (mm)

04.511.461 4

04.511.462 6

04.511.463 8

04.511.464 10

Implants


SELECTED MatrixORTHOGNATHIC INSTRUMENTS

03.503.034 Mini Plate Holder, long

03.503.035 In‑Plane Plate Bender


03.503.039 Plate Cutter for Midface Plates


Matrix 1.4 mm Drill Bits, J‑latch03.511.244 44.5 mm length, 4 mm stop03.511.246 44.5 mm length, 6 mm stop03.511.248 44.5 mm length, 8 mm stop03.511.252 44.5 mm length, 12 mm stop03.511.310 80 mm length 03.511.320 110 mm length 03.511.330 125 mm length


MatrixMIDFACE Screwdriver Blades, self‑retaining, hex coupling

03.503.201 52 mm03.503.202 76 mm03.503.203 96 mm

Selected MatrixORTHOGNATHIC Instruments


Selected MatrixORTHOGNATHIC Instruments

Screwdriver Handles, with hex coupling311.005 Small311.006 Medium311.007 Large

311.023 Ratcheting Screwdriver Handle

03.511.004 Screwdriver Handle with hex coupling, locking, medium


03.511.009 MatrixORTHOGNATHIC Trocar Drill Guide for 397.213

03.511.340 Matrix 1.4 mm Drill Bit, J‑latch Calibrated for 03.511.009

TROCAR SYSTEM

397.43 2.0 mm Cheek Retractor Ring

397.213 2.0 mm Cannula and Obturator

397.211 Universal Trocar Handle

397.42 2.0 mm Cheek Retractor Blade

397.232 Malleable C‑Retractor


Maxillary Module Assembly 60.511.008 Maxillary Generic Module (with lid) 60.511.009 Maxillary Module Lid

60.511.006 Screw, Drill Bit, Blade Insert, with Recessed Holes

60.511.007* Screw, Drill Bit, Blade Insert, with no Recessed Holes

60.511.011 Pre‑bent Plate Insert

60.511.012 90° and Oblique L‑Plate Insert

60.511.013 Anatomic L and Adaption Plate Insert

MODULES AND ACCESSORIES

*Also available.


Modules and Accessories

Mandible Module Assembly60.511.003 Mandible Generic Module (with lid)60.511.004 Mandible Module Lid

60.511.005 Sagittal Split Plate Insert

60.511.006 Screw, Drill Bit, Blade Insert, with Recessed Holes

60.511.007* Screw, Drill Bit, Blade Insert, with no Recessed Holes

60.511.010 Chin Plate Insert

Instrument Tray 60.511.014 Instrument Tray 60.511.015 Trocar Instrument Insert

*Also available.


Set01.503.514 MatrixORTHOGNATHIC Plating System Set

Graphic Case and Modules60.511.001 Graphic Case (with lid)60.511.002 Graphic Case Lid60.511.003 Mandible Generic Module (with lid)60.511.004 Mandible Module Lid60.511.005 Sagittal Split Plate Insert60.511.006 Screw, Drill Bit, Blade Insert with

Recessed Holes60.511.008 Maxillary Generic Module (with lid)60.511.009 Maxillary Module Lid60.511.010 Chin Plate Insert60.511.011 Pre‑bent Plate Insert60.511.012 90° and Oblique L‑Plate Insert60.511.013 Anatomic L and Adaption Plate Insert60.611.014 Instrument Tray60.511.015 Trocar Instrument Insert

Label Sheets and Screw Length Markers Label Sheets60.511.016 For Maxillary Module60.511.017 For Mandible Module60.511.018 For Instrument Tray60.511.019 For Screw Length Color Chart60.511.020 For MatrixMIDFACE and

MatrixORTHOGNATHIC Strength Gradients

Screw Length Markers, for self‑drilling screws (1/pkg.)

304.104W 4 mm304.105W 5 mm304.106W 6 mm304.108W 8 mm

Screw Length Markers, for self‑tapping screws (10/pkg.)

304.104 4 mm 304.112 12 mm304.105 5 mm 304.114 14 mm304.106 6 mm 304.116 16 mm304.108 8 mm 304.118 18 mm304.110 10 mm

Also Available60.511.007 Screw, Drill Bit, Blade Insert, with

no Recessed Holes

MatrixORTHOGNATHIC PLATING SYSTEM


MatrixORTHOGNATHIC Plating System

Titanium MatrixORTHOGNATHIC Plates 90° L‑Plates, 2 x 2 holes, reversible04.511.301 Short, 0.5 mm thick04.511.302 Medium, 0.5 mm thick04.511.303 Long, 0.5 mm thick04.511.304 Short, 0.7 mm thick04.511.305 Medium, 0.7 mm thick04.511.306 Long, 0.7 mm thick04.511.307 Short, 0.8 mm thick04.511.308 Medium, 0.8 mm thick04.511.309 Long, 0.8 mm thick

