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Telha W, Chen H, Al-Watary MQ, Sakran K, Wang Q, Zhu S, Jiang N. 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. Med Eng Phys 2024; 129:104176. [PMID: 38906569 DOI: 10.1016/j.medengphy.2024.104176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 06/23/2024]
Abstract
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.
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Affiliation(s)
- Wael Telha
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Haozhe Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mohammed Qasem Al-Watary
- Oral and Maxillofacial Surgery Center, Guangdong Hanfei Plastic Surgery Hospital, Guangzhou City, Guangdong, China
| | - Karim Sakran
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Guerra RC, de Fátima Borim Pulino B, Salomão Júnior VF, Dos Santos Pereira R, Thieringer FM, Sacco R, Sader R, Vieira EH. Finite element analysis of low-profile reconstruction plates for atrophic mandibles: a comparison of novel 3D grid and conventional plate designs. Oral Maxillofac Surg 2024; 28:595-603. [PMID: 37516667 DOI: 10.1007/s10006-023-01173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES This study aimed to compare the reconstruction with type 2.4 and three-dimensional (3D) grid plates relating the areas of weakness to anatomical regions of force incidence in atrophic mandibles with and without segmentation using finite element analysis (FEA). MATERIALS AND METHODS Strength and force quality in the mandible were also determined. The atrophic mandible models with and without segmentation were divided into four groups, and the behavior of each plate was analyzed using finite element analysis. In the atrophic mandible without segmentation using the type 2.4 reconstruction plate, the highest stress concentration in the plate was observed in the posterior region of the mandibular body and in the grid type 3D reconstruction plate was observed in the mandibular angle. RESULTS In the segmented atrophic mandible with the 2.4 reconstruction plate, higher stress concentration was observed in the mandibular segment defect. Analysis of the 3D grid-like reconstruction plate revealed that the geometry of the plate conferred greater stiffness to the assembly, as the most significant stress concentration was observed at the mandibular angle. CONCLUSION The width of the plate design may influence the strength, not the thickness.
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Affiliation(s)
- Raphael Capelli Guerra
- Research and Education Institute - Hospital Sírio Libanes, DASA/Leforte Group, São Paulo State University Araraquara - UNESP, São Paulo Metodista University, São Paulo, Brazil
| | - Bianca de Fátima Borim Pulino
- Research and Education Institute, Hospital Sírio Libanes; São Paulo State University Araçatuba; DASA/Leforte Group, São Paulo Metodista University, Praça Francisco Manuel, 72, São Paulo, 01541-020, Brazil.
| | | | | | | | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, London, UK
| | - Robert Sader
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt Am Main, Frankfurt, Hessen, Germany
| | - Eduardo Hochuli Vieira
- DASA/Leforte Group, Research and Education Institute, Hospital Sírio Libanes; São Paulo State University - UNESP, Araraquara, Brazil
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Grillo R, Quinta Reis BA, Lima BC, Peral Ferreira Pinto LA, Cruz Meira JB, Melhem-Elias F. The butterfly effect in oral and maxillofacial surgery: Understanding and applying chaos theory and complex systems principles. J Craniomaxillofac Surg 2024; 52:652-658. [PMID: 38582679 DOI: 10.1016/j.jcms.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024] Open
Abstract
The present paper provides a historical context for chaos theory, originating in the 1960s with Edward Norton Lorenz's efforts to predict weather patterns. It introduces chaos theory, fractal geometry, nonlinear dynamics, and the butterfly effect, highlighting their exploration of complex systems. The authors aim to bridge the gap between chaos theory and oral and maxillofacial surgery (OMFS) through a literature review, exploring its applications and emphasizing the prevention of minor deviations in OMFS to avoid significant consequences. A comprehensive literature review was conducted on PubMed, Web of Science, and Google Scholar databases. The selection process adhered to the PRISMA-ScR guidelines and Leiden Manifesto principles. Articles focusing on chaos theory principles in health sciences, published in the last two decades, were included. The review encompassed 37 articles after screening 386 works. It revealed applications in outcome variation, surgical planning, simulations, decision-making, and emerging technologies. Potential applications include predicting infections, malignancies, dental fractures, and improving decision-making through disease prediction systems. Emerging technologies, despite criticisms, indicate advancements in AI integration, contributing to enhanced diagnostic accuracy and personalized treatment strategies. Chaos theory, a distinct scientific framework, holds potential to revolutionize OMFS. Its integration with advanced techniques promises personalized, less traumatic surgeries and improved patient care. The interdisciplinary synergy of chaos theory and emerging technologies presents a future in which OMFS practices become more efficient, less traumatic, and achieve a level of precision never seen before.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília-DF, Brazil.
| | | | - Bernardo Correia Lima
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Department of Oral and Maxillofacial Surgery and Diagnosis, Hospital da Boca, Santa Casa da Misericórdia do Rio de Janeiro, RJ, Brazil
| | | | - Josete Barbosa Cruz Meira
- Department of Biomaterials and Oral Biology, University of São Paulo School of Dentistry, São Paulo-SP, Brazil
| | - Fernando Melhem-Elias
- Department of Oral and Maxillofacial Surgery, University of São Paulo School of Dentistry, São Paulo-SP, Brazil; Private Practice in Oral and Maxillofacial Surgery, São Paulo-SP, Brazil
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Lee MY, Park JH, Park SJ, Chang NY, Chae JM. A finite element analysis of stress distribution with various directions of intermaxillary fixation using orthodontic mini-implants and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy. Orthod Craniofac Res 2024; 27:102-109. [PMID: 37496461 DOI: 10.1111/ocr.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This finite element analysis (FEA) aimed to assess the stress distribution in the mandible and fixation system with various directions of the intermaxillary fixation (IMF) using mini-implants (MIs) and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy (BSSRO). MATERIALS AND METHODS A total of nine mandibular advancement models were set according to the position of the MIs (1.6 mm in diameter, 8 mm in length) and direction of the IMF elastics (1/4 inch, 5 oz). Major and minor principal stresses in the cortical and cancellous bones, von Mises stresses in the fixation system (miniplate and monocortical screws), and bending angles of the miniplate were analysed. RESULTS Compressive and tensile stress distributions in the mandible and von Mises stress distributions in the fixation system were greater in models with a Class III IMF elastic direction and a higher IMF elastic force than in models with a Class II IMF elastic direction and a lower IMF elastic force. The bending angle of the miniplate was negligible. CONCLUSIONS Stress distributions in the bone and fixation system varied depending on the direction, amount of force, and position of IMF elastics and MIs. Conclusively, IMF elastics in the Class II direction with minimal load in the area close to the osteotomy site should be recommended.
