Occlusal load distribution through the cortical and trabecular bone of the human mid-facial skeleton in natural dentition: A three-dimensional finite element study

Comparison of the biomechanical behavior between commercial and 3D-printed patient-specific Ti6Al4V L-Shaped titanium plates following le fort i osteotomy using finite element analysis: A technical Note

OBJECTIVE

To evaluate and compare the biomechanical behavior of three-dimensionally (3D) printed patient-specific Ti6Al4V with commercially made titanium mini plates following Lefort-I osteotomy using finite element analysis.

METHODS

Le Fort I osteotomy was virtually simulated with a 5 mm maxillary advancement and mediolateral rotation in the coronal plane, resulting in a 3 mm gap on the left side's posterior. Two fixation methods were modeled using software to compare 3D-printed Ti6Al4V and commercial titanium mini plates, both featuring a 4-hole l-shape with thicknesses of 0.5 mm and 0.7 mm at the strategic piriform rim and zygomaticomaxillary buttress locations. Using ANSYS R19.2, finite element models were developed to assess the fixation plates and maxilla's stress, strain, and displacement responses under occlusal forces of 125, 250, and 500 N/mm².

RESULTS

This comparative analysis revealed slight variation in stress, strain, and displacement between the two models under varying loading conditions. Stress analysis indicated maximum stress concentrations at the vertical change in the left posterior area between maxillary segments, with the Ti6Al4V model exhibiting slightly higher stress values (187 MPa, 375 MPa, and 750 MPa) compared to the commercial titanium model (175 MPa, 351 MPa, and 702 MPa). Strain analysis showed that the commercial titanium model recorded higher strain values at the bending area of the l-shaped miniplate. Moreover, displacement analysis revealed a maximum of 3 mm in the left posterior maxilla, with the Ti6Al4V model demonstrating slightly lower displacement values under equivalent forces.

CONCLUSION

The maximum stress, strain, and segment displacement of both fixation models were predominantly concentrated in the area of the gap between the maxillary segments. Notably, both fixation models exhibited remarkably close values, which can be attributed to the similar design of the fixation plates.

Stress Trajectory Variations During Occlusal Loading in Human Skull with a Maxillofacial Defect: A Finite Element Analysis

Background and Aim

Biting forces from the teeth are distributed to the facial bones and to the skull through the stress trajectories. The presence of a bony defect in either the maxilla or mandible might lead to variations in the stress distribution. The aim of this study was to evaluate the stress distribution and variations in stress trajectories from biting forces in a human skull with maxillofacial defect using a finite element (FE) model.

Methodology

In this study, a cone beam computed tomography (CBCT) of an adult male patient with a maxillectomy defect consequent to surgical treatment of mucormycosis is evaluated for the stress distribution from the biting forces of the remaining posterior teeth. Finite element model without the mandible was constructed from the patient's CBCT data. Occlusal loading forces of 600 N were applied on each side of the maxillary teeth. Stress trajectories were visualised through the stress distribution pattern.

Results

The results showed deviations in the normal stress distribution during occlusal loading and variations in zygomatic and pterygoid stress trajectories in the maxillofacial and skull regions in our FE model due to the bony defect.

Conclusion

We conclude that a skeletal maxillofacial defect should be reconstructed to resume proper stress distribution during functional forces to maintain a healthy craniofacial skeleton.

Assessment of the Relationship between the Total Occlusal Area of the Human Permanent Upper First and Second Molars and the Robusticity of the Facial Skeleton in Sex-Different Cranial Samples of Homo Sapiens: A Preliminary Study

The aim of this study was to establish whether there is a significant relationship between the total occlusal area (TOCA) of two types of permanent upper molars (first-M¹ and second-M²) and facial robusticity, as well as which of the examined facial regions indicate a relationship concerning the grade of their massiveness with the TOCA of analyzed molars in different sex adult Homo sapiens cranial samples. To obtain the values of the TOCA of the molars (n = 145), a morphometric method was performed based on the calibrated digital images of their occlusal surface using ImageJ software. The grades of the massiveness of six facial regions were assessed using qualitative scales of their expression, and an index of general facial robusticity was calculated. Two types of analyses were performed concerning standardized and non-standardized traits to the facial size, including Spearman's/or Pearson's correlations and partial rank correlations. The obtained results indicated the presence of a positive relationship between the relative TOCA of M²s and the relative general facial robusticity, as well as between the TOCA of both types of molars and the massiveness of trigone region of the facial skeleton in male crania. However, most of the obtained results were not consistent with the assumptions of the "localized masticatory stress hypothesis".