Oblique L‑Plates, 3 x 3 holes, reversible04.511.321 Short, 0.5 mm thick04.511.322 Medium, 0.5 mm thick04.511.323 Long, 0.5 mm thick04.511.324 Short, 0.7 mm thick04.511.325 Medium, 0.7 mm thick04.511.326 Long, 0.7 mm thick04.511.327 Short, 0.8 mm thick04.511.328 Medium, 0.8 mm thick04.511.329 Long, 0.8 mm thick

Oblique L‑Plates, 3 x 4 holes, reversible04.511.331 Short, 0.5 mm thick04.511.332 Medium, 0.5 mm thick04.511.334 Short, 0.7 mm thick04.511.335 Medium, 0.7 mm thick

Anatomic L‑Plates, 3 x 3 holes, reversible04.511.341 Short, 0.5 mm thick04.511.342 Medium, 0.5 mm thick04.511.343 Long, 0.5 mm thick04.511.344 Short, 0.7 mm thick04.511.345 Medium, 0.7 mm thick04.511.346 Long, 0.7 mm thick04.511.347 Short, 0.8 mm thick04.511.348 Medium, 0.8 mm thick04.511.349 Long, 0.8 mm thick

I‑Plates, 4 holes04.511.350 0.5 mm thick04.511.370 0.7 mm thick

Note: For single‑pack screws, change .05 to .01 at end of product number.

Titanium MatrixORTHOGNATHIC Screws 1.85 mm Screws, self‑tapping (5/pkg.)04.511.204.05 4 mm04.511.205.05 5 mm04.511.206.05 6 mm04.511.208.05 8 mm04.511.210.05 10 mm, coarse pitch04.511.212.05 12 mm, coarse pitch04.511.214.05 14 mm, coarse pitch04.511.216.05 16 mm, coarse pitch04.511.218.05 18 mm, coarse pitch

1.85 mm Screws, self‑drilling (5/pkg.)04.511.224.05 4 mm04.511.225.05 5 mm04.511.226.05 6 mm04.511.228.05 8 mm

2.1 mm Screws, self‑tapping (5/pkg.)04.511.234.05 4 mm04.511.235.05 5 mm04.511.236.05 6 mm04.511.238.05 8 mm04.511.240.05 10 mm, coarse pitch04.511.242.05 12 mm, coarse pitch04.511.244.05 14 mm, coarse pitch04.511.246.05 16 mm, coarse pitch04.511.248.05 18 mm, coarse pitch



Pre‑bent Maxillary Plates, 0.8 mm thick04.511.381 2 mm advancement, left04.511.382 2 mm advancement, right04.511.383 4 mm advancement, left04.511.384 4 mm advancement, right04.511.385 6 mm advancement, left04.511.386 6 mm advancement, right04.511.387 8 mm advancement, left04.511.388 8 mm advancement, right04.511.389 10 mm advancement, left04.511.390 10 mm advancement, right

Curved Sagittal Split Plates, 6 holes, 1.0 mm thick

04.511.401 6 mm bar04.511.402 8 mm bar04.511.403 10 mm bar04.511.404 12 mm bar

Straight Sagittal Split Plates, 4 holes, 1.0 mm thick

04.511.421 6 mm bar04.511.422 8 mm bar04.511.423 10 mm bar04.511.424 12 mm bar

Sagittal Split Plates with Adjustable Slider, 4 holes, 0.7 mm thick

04.511.444 33 mm04.511.445 40 mm

Chin Plates with Double Bend, 5 holes, 0.7 mm thick

04.511.461 4 mm offset04.511.462 6 mm offset04.511.463 8 mm offset04.511.464 10 mm offset

Titanium MatrixMIDFACE Plates Adaption Plates, 20 holes04.503.346 0.5 mm thick04.503.376 0.7 mm thick04.503.396 0.8 mm thick

Instruments Screwdriver Handles with hex coupling311.005 Small311.006 Medium311.007 Large311.023 Ratcheting Screwdriver Handle,

hex coupling03.511.004 Locking, medium

MatrixMIDFACE Screwdriver Blades, self‑retaining, hex coupling

03.503.201 52 mm03.503.202 76 mm03.503.203 96 mm

03.503.034 Mini Plate Holder, long03.511.003 Plate Holder for Reversible Matrix Plates03.503.035 In‑Plane Bender03.503.038 Plate Bender (2 required)03.503.039 Plate Cutter347.98 Plate Holding Forceps

Matrix 1.4 mm Drill Bits, Stryker J‑latch03.511.244 44.5 mm, 4 mm stop03.511.246 44.5 mm, 6 mm stop03.511.248 44.5 mm, 8 mm stop03.511.252 44.5 mm, 12 mm stop03.511.310 80 mm length03.511.320 110 mm length03.511.330 125 mm length