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Affiliation(s)
- Mi-Young Lee
- Department of Orthodontics, Seoul National University Gwan-ak Dental Hospital, Seoul, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona, USA
- Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Sung-Jin Park
- Department of Oral and Maxillofacial Surgery, GangNam CHA Hospital, CHA University School of Medicine, Seoul, South Korea
| | - Na-Young Chang
- Department of Orthodontics, School of Dentistry, University of Wonkwang, Wonkwang Dental Research Institute, Iksan, South Korea
| | - Jong-Moon Chae
- Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona, USA
- Department of Orthodontics, School of Dentistry, University of Wonkwang, Wonkwang Dental Research Institute, Iksan, South Korea
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Banakar VT, Bhandage S, Harish Kumar A, Swennen GRJ. Resistance and Stress Analysis of 3D Plate and Locking Plate Fixation in Bilateral Sagittal Split Osteotomy: A Comparative Finite Element Study. J Maxillofac Oral Surg 2023; 22:856-860. [PMID: 38105832 PMCID: PMC10719441 DOI: 10.1007/s12663-023-01971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/04/2023] [Indexed: 12/19/2023] Open
Abstract
Aim This study evaluates the biomechanical properties of 3D plates and compares it with locking plates, in both set back and advancement models of bilateral sagittal split osteotomy (BSSO) using finite element model analysis. Design A stereolithography model of mandibular structure was imported to hypermesh to create 3D solid finite model. A BSSO was simulated on hemimandibular model and advancement and setback simulations were carried out for a distance of 4, 6, and 8 mm each. 3D plates for the right side and locking plates for the left side were simulated for fixation. Meshing of the model was carried out. After meshing, the model was imported to Ansys V18.1 for analysis of it. Forces simulating the masticatory muscles were applied on both sides. The values for stress and resistance in the screws and plates were measured and the lowest and highest deformation regions were estimated using von Mises analysis. Results The results suggest that the tension and resistance as measured through were better distributed in 3D plates when compared with that of locking plates; the stress concentration was shown to be higher in the locking plates and deformation resistance was greater in 3D plates. Conclusion The application of 3D plating system has found its place in the field of maxillofacial trauma. However, its application in the field of orthognathic surgery is yet to be explored and this study encourages us to conduct in vivo studies.
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Affiliation(s)
- Vinayaka T. Banakar
- Department of Oral and Maxillofacial Surgery, The Oxford Dental College, Bommanahalli, Hosur Road, Bangalore, 560068 India
| | - Supriya Bhandage
- Department of Oral and Maxillofacial Surgery, The Oxford Dental College, Bommanahalli, Hosur Road, Bangalore, 560068 India
| | - A. Harish Kumar
- Department of Oral and Maxillofacial Surgery, The Oxford Dental College, Bommanahalli, Hosur Road, Bangalore, 560068 India
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Grillo R, Al-Moraissi E, Balel Y, Eshghpour M, Samieirad S, Teixeira RG. Oral and maxillofacial literature from Middle East: a bibliometric analysis and list of top-100 most cited articles. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101293. [PMID: 36152971 DOI: 10.1016/j.jormas.2022.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this work is to perform a bibliometric analysis on Middle Eastern oral and maxillofacial surgery through years and to compare the data with previous studies. A list of the top 100 most cited articles was generated. METHODS A Pubmed bibliographic search for literature journals specialized in oral and maxillofacial surgery in the Middle East was performed. A graphic representation of authorship and keywords was created with VOSviewer. Mendeley and Microsoft Excel were used for tabulation and data visualization. A list of the top 100 most cited articles was created using Web of Science. Some statistical tests were performed with a 95% confidence interval, which was considered significant. RESULTS A total of 6,536 articles were retrieved in fifteen selected oral and maxillofacial journals. A moderate correlation between number of publications and total population (R = 0.6052), low correlation with area (R = 0.302291), and a negligible correlation with the Human Development Index (HDI) were found (R = 0.1747). A disparity can be seen in the number of publications by country, leaded by Turkey (46.30%), Israel and Iran (13.68% each). The more common studied topic was oral surgery (25.77%), maxillofacial trauma (16.13%) and oral pathology (10.25%). CONCLUSIONS A useful list of the top 100 most cited articles on oral and maxillofacial surgery from Middle East has been created. Middle East publications on oral and maxillofacial surgery can be considered high quality (IF = 1.879). Some issues on performing an adequate selecting of MeSH keywords were discussed.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil; Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil.
| | - Essam Al-Moraissi
- Department of Oral & Maxillofacial Surgery, Thamar University, Dhamar, Yemen
| | - Yunus Balel
- Department of Oral & Maxillofacial Surgery, Gaziosmanpasa University, Tokat, Turkey
| | - Majid Eshghpour
- Department of Oral & Maxillofacial surgery, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Department of Oral & Maxillofacial surgery, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
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Eshghpour M, Samieirad S, Shooshtari Z, Shams A, Ghadirimoghaddam N. Three Different Fixation Modalities following Mandibular Setback Surgery with Sagittal Split Ramus Osteotomy: A Comparative Study using Three-dimensional Finite Elements Analysis. World J Plast Surg 2023; 12:43-57. [PMID: 37220573 PMCID: PMC10200092 DOI: 10.52547/wjps.12.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/30/2023] [Indexed: 05/25/2023] Open
Abstract
Background The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques. Methods This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022. The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded. Results The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings. Conclusion Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.
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Affiliation(s)
- Majid Eshghpour
- Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran
| | - Abdolrahim Shams
- Oral and Maxillofacial Surgery Depar-tment, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Ghadirimoghaddam
- Oral and Maxillofacial Surgery Depar-tment, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Costa DL, Torres AM, Bergamaschi IP, Kluppel LE, de Oliveira RB, Weber JBB. Assessment of Resorbable and Non-resorbable Fixation Systems in Sagittal Split Ramus Osteotomy: An In vitro Study. J Maxillofac Oral Surg 2022; 21:779-784. [PMID: 36274902 PMCID: PMC9474976 DOI: 10.1007/s12663-021-01581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The internal fixation has been purpose of study for many years, but there is still no consensus on the best method of fixation in relation to resistance for bilateral sagittal split ramus osteotomy (BSSO) using plates. Therefore, the aim of this study was to assess five different methods of osteosynthesis using resorbable and non-resorbable plates and screws in simulated sagittal split osteotomy (SSO) of the mandibular ramus. Materials and Methods SSO was performed in 25 polyurethane synthetic mandibular replicas. The distal segments were moved forward 5 mm, and the specimens were grouped according to the fixation method: Inion resorbable plate, KLS resorbable plate, standard four-hole titanium miniplate (Medartis), two standard four-hole titanium miniplates (Medartis) and an adjustable titanium miniplate (Slider/Medartis). Mechanical evaluation was performed by applying compression loads to first molar using an Instron universal testing machine up to a 5 mm displacement of the segments. Resistance forces were obtained in Newtons (N), and statistical analysis was performed using the software R v. 3.5 with significance level of 0.05. Linear mixed models were used to compare the force required to move each type of plate. Results The results showed that the resistance of SSO was better accomplished using two titanium miniplates and KLS resorbable plate showed the least resistance. However, both titanium and resorbable plates behaved similarly in small displacements, which are most commonly observed in BSSO postoperative time. Conclusion It can be concluded that both resorbable and non-resorbable systems might offer suitable mechanical resistance in the procedures where there are no mechanical postoperative complications.
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Affiliation(s)
- Davani Latarullo Costa
- Oral and Maxillofacial Surgery Department at Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Alexandre Machado Torres
- Oral and Maxillofacial Surgery Department at Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Isabela Polesi Bergamaschi
- Oral and Maxillofacial Surgeon, Private Practice, Rua XV de Novembro 2177 – Alto XV, Curitiba, PR CEP 80.045-125 Brazil
| | - Leandro Eduardo Kluppel
- Oral and Maxillofacial Surgery Department at Federal University of Paraná, Curitiba, PR Brazil
| | - Rogério Belle de Oliveira
- Oral and Maxillofacial Surgery Department At Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS Brazil
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Biomechanical Effects of Different Miniplate Thicknesses and Fixation Methods Applied in BSSO Surgery Under Two Occlusal Conditions. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose
Finite element analysis (FEA) was used to evaluate the effects of different thicknesses, numbers, and positions of the miniplate applied in bilateral sagittal split osteotomy (BSSO) under two occlusal conditions.
