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Carneiro DE, De La Torre Canales G, Lagravère MÓ, Campanha NH, Urban VM, Sánchez-Ayala A. Trial data for precision analysis of a three-dimensional mandibular mechanical advantage. Data Brief 2024; 54:110402. [PMID: 38665154 PMCID: PMC11043836 DOI: 10.1016/j.dib.2024.110402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
The data presented in this manuscript describe craniofacial landmark coordinate values, muscle and load moment arm lengths, and mechanical advantage rates for constructing a three-dimensional model of masticatory muscles. Cone-beam computed tomography scans from 30 subjects (aged 12-19 years, 16 females) were used. Thirty-six craniofacial landmarks were identified. Subsequently, the moment arms for 7 muscles and their corresponding load moment arms at incisor and molar positions were determined. Then, the three-dimensional mechanical advantage for each muscle and tooth position was calculated as the ratio of muscle moment arm to load moment arm. This procedure was repeated three times by a main examiner and once by two other examiners. The Friedman test and the square root of the 'method of moments' variance estimator were used to compare data among examiners and calculate random errors, respectively. Although the values for the craniofacial landmark coordinates and biomechanical variables are very close, differences were found between measurements, especially in the interexaminer comparisons. Values served as the basis for reliability (intraclass correlation coefficient) and errors (average mean of absolute differences) analysis in the research paper titled "A three-dimensional method to calculate mechanical advantage in mandibular function: Intra- and interexaminer reliability study," published in the Journal of Orofacial Orthopedics.
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Affiliation(s)
| | - Giancarlo De La Torre Canales
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Egas Moniz Centre for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
- Department of Dentistry, Ingá University Center, Uningá, Maringá, Paraná, Brazil
| | | | - Nara Hellen Campanha
- Department of Dentistry, University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
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Glovsky TE, Iwasaki LR, Wu Y, Liu H, Liu Y, Sousa Melo SL, Nickel JC. Orthognathic surgery effects on temporomandibular joint compressive stresses. Orthod Craniofac Res 2023; 26 Suppl 1:142-150. [PMID: 37000157 DOI: 10.1111/ocr.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION This study tested orthognathic surgery effects on temporomandibular joint (TMJ) compressive stresses. METHODS Pre- (T1) and post-surgery (T2) cone-beam computed tomography images were collected from consenting subjects aged ≥15 years. Anatomical data were used to measure surgical changes in anteroposterior mandibular position and occlusal plane angle (FH-OP), estimate condylar loading areas (mm2 ) and calculate T1 and T2 TMJ and jaw muscle forces (N) during canine biting via numerical modelling. Analysis of covariance tested for sex and biting angle differences in T2 - T1 TMJ compressive stresses (TMJ force/loading area, MPa). Principal component analyses identified jaw muscle forces that accounted for changes in T2 - T1 TMJ loads. Regression analyses tested the correlations between surgical changes in mandibular position, FH-OP, TMJ loads and muscle forces. RESULTS Of 148 cases screened, 28 females and 16 males provided complete records. Condylar loading areas were significantly smaller (P = .024) for females vs males (124 ± 5 vs 144 ± 7 mm2 ). T2 - T1 differences in TMJ compressive stresses varied by surgical change, biting angle and sex. Overall, the largest increases in TMJ compressive stresses post-surgery were for females with mandibular setbacks where FH-OP angle decreased. T2 - T1 changes in jaw muscle forces had moderate (ipsilateral, λ = 4.59; η2 = 0.071) to large (contralateral, λ = 1.49; η2 = 0.31) effects on TMJ loads. CONCLUSIONS T2 - T1 differences in TMJ compressive stresses during canine biting were affected by surgical changes in mandibular position and occlusal plane angle, biting angle and sex. Surgical changes altered jaw muscle forces for the same biting conditions and, thus, affected TMJ loads and compressive stresses.