Biomechanical evaluation of Chinese customized three-dimensional printed titanium miniplate in the Lefort I osteotomy: A finite element analysis

Objectives

This work aims to evaluate the biomechanical behavior of Chinese customized three-dimensional (3D) -printed miniplates by means of finite element analysis (FEA).

Methods

A 3D Lefort I osteotomy model was established by Mimics. Two models were established to compare the strain behaviors of customized miniplate and conventional L-shaped miniplate. Hypermesh and ABAQUS were used to establish computer-aided engineering finite element models. The stress distribution on the mini-plates, screws and bone and the relative displacement of the maxilla segments were analyzed by loading postoperative occlusal force.

Results

The displacements for customized mini-plate fixation were notably smaller than L-shaped mini-plate fixation. The maximum stresses on the screws, mini-plates and cortical bone for customized mini-plates were smaller than that for L-shaped miniplates.

Conclusion

Chinese customized 3D-printed miniplates provide better postoperative stability and offer a good alternative to the conventional L-shaped miniplate system.

Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate

BACKGROUND

The objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate).

METHODS

Maxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software.

RESULTS

Under corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model.

CONCLUSIONS

For UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.

Comparative biomechanics of the Pan and Macaca mandibles during mastication: finite element modelling of loading, deformation and strain regimes

The mechanical behaviour of the mandibles of Pan and Macaca during mastication was compared using finite element modelling. Muscle forces were calculated using species-specific measures of physiological cross-sectional area and scaled using electromyographic estimates of muscle recruitment in Macaca. Loading regimes were compared using moments acting on the mandible and strain regimes were qualitatively compared using maps of principal, shear and axial strains. The enlarged and more vertically oriented temporalis and superficial masseter muscles of Pan result in larger sagittal and transverse bending moments on both working and balancing sides, and larger anteroposterior twisting moments on the working side. The mandible of Pan experiences higher principal strain magnitudes in the ramus and mandibular prominence, higher transverse shear strains in the top of the symphyseal region and working-side corpus, and a predominance of sagittal bending-related strains in the balancing-side mandible. This study lays the foundation for a broader comparative study of Hominidae mandibular mechanics in extant and fossil hominids using finite element modelling. Pan's larger and more vertical masseter and temporalis may make it a more suitable model for hominid mandibular biomechanics than Macaca.

Finite element analysis of stress concentration between surface coated implants and non surface coated implants - An in vitro study

Background

To determine qualitative comparison in stress distribution between surface coated implants and non surface coated implants using 2 different lengths and vertical, oblique, and lateral forces.

Material and Methods

3 dimensional finite element study was carried out at first molar site with 4 surface coated and 4 non surface coated implants using mimic 8.11, solid edge 2004, hypermesh 9.0, and ansys12.1 software.

Results

The pattern of stress distribution was almost similar between vertical and oblique loading but varied with lateral loads between surface coated and non surface coated implants. As the length of the implants increased stress concentration had no significant variation between surface coated and non surface coated implants, but had a tendency to increase at the abutment and abutment screw on all 3 forces.

Conclusions

Among the surface coated and non surface implants the pattern of stress distribution was similar signifying that surface coating of implants had no significant role in stress distribution using 3d finite element analysis and within the limitations of this study.

Key words:Surface coating, non surface coating, implants, stress and bone.

Could mastication modify the shape of the orbit? A scannographic study in humans

PURPOSE

Since prehistory, changes of the facial skeleton have been related to the modification of diet. More recent studies have shown changes in the morphology of the mandible and maxilla due to variations of strain during mastication. The temporal muscle (TM) is a strong masticatory muscle, with its insertions extending through the temporal fossa. Our objective is to observe the relations between the TM and the lateral orbital wall (LOW) which could indicate an influence of mastication on the shape of the LOW.

METHODS

We conducted a retrospective study using 100 CT scans. The length of the lateral orbital wall (LLOW), the angle between LOW and the medial orbital wall (MOW), the cross-sectional areas of LOW and of the TMs were measured on both sides of each CT scan. The correlation between TMs and other three parameters was studied by Pearson correlations.

RESULTS

A correlation was found between TMs and LOWs, a lower with LLOW, and a very weak and negative correlation between LOW/MOW angle.

CONCLUSIONS

Anatomical knowledge about TM and investigation of masticatory strains lead us to think that mastication have minimal effect on the morphology of the LOW, only on the frontal process of zygomatic. This may explain, in part, why the LOW is the strongest wall of the orbit.