Methods
An FEA model of the mandibles was constructed and combined with different thicknesses (0.6 or 1 mm), number (one or two), positions (upper or lower) of a miniplate and was divided into six models. In addition, external forces were applied to the muscles to simulate the intercuspal position (ICP) and right unilateral molar clench. This study used the reaction force of the temporomandibular joints and the stress of the mandible as observation indexes.
Results
The results of this study show that, under ICP, the 0.6 mm lower model generated greater TMJ force reaction compared to the 0.6 mm upper model. The same trend was seen in the 1 mm lower model compared to the 1 mm upper model. Regarding the stress of the bone on the screw-implanted sites, under ICP, screw 10 showed greater stress than screw 2, and screw 11 showed greater stress than screw 3. The stress values of the miniplates showed, under ICP, point 1-c was greater than point 3-c, and point 1-b was greater than point 3-b.
Conclusion
In the case of BSSO mandibular advancement surgery, implanting the miniplate at the upper position can reduce the force on the TMJ and the stress on the distal segment of the mandible. The miniplate can also resist the tensile stress more effectively. In addition, implanting two miniplates with thinner sizes may be an alternative in clinical practice.
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Dumrongwanich O, Chantarapanich N, Patchanee S, Inglam S, Chaiprakit N. Finite element analysis between Hunsuck/Epker and novel modification of Low Z plasty technique of mandibular sagittal split osteotomy. Proc Inst Mech Eng H 2022; 236:646-655. [DOI: 10.1177/09544119221082436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A novel modification of the Low Z plasty (NM-Low Z) technique for bilateral sagittal split osteotomy was recently proposed. The osteotomy line was modified more inferiorly than in the conventional Hunsuck–Epker (HE) approach. The NM-Low Z technique enhances the mandibular setback distance and degree of rotation in severe skeletal discrepancies. This study aimed to investigate the biomechanical behavior under simulated forces, and to compare the NM-Low Z and HE techniques on the mandible with Class III skeletal deformity at 1 week, 3 weeks, and 6 weeks post-operation. Physiological muscular and occlusal loads were simulated using the finite element (FE) method. Stresses on the miniplate, screws, and bone were observed and compared between the two models. The elastic strain at the fracture site was observed for the optimal bone-healing capacity. The NM-Low Z model exhibited a lower stress than the HE model at every stage post-operation. Both models demonstrated elastic strains within the normal range for bone healing. In summary, the biomechanical behavior of the NM-Low Z technique is comparable to that of the conventional EH technique. NM-Low Z could facilitate post-operation skeletal stability by reducing the stress on fixation materials during bone healing.
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Affiliation(s)
- Orawee Dumrongwanich
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Nattapon Chantarapanich
- Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, Thailand
| | - Siripatra Patchanee
- Division of Orthodontics, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Samroeng Inglam
- Division of Oral Diagnostic Science, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Narissaporn Chaiprakit
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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Can S, Basa S, Varol A. Comparison of bicortical, miniplate and hybrid fixation techniques in mandibular advancement and counterclockwise rotation: A finite element analysis study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e7-e14. [PMID: 33848666 DOI: 10.1016/j.jormas.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/28/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to evaluate biomechanical stability and stress distribution of five different fixation types with finite element analysis using 10-mm advancement with or without counterclockwise rotation of the mandible. MATERIALS AND METHODS After sagittal split osteotomy, 10-mm advancement was performed in the first group and 10-mm advancement and 10-degree counterclockwise rotation were performed in the second group. One miniplate (M-1), two-miniplate (M-2), one miniplate and a bicortical screw (H), l-shaped bicortical screw (B-1), and inverted l-shaped bicortical screw (B-2) systems were placed. Totally, 120 N force was applied to the models at a 45-degree angle from the lower edge of the symphysis. RESULTS The highest values on fixation were seen with miniplate, while the mean values were obtained with bicortical screw system. The highest values on bone were achieved using bicortical screws. One miniplate (M-1) showed both the highest and mean displacement. The highest values in counterclockwise-rotated models increased in all parameters, compared to non-rotated models. CONCLUSION In cases in which passive alignment between segments and adequate bone contact are ensured, inverted l-shaped bicortical screw, two-miniplate, or hybrid systems are recommended.
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Affiliation(s)
- Serhat Can
- Specialist, Bahcesehir University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey.
| | - Selcuk Basa
- Professor & Dean, Bahcesehir University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Altan Varol
- Professor, Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
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Evaluation of the effect of mandibular length and height on the sagittal split ramus osteotomy rigid internal fixation techniques: A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:652-657. [DOI: 10.1016/j.jormas.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/24/2022]
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da Silveira MLM, de Oliveira Bueno ML, da Silva JSP, Germano AR. Biomechanical analysis in mandibular advancement and occlusal plane rotation with finite element analysis. Br J Oral Maxillofac Surg 2020; 59:362-367. [PMID: 33358030 DOI: 10.1016/j.bjoms.2020.08.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
We used finite element analysis to assess stress on the cortical bone and plate fixation system, as well as mandibular resistance after sagittal split ramus osteotomy with different mandibular advancements and rotations of the occlusal plane. Three-dimensional mandibular models were obtained, and 6mm and 12mm advancements were planned associated with linear, clockwise, and counter-clockwise rotation of the angle of the occlusal plane. Each model was then fixed with one or two 2.0mm system plates and secured with four monocortical screws. A total of 12 models were built and subjected to a vertical load in the lower central incisor ranging from 50N to 500N in 50N increments. Results showed that the 12mm advancement was associated with higher stress on the bone and plate surface. Additionally, the models fixed with two plates exhibited lower plate stress than those fixed with a single plate. Counter-clockwise rotation of the angle of the mandibular plane in the 6mm advancement caused more plate stress, which did not occur in the 12mm advancement. This analysis has shown that change in the occlusal plane in large mandibular advancements does not act as an additional stress factor. These findings can help to better understand the tensions on bone and plate surfaces in patients who need large mandibular advancements that are associated with a change in the occlusal plane, and will aid better surgical planning.
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Affiliation(s)
| | | | - J S P da Silva
- Department of Dentistry (UFRN). Av. Nilo Peçanha, 620 - Petrópolis, Natal, RN, 59.012-300, Brazil.
| | - A R Germano
- Department of Dentistry (UFRN). Av. Nilo Peçanha, 620 - Petrópolis, Natal, RN, 59.012-300, Brazil.
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de Carvalho PHM, Oliveira SDS, Favaro M, Sverzut CE, Trivellato AE. Which type of method shows the best mechanical behavior for internal fixation of bilateral sagittal split osteotomy in major advancements with clockwise rotation? Comparison of four methods. Oral Maxillofac Surg 2020; 25:27-34. [PMID: 32661574 DOI: 10.1007/s10006-020-00883-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the four methods for bilateral sagittal osteotomy fixation. METHODS In this study, 56 replicas of whole mandibles made of rigid polyurethane were used. After simulation of major advancement (11 mm) with clockwise rotation of the mandible (6o) in relation to the occlusal plane, the bone segments were fixed with plates and screws of the 2.0-mm system on both the right and left sides: group I, double "H" plate; group II, two mini-plates; group III, "hybrid technique"; and group IV, three bicortical screws in the "inverted L" pattern. The mandibles were submitted to load on the central incisors and right first molar. RESULTS The mean value of group I was higher than those of groups IV and II in the displacement of 1 mm (F = 4.705; p = 0.010) with load on the incisor. The mean value of group III was higher than those of groups I and II in the displacement of 1 mm (F = 5.166; p = 0.007) and 3 mm (F = 5.166; p = 0.007). The mean value of group IV was higher than that of group II (F = 3.142; p = 0.044) with load on the molar. CONCLUSION Therefore, after the analyses, the hybrid technique was the one that showed the best results.