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Affiliation(s)
- Taylor E Glovsky
- School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Laura R Iwasaki
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Ying Wu
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Hongzeng Liu
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, 37614, USA
| | - Saulo L Sousa Melo
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Jeffrey C Nickel
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
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Sánchez-Ayala A, Sánchez-Ayala A, Kolodzejezyk RC, Urban VM, Lagravère MÓ, Campanha NH. A three-dimensional method to calculate mechanical advantage in mandibular function : Intra- and interexaminer reliability study. J Orofac Orthop 2023; 84:321-339. [PMID: 35254453 DOI: 10.1007/s00056-022-00378-7] [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: 06/20/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Masticatory muscles are physically affected by several skeletal features. The muscle performance depends on muscle size, intrinsic strength, fiber direction, moment arm, and neuromuscular control. To date, for the masticatory apparatus, only a two-dimensional cephalometric method for assessing the mechanical advantage, which is a measure for the ratio of the output force to the input force in a system, is available. This study determined the reliability and errors of a three-dimensional (3D) mechanical advantage calculation for the masticatory system. METHODS Using cone-beam computed tomography images from teenage patients undergoing orthodontic treatments, 36 craniofacial landmarks were identified, and the moment arms for seven muscles and their load moment arms (biomechanical variables) were determined. The 3D mechanical advantage for each muscle was calculated. This procedure was repeated by three examiners. Reliability was verified using the intraclass correlation coefficient (ICC) and the errors by calculating the absolute differences, variance estimator and coefficient of variation (CV). RESULTS Landmark coordinates demonstrated excellent intra- and interexaminer reliability (ICC 0.998-1.000; p < 0.0001). Intraexaminer data showed errors < 1.5 mm. Unsatisfactory interexaminer errors ranged from 1.51-5.83 mm. All biomechanical variables presented excellent intraexaminer reliability (ICC 0.919-1.000, p < 0.0001; CV < 7%). Interexaminer results were almost excellent, but with lower values (ICC 0.750-1.000, p < 0.0001; CV < 10%). However, the muscle moment arm and 3D mechanical advantage of the lateral pterygoid muscles had ICCs < 0.500 (p < 0.05) and CV < 30%. Intra- and interexaminer errors were ≤ 0.01 and ≤ 0.05, respectively. CONCLUSIONS Both landmarks and biomechanical variables showed high reliability and acceptable errors. The proposed method is viable for the 3D mechanical advantage measure.
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Affiliation(s)
- Alejandro Sánchez-Ayala
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Alfonso Sánchez-Ayala
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil.
| | - Rafaela Cristina Kolodzejezyk
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Vanessa Migliorini Urban
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Manuel Óscar Lagravère
- Department of Dentistry, University of Ponta Grossa, Avenida General Carlos Cavalcanti n° 4748, Bloco M, Sala 64A, 84030-900, Ponta Grossa, Paraná, Brazil
| | - Nara Hellen Campanha
- Orthodontic Graduate Program, University of Alberta, 116 St & 85 Ave, T6G 2R3, Edmonton, Alberta, Canada
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The Retrospective Study of Magnetic Resonance Imaging Signal Intensity Ratio in the Quantitative Diagnosis of Temporomandibular Condylar Resorption in Young Female Patients. J Pers Med 2023; 13:jpm13030378. [PMID: 36983560 PMCID: PMC10057084 DOI: 10.3390/jpm13030378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
According to the literature, there is no reliable and quantitative method available for the diagnosis and prognosis of early or potential temporomandibular joint (TMJ) condylar resorption (CR) thus far. The purpose of this study was to raise a new noninvasive method to quantitatively evaluate condylar quality using the signal intensity ratio (SIR) on magnetic resonance imaging (MRI) in order to assist in the diagnosis of TMJ CR. A retrospective exploratory study was performed to compare the condyle-to-cerebral cortex signal intensity ratios (SIR) on MRI among young female patients. We included 60 patients, and they were divided into three groups: the bilateral normal TMJ group (group 1), the bilateral TMJ anterior disc displacement (ADD) but without CR group (group 2), and the bilateral TMJ anterior disc displacement (ADD) with CR group (group 3). The SIR difference between the three groups was analyzed by the Kruskal–Wallis test (K-W test). The sensitivity, specificity, accuracy, and area under curve (AUC) were calculated by the receiver operating characteristic (ROC) curves. There was high consistency between the surgeon and the radiologist in the evaluation of the magnetic signal intensity with intraclass correlation coefficients of 0.939–0.999. The average SIR was 1.07 in the bilateral normal TMJ group (group 1), 1.03 in the ADD without CR group (group 2), and 0.78 in the ADD with CR group (group 3). It could be found by the K-W test that group 3 was significantly different from group 1 and group 2 (p < 0.05), while there was no significant difference between group 1 and group 2. The optimal critical SIR value was 0.96 for the diagnosis of CR according to the ROC curves and Youden index (p < 0.001, AUC = 0.9). The condyle-to-cerebral cortex SIR can be used as a noninvasive diagnostic tool for the quantitative evaluation of condylar quality and diagnosis and prognosis of CR. SIR ≥ 0.96 indicates a healthy condyle, while SIR < 0.96 is considered the optimal critical value for the diagnosis of CR. These findings are important for personalized and accurate treatment and prognosis prediction.