Functional stability analyses of maxillofacial skeleton bearing cleft deformities

The symmetrically stable craniofacial bony structure supports the complex functions and delicate contour of the face. Congenital craniofacial deformities are often accompanied by bony defects and have been repetitively correlated with compromised dento-maxillary stability, but neither the extent nor the pattern of cleft-related maxillary instability has been explored in detail. Furthermore, it is largely unknown if the bony defect and related instability are correlated with secondary maxillary deformity common among patients with orofacial clefts. With the aid of finite element modeling, we studied the detailed relationship between cleft-related bony defect and maxillary stability under occlusal loading. Craniofacial models were generated based on cone-beam computed tomography data and loaded with mimicked bite forces along the axial axis of each tooth. Our data showed that all cleft models exhibited more asymmetrical deformations under mastication compared with the normal. Models with palatal cleft demonstrated greater asymmetry, greater dental arch contraction, and less maxillary protrusion compared to models with alveolar cleft only. For unilateral cleft models, alveolus on non-cleft side tended to be more protruded and lifted than the cleft side. For bilateral cleft models, the most prominent feature was the seriously contracted alveolar arch and curved and pitched premaxillae. These findings indicated cleft type-specific pattern of maxillary instability, which were largely in accordance with dentoalveolar morphological features among patients. Collectively, our study elucidated the detailed relationship between cleft bony defect and the pattern of maxillary instability, and suggested a prototype for studying the abnormal maxillary and dental arch growth among patients with craniofacial deformities.

BIOMECHANICAL ANALYSIS TO VERIFY THE BUTTRESS THEORY WHEN USING THE ANATOMICAL THIN TITANIUM MESH PLATE FOR ZYGOMATICOMAXILLARY COMPLEX BONE FRACTURE

Objective: The aim of this study was to investigate the biomechanics of the facial skeletal for understanding the buttress after fixation with standard and modified anatomical thin titanium mesh (ATTM) plates by finite element (FE) analysis. Methods: Standard ATTM (SATTM) plate designed as the “L”-shape anticipated to be fixed in the ZMC anterior maxilla and lateral buttress to increase the fixation screw anchoring strength and another modified ATTM (MATTM) plate with a protrusion in the medial side and a slot and barb design in the lateral side to enhance the zygomaticomaxillary/nasomaxillary buttresses and provide precise positioning to the ZMC segments were studied by the FE analysis under masticatory forces with 250[Formula: see text]N. Result: The FE simulation results indicated that the total displacement distribution of the maxillary for ZMC fracture fixation with MATTM plate was smaller than that of SATTM plate. Stress concentration was found at the frontal and alveolar processes of the maxillary bone for SATTM plate fixation. Local vector plots of the first principal stress near the frontal process of the maxillary and zygomaticofacial formen of the zygomatic indicated that the stress flow for MATTM plate fixation was relatively close to nasomaxillary buttress, and the zygomaticomaxillary buttress, respectively. Conclusions: This study concluded that “L”-shape ATTM plate designed with a protrusion in the medial side and a slot and barb design in the lateral side can enhance the zygomaticomaxillary/nasomaxillary buttresses under uniform occlusal condition.

Anatomical Thin Titanium Mesh Plate Structural Optimization for Zygomatic-Maxillary Complex Fracture under Fatigue Testing

This study performs a structural optimization of anatomical thin titanium mesh (ATTM) plate and optimal designed ATTM plate fabricated using additive manufacturing (AM) to verify its stabilization under fatigue testing. Finite element (FE) analysis was used to simulate the structural bending resistance of a regular ATTM plate. The Taguchi method was employed to identify the significance of each design factor in controlling the deflection and determine an optimal combination of designed factors. The optimal designed ATTM plate with patient-matched facial contour was fabricated using AM and applied to a ZMC comminuted fracture to evaluate the resting maxillary micromotion/strain under fatigue testing. The Taguchi analysis found that the ATTM plate required a designed internal hole distance to be 0.9 mm, internal hole diameter to be 1 mm, plate thickness to be 0.8 mm, and plate height to be 10 mm. The designed plate thickness factor primarily dominated the bending resistance up to 78% importance. The averaged micromotion (displacement) and strain of the maxillary bone showed that ZMC fracture fixation using the miniplate was significantly higher than those using the AM optimal designed ATTM plate. This study concluded that the optimal designed ATTM plate with enough strength to resist the bending effect can be obtained by combining FE and Taguchi analyses. The optimal designed ATTM plate with patient-matched facial contour fabricated using AM provides superior stabilization for ZMC comminuted fractured bone segments.