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Affiliation(s)
- Pedro Henrique Mattos de Carvalho
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Soraya da Silva Oliveira
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Matheus Favaro
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Avenida do Café, S/N, Ribeirão Preto, SP, 14040-904, Brazil.
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Lisiak-Myszke M, Marciniak D, Bieliński M, Sobczak H, Garbacewicz Ł, Drogoszewska B. Application of Finite Element Analysis in Oral and Maxillofacial Surgery-A Literature Review. MATERIALS 2020; 13:ma13143063. [PMID: 32659947 PMCID: PMC7411758 DOI: 10.3390/ma13143063] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
In recent years in the field of biomechanics, the intensive development of various experimental methods has been observed. The implementation of virtual studies that for a long time have been successfully used in technical sciences also represents a new trend in dental engineering. Among these methods, finite element analysis (FEA) deserves special attention. FEA is a method used to analyze stresses and strains in complex mechanical systems. It enables the mathematical conversion and analysis of mechanical properties of a geometric object. Since the mechanical properties of the human skeleton cannot be examined in vivo, a discipline in which FEA has found particular application is oral and maxillofacial surgery. In this review we summarize the application of FEA in particular oral and maxillofacial fields such as traumatology, orthognathic surgery, reconstructive surgery and implantology presented in the current literature. Based on the available literature, we discuss the methodology and results of research where FEA has been used to understand the pathomechanism of fractures, identify optimal osteosynthesis methods, plan reconstructive operations and design intraosseous implants or osteosynthesis elements. As well as indicating the benefits of FEA in mechanical parameter analysis, we also point out the assumptions and simplifications that are commonly used. The understanding of FEA's opportunities and advantages as well as its limitations and main flaws is crucial to fully exploit its potential.
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Affiliation(s)
- Magdalena Lisiak-Myszke
- Maxillofacial Surgery Ward, Alfa-Med Medical Center, 85-095 Bydgoszcz, Poland
- Correspondence:
| | - Dawid Marciniak
- Faculty of Mechanical Engineering, Department of Manufacturing Technology, UTP University of Science and Technology, 85-796 Bydgoszcz, Poland; (D.M.); (M.B.)
| | - Marek Bieliński
- Faculty of Mechanical Engineering, Department of Manufacturing Technology, UTP University of Science and Technology, 85-796 Bydgoszcz, Poland; (D.M.); (M.B.)
| | - Hanna Sobczak
- Department of Maxillofacial Surgery, Medical University of Gdansk, 80-210 Gdansk, Poland; (H.S.); (Ł.G.); (B.D.)
| | - Łukasz Garbacewicz
- Department of Maxillofacial Surgery, Medical University of Gdansk, 80-210 Gdansk, Poland; (H.S.); (Ł.G.); (B.D.)
| | - Barbara Drogoszewska
- Department of Maxillofacial Surgery, Medical University of Gdansk, 80-210 Gdansk, Poland; (H.S.); (Ł.G.); (B.D.)
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Ergezen E, Akdeniz SS. Evaluation of Stress Distribution of Four Different Fixation Systems at High- and Low-Level Subcondylar Fractures on a Nonhomogenous Finite Element Model. J Oral Maxillofac Surg 2020; 78:1596.e1-1596.e12. [PMID: 32445628 DOI: 10.1016/j.joms.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the present study was to provide insight into a suitable fixation system for subcondylar fractures located at different levels. MATERIALS AND METHODS High and low subcondylar fractures were simulated on a nonhomogenous mandibular model, and rhombic, trapezoid, and lambda plates and 2 miniplates were used for fixation. The stress in the bone and displacement of the fracture site were measured using finite element analysis. RESULTS For both high and low subcondylar fractures, the lowest von Mises stress was measured in the rhombic plate system. For high subcondylar fractures, the highest tension in the cortical bone was measured in the trapezoid plate system, and the highest compression was measured in the rhombic plate system. For low subcondylar fractures, the highest tension in the bone was measured in the rhombic system and the highest compression was measured in the trapezoid system. In both high and low subcondylar fracture models, the least displacement amount was measured in the 2-plate system. CONCLUSIONS The results of the present study have shown that the rhombic plate system might be the proper choice for high subcondylar fractures and the 2-plate system might provide better results for low subcondylar fractures.
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Affiliation(s)
- Ezgi Ergezen
- Specialist, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Başkent University, Ankara, Turkey.
| | - Sıdıka Sinem Akdeniz
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Başkent University, Ankara, Turkey
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Biomechanical Analysis of the Forces Exerted during Different Occlusion Conditions following Bilateral Sagittal Split Osteotomy Treatment for Mandibular Deficiency. Appl Bionics Biomech 2019; 2019:4989013. [PMID: 31281415 PMCID: PMC6589323 DOI: 10.1155/2019/4989013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 11/23/2022] Open
Abstract
The bilateral sagittal split osteotomy (BSSO) technique is commonly used to correct mandibular deficiency. If the patient is exposed to excessive external forces after the procedure, occlusal changes or nonunion may occur. However, previous studies only focused on single external forces on the mandible and did not conduct relevant research on the forces exerted by different occlusion conditions. The main purpose of this study was to use finite element analysis methods to determine the biomechanics of four common occlusion conditions after BSSO surgical treatment. This study constructed a finite element analysis computer model of a miniplate implanted in the lower jaw. The structure of the model consisted of the mandible, miniplate, and screws. In addition, external forces were applied to the superficial masseter, deep masseter, medial pterygoid, anterior temporalis, middle temporalis, and posterior temporalis muscles to simulate the incisal clench, intercuspal position (ICP), right unilateral molar clench (RMOL), and right group function occlusion conditions. Subsequently, this study observed the effects of these conditions on the miniplate, screws, and mandible, including the von Mises stress values. The results showed that all of the different occlusion conditions that this study evaluated placed high stress on the miniplate. In the ICP and RMOL occlusion conditions, the overall mandibular structure experienced very high stress. The screw on the proximal segment near the bone gap experienced high stress, as did the screw on the buccal side. According to the present analysis, although the data were not directly obtained from clinical practice, the finite element analysis could evaluate the trend of results under different external forces. The result of this study recommended that patients without intermaxillary fixation avoid the ICP and RMOL occlusion conditions. It can be used as a pilot study in the future for providing clinicians more information on the biomechanics of implantation.