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Mashkina AA, Chkadua TZ, Ermolin VI, Isaichikova OV, Romanovsky MA. [Condylar displacement following orthognathic surgery]. STOMATOLOGIIA 2022; 101:77-84. [PMID: 36268926 DOI: 10.17116/stomat202210105177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The overview of the current literature in the research of mandibular condyle displacement after orthognathic surgeries was done. The correct postoperative mandibular condyle position is considered as one of the determinants of the stability of treatment results.
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Affiliation(s)
- A A Mashkina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V I Ermolin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - M A Romanovsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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An assessment of surgical and 10-year follow-up vertical changes after contemporary Class II and III orthognathic surgery. Am J Orthod Dentofacial Orthop 2021; 161:e380-e389. [DOI: 10.1016/j.ajodo.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
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Abotaleb BM, Bi R, Liu Y, Jiang N, Telha W, Zhu S. Three-dimensional condylar displacement and remodelling in patients with asymmetrical mandibular prognathism following bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2021; 51:509-517. [PMID: 34446294 DOI: 10.1016/j.ijom.2021.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/25/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
This study aims to assess the postoperative condylar displacement and the long-term condylar remodelling in patients with mandibular prognathism with transverse asymmetry after bilateral sagittal split ramus osteotomy (BSSRO). Forty-one consecutive patients (82 condyles) with a transverse mandibular asymmetry of more than 4 mm without occlusal canting treated by BSSRO were included. The preoperative (T1), immediate postoperative (T2) and long-term follow-up of an average of 16.2 months (T3) spiral computed tomography scans were gathered and processed to measure the condylar displacement and remodelling based on cranial base voxel-based and rigid regional registrations. The statistical analysis revealed that the majority of condyles (T1-T2) were transitionally displaced forwards, downwards and laterally, and were not fully returned to the preoperative position at T3. Condylar lateral displacement was significantly higher on the deviated side (DS) (P = 0.035). Non-deviated side (NDS) condyles were mainly subjected to upward pitch, medial yaw and medial roll compared with downward pitch, lateral yaw and lateral roll on DS. Condylar remodelling at T3 was observed, with the superior and posterior surfaces commonly subjected to bone resorption, whereas the anterior and medial surfaces were commonly subjected to bone apposition. Condylar volumetric changes were relatively comparable on NDS (3 ± 85.2 mm3) and DS (8.3 ± 111.7 mm3) condyles. Age, amount of preoperative asymmetry and follow-up period were not correlated with the condylar remodelling. Transitional and rotational displacements were to some extent significantly correlated with the condylar remodelling on both sides. Consequently, passive condylar seating without torque might prevent the long-term unfavourable condylar remodelling.
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Affiliation(s)
- B M Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - R Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Y Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - N Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - W Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - S Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Shu J, Luo H, Zhang Y, Liu Z. 3D Printing Experimental Validation of the Finite Element Analysis of the Maxillofacial Model. Front Bioeng Biotechnol 2021; 9:694140. [PMID: 34336806 PMCID: PMC8322983 DOI: 10.3389/fbioe.2021.694140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022] Open
Abstract
Contacts used in finite element (FE) models were considered as the best simulation for interactions in the temporomandibular joint (TMJ). However, the precision of simulations should be validated through experiments. Three-dimensional (3D) printing models with the high geometric and loading similarities of the individuals were used in the validation. This study aimed to validate the FE models of the TMJ using 3D printing models. Five asymptomatic subjects were recruited in this study. 3D models of mandible, disc, and maxilla were reconstructed according to cone-beam CT (CBCT) image data. PLA was chosen for 3D printing models from bottom to top. Five pressure forces corresponding to the central occlusion were applied to the 3D printing models. Ten strain rosettes were distributed on the mandible to record the horizontal and vertical strains. Contact was used in the FE models with the same geometries, material properties, loadings, and boundary conditions as 3D printing models to simulate the interaction of the disc-condyle, disc-temporal bone, and upper-lower dentition. The differences of the simulated and experimental results for each sample were less than 5% (maximum 4.92%) under all five loadings. In conclusion, it was accurate to use contact to simulate the interactions in TMJs and upper-lower dentition.