Trocar System03.511.340 1.4 mm Calibrated Drill Bit, J‑latch 397.211 Universal Trocar Handle397.213 2.0 mm Cannula and Obturator 03.511.009 MatrixORTHOGNATHIC Trocar Drill Guide 397.42 2.0 mm Cheek Retractor Blade397.43 2.0 mm Cheek Retractor Ring 397.232 Malleable C‑Retractor03.503.036 MatrixMANDIBLE Depth Gauge



Titanium MatrixMIDFACE Screws 1.33 mm Titanium MatrixMIDFACE

Screws, self-tapping (3/pkg.)04.503.204.05 4 mm 04.503.205.05 5 mm 04.503.206.05 6 mm 04.503.208.05 8 mm04.503.210.05 10 mm04.503.212.05 12 mm04.503.214.05 14 mm04.503.216.05 16 mm 04.503.218.05 18 mm

1.55 mm Titanium MatrixMIDFACE Screws, self-drilling (5/pkg.)

04.503.224.05 4 mm 04.503.225.05 5 mm 04.503.226.05 6 mm 04.503.228.05 8 mm

*Bending templates cannot be used as drill guides.

Also Available Matrix 1.4 mm Drill Bits03.511.342 Universal Trocar Drill Bit, quick coupling,

Calibrated, (8–18 mm), 100 mm03.511.343 Basic Trocar Drill Bit, J-latch, calibrated,

125 mm

Bending Templates, 0.5 mm thick*03.503.366 For Adaption Plate, 20 holes03.511.360 For Reversible Anatomic L-Plate, short03.511.361 For Reversible Anatomic L-Plate, medium03.511.362 For Reversible Anatomic L-Plate, long03.511.363 For Reversible Oblique L-Plate, short03.511.364 For Reversible Oblique L-Plate, medium03.511.365 For Reversible Oblique L-Plate, long03.511.366 For Reversible 90° L-Plate, short03.511.367 For Reversible 90° L-Plate, medium03.511.368 For Reversible 90° L-Plate, long03.511.369 For Curved Sagittal Split Plate, 6 mm bar03.511.370 For Curved Sagittal Split Plate, 8 mm bar03.511.371 For Curved Sagittal Split Plate, 10 mm bar03.511.372 For Curved Sagittal Split Plate, 12 mm bar03.511.373 For Straight Sagittal Split Plate, 6 mm bar03.511.374 For Straight Sagittal Split Plate, 8 mm bar03.511.375 For Straight Sagittal Split Plate, 10 mm bar03.511.376 For Straight Sagittal Split Plate, 12 mm bar03.511.377 For Sagittal Split Plate with Slider, 33 mm03.511.378 For Sagittal Split Plate with Slider, 40 mm

1.5 mm Drill Bits, Stryker J-latch317.64 44.5 mm length, 4 mm stop317.66 44.5 mm length, 6 mm stop317.68 44.5 mm length, 8 mm stop317.72 44.5 mm length, 12 mm stop317.435 85 mm length, 60 mm stop317.835 110 mm length

Matrix 1.4 mm Drill Bits for 90° Screwdriver03.505.141 13 mm length, 6 mm stop03.505.144 15 mm length, 8 mm stop03.505.147 19 mm length, 12 mm stop03.505.165 21 mm length, 14 mm stop03.505.166 23 mm length, 16 mm stop03.505.167 25 mm length, 18 mm stop

68.505.060 Mini Module for MatrixORTHOGNATHIC, for 90° Screwdriver

For detailed cleaning and sterilizationinstructions, please refer towww.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.


REFERENCES

1. Müller, ME, M. Allgöwer, R. Schneider, H. Willenegger. Manual of Internal Fixation, 3rd edition. Berlin: Springer‑Verlag. 1991.

2. Rüedi, TP, RE. Buckley, CG. Moren. AO Principles of Fracture Management. 2nd expanded ed. 2002. Stuttgart, New York: Thieme.

3. Schendel SA, Wolford LM, Epker BN. Surgical advancement of the mandible in growing children: Treatment results in twelve patients. J Oral Surg. 1976;45.

4. Wolford LM, Karras SC, Mehra P. Considerations for orthognathic surgery during growth, part 2: maxillary deformities. Am J Orthod Dentofacial Orthop. 2001;119:102‑105.

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.

Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.

CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.

Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

Not all products may currently be available in all markets.

© DePuy Synthes 2009–2017. All rights reserved.DSUS/CMF/1114/0249(2) 3/18 DV

Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

Manufactured or distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380

To order (USA): 800‑523‑0322 To order (Canada): 855‑946‑8999

Note: For recognized manufacturer, refer to the product label.

www.depuysynthes.com

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