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Sigua-Rodriguez EA, Caldas RA, Goulart DR, Hemerson de Moraes P, Olate S, Ricardo Barão VA, Ricardo de Albergaria-Barbosa J. Comparative evaluation of different fixation techniques for sagittal split ramus osteotomy in 10 mm advancements. Part two: Finite element analysis. J Craniomaxillofac Surg 2019; 47:1015-1019. [DOI: 10.1016/j.jcms.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/12/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
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Finite Element Simulation of Displacement of the Broken Zygoma and Forces Exerted to the Complex After Fixation with Resorbable and Non-Resorbable One-Point Mini-Plates and Applying Normal or Severe Occlusal Loads. Trauma Mon 2019. [DOI: 10.5812/traumamon.85586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Sigua-Rodriguez EA, de Medeiros RC, Goulart DR, Bomfim-Azevedo VL, Olate S, de Albergaria-Barbosa JR. Comparative evaluation of different fixation techniques of the sagittal split ramus osteotomy in 10 mm advancements: Mechanical testing and screw insertion torque. J Craniomaxillofac Surg 2018; 46:2082-2087. [DOI: 10.1016/j.jcms.2018.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 08/11/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022] Open
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21
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Lei J, Liu H, Li Z, Wang Z, Liu X, Zhao L. Biomechanical comparison of fixation systems in posterior wall fracture of acetabular by finite element analysis. Comput Assist Surg (Abingdon) 2018; 21:117-126. [PMID: 27973947 DOI: 10.1080/24699322.2016.1218052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The use of reconstruction plates and lag screws has been recommended for fractures to the posterior wall of the acetabulum. However, little information about the rigidity of recommended forms of fracture fixation is available. This study aimed to evaluate the biomechanical difference among the fixation systems. METHODS A posterior wall fracture, which is represented by softer elements with lower elastic modulus, was created along an arc of 40-90° about the acetabular rim. Three different fixation systems: screws alone, reconstruction plate with screws, reconstruction plate with T-shaped plates were used to fix the posterior wall fractures to the acetabulum. RESULTS All three fixation system can be used to obtain good functional outcomes. The reconstruction plate with T-shaped plates was beneficial to increasing the effective stiffness, decreasing the stress concentration and enhancing the rigidity of fracture fixation. So this fixation system served an ideal result in the analysis. CONCLUSION Theoretically, the reconstruction plate with T-shaped plates system may reduce many of the risks and limitations compared to the other fixation systems. This fixation system may result in a clinical benefit.
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Affiliation(s)
- Jianyin Lei
- a College of Mechanics , Taiyuan University of Technology , Taiyuan , China
| | - Haibo Liu
- a College of Mechanics , Taiyuan University of Technology , Taiyuan , China
| | - Zhiqiang Li
- a College of Mechanics , Taiyuan University of Technology , Taiyuan , China
| | - Zhihua Wang
- a College of Mechanics , Taiyuan University of Technology , Taiyuan , China
| | - Ximing Liu
- b Department of Orthopedics , Wuhan General Hospital of Guangzhou Command , Wuhan , China
| | - Longmao Zhao
- a College of Mechanics , Taiyuan University of Technology , Taiyuan , China
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22
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Modified hybrid fixation using absorbable plate and screw for mandibular advancement surgery. J Craniomaxillofac Surg 2017; 45:1788-1793. [DOI: 10.1016/j.jcms.2017.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/27/2017] [Accepted: 08/02/2017] [Indexed: 11/19/2022] Open
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Sukegawa S, Kanno T, Manabe Y, Matsumoto K, Sukegawa-Takahashi Y, Masui M, Furuki Y. Biomechanical Loading Evaluation of Unsintered Hydroxyapatite/poly-l-lactide Plate System in Bilateral Sagittal Split Ramus Osteotomy. MATERIALS 2017; 10:ma10070764. [PMID: 28773126 PMCID: PMC5551807 DOI: 10.3390/ma10070764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 11/16/2022]
Abstract
OSTEOTRANS MX® (Takiron Co., Ltd., Osaka, Japan) is a bioactive resorbable maxillofacial osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its effective osteoconductive capacity has been previously documented. However, the mechanical strength of this plate system is unclear. Thus, the aim of this in vitro study was to assess its tensile and shear strength and evaluate the biomechanical intensity of different osteosynthesis plate designs after sagittal split ramus osteotomy by simulating masticatory forces in a clinical setting. For tensile and shear strength analyses, three mechanical strength measurement samples were prepared by fixing unsintered hydroxyapatite/poly-l-lactide composed plates to polycarbonate skeletal models. Regarding biomechanical loading evaluation, 12 mandibular replicas were used and divided into four groups for sagittal split ramus osteotomy fixation. Each sample was secured in a jig and subjected to vertical load on the first molar teeth. Regarding shear strength, the novel-shaped unsintered hydroxyapatite/poly-l-lactide plate had significantly high intensity. Upon biomechanical loading evaluation, this plate system also displayed significantly high stability in addition to bioactivity, with no observed plate fracture. Thus, we have clearly demonstrated the efficacy of this plate system using an in vitro model of bilateral sagittal split ramus osteotomy of the mandible.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Takahiro Kanno
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane 693-8501, Japan.
| | - Yoshiki Manabe
- Admission Center, Kagawa University, Takamatsu, Kagawa 760-0016, Japan.
| | - Kenichi Matsumoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Yuka Sukegawa-Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Masanori Masui
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan.
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Larson BE, Lee NK, Jang MJ, Jo DW, Yun PY, Kim YK. Comparative evaluation of the sliding plate technique for fixation of a sagittal split ramus osteotomy: finite element analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:e148-e152. [PMID: 28153566 DOI: 10.1016/j.oooo.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/07/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study evaluated the stress distribution of the sliding plate (SP) and conventional miniplate (CM) fixation techniques of a sagittal split ramus osteotomy (SSRO) using 3-dimensional (3-D) finite element analysis. STUDY DESIGN Four 3-D finite element models according to the number and shape of screw holes in the plate were simulated, and the von Mises stress was analyzed: SP with 2 round and 2 oval holes (SP-2 R2 O), SP with 2 round and 1 oval holes (SP-2 R1 O), CM with 4 round holes (CM-4 R), and CM with 3 round holes (CM-3 R). RESULTS The fixation technique with CM-4 R showed a better stress distribution than CM-3 R, which in turn showed better results compared to the 2 different SPs. SP-2 R2 O showed the worst stress distribution in the bone and fixation components. CONCLUSIONS The results suggest that the SP-2 R2 O technique increases the stress distribution of the plate and screws, which may reduce the stability of fixation after SSRO.
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Affiliation(s)
- Brent E Larson
- Division of Orthodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Nam-Ki Lee
- Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Moon-Jung Jang
- Department of Orthodontics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Deuk-Won Jo
- Department of Prosthodontics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Pil-Young Yun
- Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Stringhini DJ, Sommerfeld R, Uetanabaro LC, Leonardi DP, Araújo MR, Rebellato NLB, Costa DJD, Scariot R. Resistance and Stress Finite Element Analysis of Different Types of Fixation for Mandibular Orthognathic Surgery. Braz Dent J 2016; 27:284-91. [DOI: 10.1590/0103-6440201600336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 12/06/2015] [Indexed: 05/29/2023] Open
Abstract
Abstract The aim of this study was to evaluate the stress and dislodgement resistance by finite element analysis of different types of fixation in mandibular orthognathic surgery. A 3D solid finite element model of a hemi-mandible was obtained. A bilateral sagittal split osteotomy was simulated and the distal segment was advanced 5 mm forward. After the adjustment and superimposing of segments, 9 different types of osteosynthesis with 2.0 miniplates and screws were simulated: A, one 4-hole conventional straight miniplate; B, one 4-hole locking straight miniplate; C, one 4-hole conventional miniplate and one bicortical screw; D, one 4-hole locking miniplate and 1 bicortical screws; E, one 6-hole conventional straight miniplate; F, one 6-hole locking miniplate; G, two 4-hole conventional straight miniplates; H, two 4-hole locking straight miniplates; and I, 3 bicortical screws in an inverted-L pattern. In each model, forces simulating the masticatory muscles were applied. The values of stress in the plates and screws were checked. The dislodgement resistance was checked at the proximal segment since the distal segment was stable because of the screen at the occlusal tooth. The regions with the lowest and highest displacement were measured. The offset between the osteotomized segments was verified by millimeter intervals. Inverted-L with bicortical screws was the model that had the lowest dislodgment and the model with the lowest tension was the one with two conventional plates. The results suggest that the tension was better distributed in the locking miniplates, but the locking screws presented higher concentration of tension.