Quantitative evaluation of palatal bone thickness in patients with normal and open vertical skeletal configurations using cone-beam computed tomography

Purpose

To perform a comparative analysis of the palatal bone thickness in Thai patients exhibiting class I malocclusion according to whether they exhibited a normal or open vertical skeletal configuration using cone-beam computed tomography (CBCT).

Materials and Methods

Thirty CBCT images of Thai orthodontic patients (15–30 years of age) exhibiting class I malocclusion with a normal or open vertical skeletal configuration were selected. Palatal bone thickness was measured in a 3.0-mm grid pattern on both the right and left sides. The palatal bone thickness of the normal-bite and open-bite groups was compared using the independent t-test. The level of significance was established at P<.05.

Results

The palatal bone thickness in the normal-bite group ranged from 2.2±1.0 mm to 12.6±4.1 mm. The palatal bone thickness in the open-bite group ranged from 1.9±1.1 mm to 13.2±2.3 mm. The palatal bone thickness was lower at almost all sites in patients with open bite than in those with normal bite. Significant differences were found at almost all anteroposterior sites along the 3 most medial sections (3.0, 6.0, and 9.0 mm lateral to the midsagittal plane) (P<.05).

Conclusion

Class I malocclusion with open vertical skeletal configuration may affect palatal bone thickness, so the placement of temporary anchorage devices or miniscrew implants in the palatal area in such patients should be performed with caution.

Zygomaticomaxillary Morphology and Maxillary Sinus Form and Function: How Spatial Constraints Influence Pneumatization Patterns among Modern Humans

Previous research has suggested that the maxillary sinuses may act as "zones of accommodation" for the nasal region, minimizing the impact of climatic-related changes in nasal cavity breadth on surrounding skeletal structures. However, a recent study among modern human crania has identified that, in addition to nasal cavity breadth, sinus morphology also tracks lateral facial form, especially anterior-posterior positioning of the zygomatics. Here, we expand upon this previous study to further investigate these covariation patterns by employing three samples with distinct combinations of nasal and zygomatic morphologies: Northern Asians (n = 28); sub-Saharan Africans (n = 30); and Europeans (n = 29). For each cranium, 30 landmarks were digitized from CT-rendered models and subsequently assigned to either a midfacial or maxillary sinus "block." Two block partial least squares (2B-PLS) analyses indicate that sinus morphology primarily reflects superior-inferior dimensions of the midface, rather than either nasal cavity breadth or zygomatic position. Specifically, individuals with relatively tall midfacial skeletons exhibit more inferiorly and laterally expanded sinuses compared to those with shorter midfaces. Further, separate across-group and within-group 2B-PLS analyses indicate that regional differences between samples primarily build upon a common pattern of midfacial and sinus covariation already present within each regional group. Allometry, while present, only explains a small portion of the midface-sinus covariation pattern. We conclude that previous findings of larger maxillary sinuses among cold-adapted individuals are not predominantly due to possession of relatively narrow nasal cavities, but to greater maxillary and zygomatic heights. Implications for sinus function and midfacial ontogeny are discussed. Anat Rec, 300:209-225, 2017. © 2016 Wiley Periodicals, Inc.

In vivo bone strain and finite element modeling of a rhesus macaque mandible during mastication

Finite element analysis (FEA) is a commonly used tool in musculoskeletal biomechanics and vertebrate paleontology. The accuracy and precision of finite element models (FEMs) are reliant on accurate data on bone geometry, muscle forces, boundary conditions and tissue material properties. Simplified modeling assumptions, due to lack of in vivo experimental data on material properties and muscle activation patterns, may introduce analytical errors in analyses where quantitative accuracy is critical for obtaining rigorous results. A subject-specific FEM of a rhesus macaque mandible was constructed, loaded and validated using in vivo data from the same animal. In developing the model, we assessed the impact on model behavior of variation in (i) material properties of the mandibular trabecular bone tissue and teeth; (ii) constraints at the temporomandibular joint and bite point; and (iii) the timing of the muscle activity used to estimate the external forces acting on the model. The best match between the FEA simulation and the in vivo experimental data resulted from modeling the trabecular tissue with an isotropic and homogeneous Young's modulus and Poisson's value of 10GPa and 0.3, respectively; constraining translations along X,Y, Z axes in the chewing (left) side temporomandibular joint, the premolars and the m₁; constraining the balancing (right) side temporomandibular joint in the anterior-posterior and superior-inferior axes, and using the muscle force estimated at time of maximum strain magnitude in the lower lateral gauge. The relative strain magnitudes in this model were similar to those recorded in vivo for all strain locations. More detailed analyses of mandibular strain patterns during the power stroke at different times in the chewing cycle are needed.