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Biomechanical Evaluation of Different Fixation Methods for Mandibular Anterior Segmental Osteotomy Using Finite Element Analysis, Part Two. J Craniofac Surg 2016; 27:36-40. [DOI: 10.1097/scs.0000000000002173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Biomechanical Evaluation of Different Fixation Methods for Mandibular Anterior Segmental Osteotomy Using Finite Element Analysis, Part One. J Craniofac Surg 2016; 27:32-5. [DOI: 10.1097/scs.0000000000002172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:790575. [PMID: 26495033 PMCID: PMC4606186 DOI: 10.1155/2015/790575] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 01/05/2023]
Abstract
This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated.
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Biomechanical Analysis of the Fixation System for T-Shaped Acetabular Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:370631. [PMID: 26495030 PMCID: PMC4606111 DOI: 10.1155/2015/370631] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/24/2015] [Indexed: 12/20/2022]
Abstract
This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2), anterior column plate combined with posterior column screws (P + PS), and anterior column plate combined with quadrilateral area screws (P + QS)) were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS) was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems.
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Oguz Y, Watanabe ER, Reis JM, Spin-Neto R, Gabrielli MA, Pereira-Filho VA. In vitro biomechanical comparison of six different fixation methods following 5-mm sagittal split advancement osteotomies. Int J Oral Maxillofac Surg 2015; 44:984-8. [PMID: 25840861 DOI: 10.1016/j.ijom.2014.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/07/2014] [Accepted: 11/25/2014] [Indexed: 11/27/2022]
Abstract
The sagittal split ramus osteotomy (SSRO) is a surgical technique used widely to treat many congenital and acquired mandibular discrepancies. Stabilization of the osteotomy site and the potential for skeletal relapse after the procedure are still major problems. The aim of this study was to compare the mechanical stability of six methods of rigid fixation in SSRO using a biomechanical test model. Sixty polyurethane replicas of human hemimandibles were divided into six groups. In group I, the osteotomies were fixed with two four-hole titanium miniplates; in group II, with one four-hole miniplate; in group III, with one four-hole miniplate+a bicortical screw; in group IV, with a grid miniplate; in group V, with a four-hole locking miniplate; and in group VI, with a six-hole miniplate. A linear load in the premolar region was applied to the hemimandibles. The resistance forces (N) needed to displace the distal segment by 1, 3, and 5mm were recorded and the data transmitted from the load cell to a computer. One-way analysis of variance with Tukey's post hoc test was performed to compare the means between groups. For the three displacement conditions, there was a strong tendency for the 2.0-mm plate+screw and the grid plate to have higher values.
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Affiliation(s)
- Y Oguz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.
| | - E R Watanabe
- Division of Oral and Maxillofacial Surgery, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
| | - J M Reis
- Department of Prosthodontics, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
| | - R Spin-Neto
- Section of Oral Radiology, Department of Dentistry, Faculty of Health, Aarhus University, Denmark
| | - M A Gabrielli
- Division of Oral and Maxillofacial Surgery, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
| | - V A Pereira-Filho
- Division of Oral and Maxillofacial Surgery, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
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Albougha S, Darwich K, Darwich MA, Albogha MH. Assessment of sagittal split ramus osteotomy rigid internal fixation techniques using a finite element method. Int J Oral Maxillofac Surg 2015; 44:823-9. [PMID: 25766461 DOI: 10.1016/j.ijom.2015.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/10/2014] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
In this study, finite element analysis (FEA) was used to evaluate nine rigid internal fixation techniques for sagittal split ramus osteotomy. To achieve this, a computed tomography (CT) scan of a healthy patient was obtained and used to generate the geometry of a half-mandible. The geometries of bicortical screws, miniplates, and monocortical screws were designed and combined with the mandible in nine models simulating various techniques. Four models used bicortical screws in various arrangements and four used miniplates of various designs. One model represented a hybrid technique. A load of 500 N was applied to the posterior teeth and FEA was applied. The most stable techniques were the hybrid technique and a single straight miniplate, presenting the least displacement among all models. Bicortical screws, while presenting reasonable stability, showed high strain areas near the anterior ramus ridge, superoposterior to the screws, implying a risk of bone fracture in this area. On the other hand, the T-shaped and double Y-shaped miniplates were associated with high von Mises stresses that would impair their rigidity, especially where angles appeared in their designs. We recommend the use of a single straight miniplate because it provides sufficient stable fixation with minimal risks or disadvantages.
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Affiliation(s)
- S Albougha
- Department of Oral and Maxillofacial Surgery, Dental Faculty, Damascus University, Damascus, Syria
| | - K Darwich
- Department of Oral and Maxillofacial Surgery, Dental Faculty, Damascus University, Damascus, Syria
| | - M A Darwich
- Faculty of Technical Engineering, Tartous University, Syria; Faculty of Biomedical Engineering, Al Andalus University for Medical Sciences, Syria
| | - M H Albogha
- Section of Orthodontics and Dentofacial Orthopedics, Dental Graduate School, Kyushu University, Japan; Department of Orthodontics, Faculty of Dental Medicine, Damascus University, Syria.
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Oh JS, Kim SG. In vitro biomechanical evaluation of fixation methods of sagittal split ramus osteotomy in mandibular setback. J Craniomaxillofac Surg 2015; 43:186-91. [DOI: 10.1016/j.jcms.2014.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/09/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022] Open
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de Medeiros RC, de Moura AL, Sawazaki R, Fernandes Moreira RW. Comparative in vitro mechanical evaluation of techniques using a 2.0 mm locking fixation system for simulated fractures of the mandibular body. J Craniomaxillofac Surg 2015; 43:302-5. [PMID: 25573304 DOI: 10.1016/j.jcms.2014.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To perform a comparative evaluation of the mechanical resistance of simulated fractures of the mandibular body which were repaired using different fixation techniques with two different brands of 2.0 mm locking fixation systems. MATERIALS AND METHODS Four aluminum hemimandibles with linear sectioning simulating a mandibular body fracture were used as the substrates and were fixed using the two techniques and two different brands of fixation plate. These were divided into four groups: groups I and II were fixed with one four-hole plate, with four 6 mm screws in the tension zone and one four-hole plate, with four 10 mm screws in the compression zone; and groups III and IV were fixed with one four-hole plate with four 6 mm screws in the neutral zone. Fixation plates manufactured by Tóride were used for groups I and III, and by Traumec for groups II and IV. The hemimandibles were submitted to vertical, linear load testing in an Instron 4411 servohydraulic mechanical testing unit, and the load/displacement (3 mm, 5 mm and 7 mm) and the peak loads were measured. Means and standard deviations were evaluated applying variance analysis with a significance level of 5%. RESULTS The only significant difference between the brands was seen at displacements of 7 mm. Comparing the techniques, groups I and II showed higher mechanical strength than groups III and IV, as expected. CONCLUSION For the treatment of mandibular linear body fracture, two locking plates, one in the tension zone and another in the compression zone, have a greater mechanical strength than a single locking plate in the neutral zone.
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Affiliation(s)
| | | | - Renato Sawazaki
- Department of Oral and Maxillofacial Surgery, Piracicaba Dental School Unicamp, SP, Brazil; Department of Oral and Maxillofacial Surgery, University of Passo Fundo, Rio Grande do Sul, Brazil
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Evaluation of mandibular angle ostectomy using three-dimensional finite element analysis. J Craniofac Surg 2014; 25:e375-8. [PMID: 25006954 DOI: 10.1097/scs.0000000000000868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study was designed to investigate the stress and the displacement distributions of the mandible after mandibular angle ostectomy (MAO) by means of three-dimensional finite element analysis. METHODS On the basis of a female patient with a prominent angle of the mandible, the finite element models were generated by helical computed tomography and related software and were analyzed under muscle forces and 3 kinds of biting conditions, including intercuspal position (ICP), incisal clenching (INC), and right unilateral molar clenching (RMOL). The mandibular stress and displacement distributions were analyzed by Abaqus software. RESULTS In the model of MAO, the increased stress and the decreased displacement was found in ICP, INC, and RMOL at the area of mandibular angle. The stress and the displacement increased in ICP and RMOL, whereas the others remained unchanged in INC at the area of mandibular condylar neck. CONCLUSIONS The results of this study have shown that MAO could alter biomechanical characteristics in the operated mandible, which suggested that a greater hit on face may lead to a higher incidence rate of condyle fracture and a lower incidence rate of angle fracture after MAO.
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Xin P, Jiang B, Dai J, Hu G, Wang X, Xu B, Shen SG. Finite element analysis of type B condylar head fractures and osteosynthesis using two positional screws. J Craniomaxillofac Surg 2014; 42:482-8. [DOI: 10.1016/j.jcms.2013.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/04/2013] [Accepted: 06/05/2013] [Indexed: 11/26/2022] Open
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Valladares-Neto J, Cevidanes LH, Rocha WC, Almeida GDA, Paiva JBD, Rino-Neto J. TMJ response to mandibular advancement surgery: an overview of risk factors. J Appl Oral Sci 2014; 22:2-14. [PMID: 24626243 PMCID: PMC3908759 DOI: 10.1590/1678-775720130056] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022] Open
Abstract
Objective In order to understand the conflicting information on temporomandibular joint
(TMJ) pathophysiologic responses after mandibular advancement surgery, an overview
of the literature was proposed with a focus on certain risk factors. Methods A literature search was carried out in the Cochrane, PubMed, Scopus and Web of
Science databases in the period from January 1980 through March 2013. Various
combinations of keywords related to TMJ changes [disc displacement, arthralgia,
condylar resorption (CR)] and aspects of surgical intervention (fixation
technique, amount of advancement) were used. A hand search of these papers was
also carried out to identify additional articles. Results A total of 148 articles were considered for this overview and, although
methodological troubles were common, this review identified relevant findings
which the practitioner can take into consideration during treatment planning: 1-
Surgery was unable to influence TMJ with preexisting displaced disc and crepitus;
2- Clicking and arthralgia were not predictable after surgery, although there was
greater likelihood of improvement rather than deterioration; 3- The amount of
mandibular advancement and counterclockwise rotation, and the rigidity of the
fixation technique seemed to influence TMJ position and health; 4- The risk of CR
increased, especially in identified high-risk cases. Conclusions Young adult females with mandibular retrognathism and increased mandibular plane
angle are susceptible to painful TMJ, and are subject to less improvement after
surgery and prone to CR. Furthermore, thorough evidenced-based studies are
required to understand the response of the TMJ after mandibular advancement
surgery.
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Affiliation(s)
- José Valladares-Neto
- Federal University of Goiás, School of Dentistry, Department of Orthodontics, GoiâniaGO, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Lucia Helena Cevidanes
- University of Michigan, School of Dentistry, Department of Orthodontics, Ann Arbor, USA, Department of Orthodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Wesley Cabral Rocha
- General Hospital of Goiânia, Department of Oral and Maxillofacial Surgery, GoiâniaGO, Brazil, Department of Oral and Maxillofacial Surgery, General Hospital of Goiânia, Goiânia, GO, Brazil
| | - Guilherme de Araújo Almeida
- Federal University of Uberlândia, School of Dentistry, Department of Orthodontics, UberlândiaMG, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - João Batista de Paiva
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - José Rino-Neto
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Han J, Hou J, Zhou G, Wang C, Fan Y. A histological and biomechanical study of bone stress and bone remodeling around immediately loaded implants. SCIENCE CHINA-LIFE SCIENCES 2014; 57:618-26. [PMID: 24824585 DOI: 10.1007/s11427-014-4657-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Immediate loading (IL) increases the risk of marginal bone loss. The present study investigated the biomechanical response of peri-implant bone in rabbits after IL, aiming at optimizing load management. Ninety-six implants were installed bilaterally into femurs of 48 rabbits. Test implants on the left side created the maximal initial stress of 6.9 and 13.4 MPa in peri-implant bone and unloaded implants on the contralateral side were controls. Bone morphology and bone-implant interface strength were measured with histological examination and push-out testing during a 12-week observation period. Additionally, the animal data were incorporated into finite element (FE) models to calculate the bone stress distribution at different levels of osseointegration. Results showed that the stress was concentrated in the bone margin and the bone stress gradually decreased as osseointegration proceeded. A stress of about 2.0 MPa in peri-implant bone had a positive effect on new bone formation, osseointegration and bone-implant interface strength. Bone loss was observed in some specimens with stress exceeding 4.0 MPa. Data indicate that IL significantly increases bone stress during the early postoperative period, but the load-bearing capacity of peri-implant bone increases rapidly with an increase of bone-implant contact. Favorable bone responses may be continually promoted when the stress in peri-implant bone is maintained at a definite level. Accordingly, the progressive loading mode is recommended for IL implants.
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Affiliation(s)
- JingYun Han
- Key Lab for Biomechanics and Mechanobiology of Ministry of Education, School of Biological and Medical Engineering, Beihang University, Beijing, 100191, China
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Li P, Shen L, Li J, Liang R, Tian W, Tang W. Optimal design of an individual endoprosthesis for the reconstruction of extensive mandibular defects with finite element analysis. J Craniomaxillofac Surg 2014; 42:73-8. [DOI: 10.1016/j.jcms.2013.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022] Open
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Lee JY, Lee JW, Pang KM, Kim HE, Kim SM, Lee JH. Biomechanical evaluation of magnesium-based resorbable metallic screw system in a bilateral sagittal split ramus osteotomy model using three-dimensional finite element analysis. J Oral Maxillofac Surg 2013; 72:402.e1-13. [PMID: 24280169 DOI: 10.1016/j.joms.2013.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the stress distribution of a magnesium (Mg)-based resorbable screw system in a bilateral sagittal split ramus osteotomy (BSSO) and to compare its biomechanical stability with those of titanium (Ti)-based and polymer (IN)-based systems. MATERIALS AND METHODS A 3-dimensional BSSO model (10-mm advancement and setback) was constructed with Mimics. Bicortical screw fixation using Ti, IN, and Mg screws was performed with 4 different geometries of fixation. With an occlusal load of 132 N on the lower first molar, the von Mises stress (VMS) distribution was calculated using ANSYS. RESULTS The VMS distribution of Mg was more similar to that of Ti than to that of IN. In all cases, the highest VMS was concentrated on the screw at the most posterior and superior area. Stress was distributed mainly around the screw holes (cancellous bone) and the retromolar area (cortical bone). In the advancement surgery, fixation with 5 Mg screws (5A-Mg, 99.810 MPa at cortical bone) showed biomechanical stability, whereas fixation with the same number of IN screws did not (5A-IN, 109.021 MPa at cortical bone). In the setback surgery, although the maximum VMSs at cortical bone for Mg, IN, and Ti were lower than 108 MPa (yield strength of cortical bone), Mg screws showed more favorable results than IN screws because the maximum VMSs of Mg at cancellous bone were lower than those of IN. CONCLUSION The Mg-based resorbable screw system is a promising alternative to the IN-based system.