Review of In Vivo Bone Strain Studies and Finite Element Models of the Zygomatic Complex in Humans and Nonhuman Primates: Implications for Clinical Research and Practice

The craniofacial skeleton is often described in the clinical literature as being comprised of vertical bony pillars, which transmit forces from the toothrow to the neurocranium as axial compressive stresses, reinforced transversely by buttresses. Here, we review the literature on bony microarchitecture, in vivo bone strain, and finite-element modeling of the facial skeleton of humans and nonhuman primates to address questions regarding the structural and functional existence of facial pillars and buttresses. Available bone material properties data do not support the existence of pillars and buttresses in humans or Sapajus apella. Deformation regimes in the zygomatic complex emphasize bending and shear, therefore conceptualizing the zygomatic complex of humans or nonhuman primates as a pillar obscures its patterns of stress, strain, and deformation. Human fossil relatives and chimpanzees exhibit strain regimes corroborating the existence of a canine-frontal pillar, but the notion of a zygomatic pillar has no support. The emerging consensus on patterns of strain and deformation in finite element models (FEMs) of the human facial skeleton corroborates hypotheses in the clinical literature regarding zygomatic complex function, and provide new insights into patterns of failure of titanium and resorbable plates in experimental studies. It is suggested that the "pillar and buttress" model of human craniofacial skeleton function be replaced with FEMs that more accurately and precisely represent in vivo function, and which can serve as the basis for future research into implants used in restoration of occlusal function and fracture repair. Anat Rec, 299:1753-1778, 2016. © 2016 Wiley Periodicals, Inc.

Bite force and dental implant treatment: a short review

Dental implants are placed endosseously, and the bone is the ultimate bearer of the occlusal load. Patients are not uniform in the maximum bite force they can generate. The occlusal biting load in the posterior jaw is usually about three times of that found in the anterior. It is possible for supporting implants to be overloaded by the patients’ biting force, resulting in bone loss and failure of the fixture. Bite force measurement may be an important parameter when planning dental implant treatment. Some patients can generate extreme biting loads that may cause a luxation of the fixture and subsequent loss of osseointegration. A patient with low biting force may be able to have a successful long-term outcome even with poor anatomical bone qualities. Patients with a high bite force capability may have an increased risk for late component fracture or implant failure. There is no correlation of any bite force value that would indicate any overload of a given implant in a given osseous site. Nonetheless, after bite force measurement, a qualitative judgement may be made by the clinician for the selection of an implant diameter and length and prosthetic design.

Morphological Covariation between the Maxillary Sinus and Midfacial Skeleton among Sub-Saharan and Circumpolar Modern Humans

OBJECTIVES

Maxillary sinus volume tracks ecogeographic differences in nasal form and may serve as a zone of accommodation for ontogenetic and evolutionary changes in nasal cavity breadth. However, little is known regarding how sinus volume is distributed within the midface. This study investigates morphological covariation between midfacial and sinus shape to better understand structural and functional relationships between the sinus, midface, and nasal cavity.

METHODS

Cranial and sinus models were rendered from CT scans of modern human samples from two disparate climates: sub-Saharan (South Africans [n = 15], West Africans [n = 17]), and circumpolar (Siberian Buriats [n = 18], Alaskan Inuit [n = 20]). Twenty-five 3D coordinate landmarks were placed on the models and subjected to generalized Procrustes analysis. Two-block partial least squares (2B-PLS) analysis was employed to identify patterns of covariation.

RESULTS

The 2B-PLS analysis indicates PLS1 (58.6% total covariation) relates to height and breadth relationships between the midface, nasal cavity, and maxillary sinus. Significant regional differences in PLS1 scores are evident: circumpolar samples possess taller/narrower noses with taller/wider sinuses compared to sub-Saharan samples. Importantly, PLS1 indicates that sinus breadth is not exclusively related to nasal cavity breadth; variation in lateral sinus expansion toward the zygoma represents an important contributing factor. PLS2 (16%) relates to supero-inferior positioning of the sinus within the midface. Allometric trends, while statistically significant, explain only a small portion of these covariation patterns.

CONCLUSIONS

These results suggest that the maxillary sinus serves as a zone of accommodation at the confluence of multiple facial components, potentially minimizing effects of morphological alterations to certain components on adjacent structures. Am J Phys Anthropol 160:483-497, 2016. © 2016 Wiley Periodicals, Inc.