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Affiliation(s)
- Jin-Yong Lee
- Clinical Assistant Professor, Department of Dentistry, Korea University Guro Hospital, Seoul, Korea
| | - Jung-Woo Lee
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, Kyunghee University School of Dentistry, Seoul, Korea
| | - Kang-Mi Pang
- Clinical Assistant Professor, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
| | - Hyoun-Ee Kim
- Professor, Department of Materials Science and Engineering, Seoul National University, Seoul, Korea
| | - Soung-Min Kim
- Associate Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry, Seoul, Korea
| | - Jong-Ho Lee
- Professor, Department of Oral and Maxillofacial Surgery, Seoul National University School of Dentistry, Seoul, Korea.
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Lauria A, Rodrigues DC, Sato FRL, Moreira RWF. Biomechanical strength analysis of mini anchors for the temporomandibular joint. Oral Maxillofac Surg 2013; 18:425-30. [PMID: 24062014 DOI: 10.1007/s10006-013-0431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 09/09/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The usage of mini anchors for the treatment of internal derangements of the temporomandibular joint (TMJ) is considered an innovative treatment, and it has presented excellent clinical results in the stabilization of the articular disc. This study aimed to evaluate, through mechanical tensile testing, the resistance of mini anchors for TMJ articular disc repositioning. MATERIALS AND METHODS Ten thermoplastic polymer poly-ether-ether-ketone (PEEK) mini anchors were tested in artificial polyurethane blocks with a pullout test in a mechanical Instron™ machine, model 4411. The mini anchors were pulled out until failure and the force and displacement were recorded for each specimen. A small standard deviation was noted, which indicated reproducibility. RESULTS The findings indicate that Cillen™ mini anchors presented a mean force at failure up to 46.1 N with similar values in the scientific literature. Nevertheless, further studies should be conducted for a comparison of PEEK mini anchors with other commercially available anchors, in addition to studies related to PEEK, a scarcely known material in the dentistry field.
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Affiliation(s)
- Andrezza Lauria
- Department of Oral and Maxillofacial Surgery, School of Dentistry of Piracicaba, State University of Campinas (UNICAMP), Avenida Limeira, 901, Caixa Postal 52, #191, Areião, 13414-903, Piracicaba, São Paulo, Brazil,
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In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate. Int J Oral Maxillofac Surg 2013; 42:316-20. [DOI: 10.1016/j.ijom.2012.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 07/05/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022]
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Comparison of five different fixation techniques of sagittal split ramus osteotomy using three-dimensional finite elements analysis. Int J Oral Maxillofac Surg 2012; 41:934-41. [DOI: 10.1016/j.ijom.2012.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 01/15/2012] [Accepted: 03/16/2012] [Indexed: 11/21/2022]
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Analysis of Stress Distribution on Fixation of Bilateral Sagittal Split Ramus Osteotomy With Resorbable Plates and Screws Using the Finite-Element Method. J Oral Maxillofac Surg 2012; 70:1434-8. [DOI: 10.1016/j.joms.2011.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/23/2011] [Accepted: 05/23/2011] [Indexed: 11/18/2022]
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Khattak ZG, Benington PC, Khambay BS, Green L, Walker F, Ayoub AF. An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic. J Craniomaxillofac Surg 2012; 40:243-7. [DOI: 10.1016/j.jcms.2011.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 04/06/2011] [Accepted: 04/07/2011] [Indexed: 10/17/2022] Open
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Yun KI, Cho YG, Lee JM, Park YH, Park MK, Park JU. Three-dimensional finite element analysis of the stress distribution and displacement in different fixation methods of bilateral sagittal split ramus osteotomy. J Korean Assoc Oral Maxillofac Surg 2012. [DOI: 10.5125/jkaoms.2012.38.5.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kyoung In Yun
- Department of Oral and Maxillofacial Surgery, St. Paul's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Young-Gyu Cho
- Department of Oral and Maxillofacial Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jong-Min Lee
- Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Yoon-Hee Park
- Department of Oral and Maxillofacial Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Korea
| | - Myung-Kyun Park
- Department of Mechanical Engineering, Myongji University, Seoul, Korea
| | - Je Uk Park
- Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Orthognathic Surgical Planning on Three-Dimensional Stereolithographic Biomodel. J Craniofac Surg 2011; 22:1336-41. [DOI: 10.1097/scs.0b013e31821c930b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zizelmann C, Hammer B, Gellrich NC, Kokemüller H, Bormann KH, Rohner D. In Vitro Biomechanical Comparison of the Effect of Pattern, Inclination, and Size of Positional Screws on Load Resistance for Bilateral Sagittal Split Osteotomy. J Oral Maxillofac Surg 2011; 69:1458-63. [DOI: 10.1016/j.joms.2010.06.199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 06/26/2010] [Indexed: 11/15/2022]
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Stability of osteosynthesis with bicortical screws placed in a triangular shape in mandibular sagittal split 5mm advancement osteotomy: Biomechanical tests. Br J Oral Maxillofac Surg 2010; 48:624-8. [DOI: 10.1016/j.bjoms.2009.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 11/18/2009] [Indexed: 11/21/2022]
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Bohluli B, Motamedi MHK, Bohluli P, Sarkarat F, Moharamnejad N, Tabrizi MHS. Biomechanical Stress Distribution on Fixation Screws Used in Bilateral Sagittal Split Ramus Osteotomy: Assessment of 9 Methods via Finite Element Method. J Oral Maxillofac Surg 2010; 68:2765-9. [DOI: 10.1016/j.joms.2010.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 01/30/2010] [Accepted: 03/04/2010] [Indexed: 11/28/2022]
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Pereira FL, Janson M, Sant'Ana E. Hybrid fixation in the bilateral sagittal split osteotomy for lower jaw advancement. J Appl Oral Sci 2010; 18:92-9. [PMID: 20379687 PMCID: PMC5349032 DOI: 10.1590/s1678-77572010000100015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 06/02/2009] [Indexed: 11/21/2022] Open
Abstract
Miniplate and screw fixation has been widely used in bilateral sagittal split osteotomy, but some issues remain unclear concerning its lack of rigidity when compared to Spiessl's bicortical technique. This paper demonstrates the hybrid fixation technique in a case report. A 34-year-old female patient underwent a double jaw surgery with counter-clockwise rotation of the mandible fixed using the hybrid fixation technique. The patient evolved well in the postoperative period and is still under follow up after 14 months, reporting satisfaction with the results and no significant deviation from the treatment plan up to now. No damage to tooth roots was done, maxillomandibular range of motion was within normality and regression of the inferior alveolar nerve paresthesia was observed bilaterally. The hybrid mandibular fixation is clearly visible in the panoramic and cephalometric control radiographs. It seems that the hybrid fixation can sum the advantages of both monocortical and bicortical techniques in lower jaw advancement, increasing fixation stability without significant damage to the mandibular articulation and the inferior alveolar nerve. A statistical investigation seems necessary to prove its efficacy.
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