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Affiliation(s)
- Jingheng Shu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Haotian Luo
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Yuanli Zhang
- Department of Medical Technology, Chongqing Three Gorges Medical College, Chongqing, China
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
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Pachnicz D, Stróżyk P. A Biomechanical Analysis of Muscle Force Changes After Bilateral Sagittal Split Osteotomy. Front Physiol 2021; 12:679644. [PMID: 34149457 PMCID: PMC8209381 DOI: 10.3389/fphys.2021.679644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
A basic procedure affecting maxillofacial geometry is the bilateral sagittal split osteotomy. During the surgery, the bony segments are placed in a new position that provides the correct occlusion. Changes in the geometry of the mandible will affect the surrounding structures and will have a significant impact on the functioning of the masticatory system. As a result of the displacement of the bone segment, the biomechanical conditions change, i.e., the load and the position of the muscles. The primary aim of this study was to determine the changes in the values of the muscular forces caused by mandible geometry alteration. The study considered the translation and rotation of the distal segment, as well as rotations of the proximal segments in three axes. Calculations were performed for the unilateral, static loading of a model based on rigid body mechanics. Muscles were modeled as spring elements, and a novel approach was used to determine muscle stiffness. In addition, an attempt was made, based on the results obtained for single displacements separately, to determine the changes in muscle forces for geometries with complex displacements. Based on the analysis of the results, it was shown that changes in the geometry of the mandibular bone associated with the bilateral sagittal split osteotomy will have a significant effect on the values of the masticatory muscle forces. Displacement of the distal segment has the greatest effect from -21.69 to 26.11%, while the proximal segment rotations affected muscle force values to a less extent, rarely exceeding 1%. For Yaw and Pitch rotations, the opposite effect of changes within one muscle is noticed. Changes in muscle forces for complex geometry changes can be determined with a high degree of accuracy by the appropriate summation of results obtained for simple cases.
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Affiliation(s)
- Dominik Pachnicz
- Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Przemysław Stróżyk
- Department of Mechanics, Materials and Biomedical Engineering, Wrocław University of Science and Technology, Wrocław, Poland
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Van den Bempt M, Vinayahalingam S, Han MD, Bergé SJ, Xi T. The role of muscular traction in the occurrence of skeletal relapse after advancement bilateral sagittal split osteotomy (BSSO): A systematic review. Orthod Craniofac Res 2021; 25:1-13. [PMID: 33938136 PMCID: PMC9292715 DOI: 10.1111/ocr.12488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
The aim of this systematic review was (i) to determine the role of muscular traction in the occurrence of skeletal relapse after advancement BSSO and (ii) to investigate the effect of advancement BSSO on the perimandibular muscles. This systematic review reports in accordance with the recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Electronic database searches were performed in the databases MEDLINE, Embase and Cochrane Library. Inclusion criteria were as follows: assessment of relapse after advancement BSSO; assessment of morphological and functional change of the muscles after advancement BSSO; and clinical studies on human subjects. Exclusion criteria were as follows: surgery other than advancement BSSO; studies in which muscle activity/traction was not investigated; and case reports with a sample of five cases or fewer, review articles, meta‐analyses, letters, congress abstracts or commentaries. Of the initial 1006 unique articles, 11 studies were finally included. In four studies, an intervention involving the musculature was performed with subsequent assessment of skeletal relapse. The changes in the morphological and functional properties of the muscles after BSSO were studied in seven studies. The findings of this review demonstrate that the perimandibular musculature plays a role in skeletal relapse after advancement BSSO and may serve as a target for preventive strategies to reduce this complication. However, further research is necessary to (i) develop a better understanding of the role of each muscle group, (ii) to develop new therapeutic strategies and (iii) to define criteria that allow identification of patients at risk.
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Affiliation(s)
- Maxim Van den Bempt
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Michael D Han
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Pachnicz D, Ramos A. Mandibular condyle displacements after orthognathic surgery-an overview of quantitative studies. Quant Imaging Med Surg 2021; 11:1628-1650. [PMID: 33816197 DOI: 10.21037/qims-20-677] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The repositioning of bone segments during orthognathic surgeries often results in mandibular condyle positional changes and can also affect jaw muscles, soft tissues and the temporomandibular joint (TMJ). Condylar displacements are considered as one of the factors of bone remodeling and further skeletal relapse. The quantitative approach is commonly used in comparative analyses and evaluations of the relationships between examined factors. The aim of this study is the overview of the current literature including quantitative analysis in the research of mandibular condyle positional changes as a consequence of orthognathic surgeries. Thirty articles were included in the overview. Most of the articles present a comparative and evaluative analysis of treatment results concerning different surgical approaches, fixation methods or types of skeletal defects. The correlation between condylar displacements and bone remodeling, skeletal relapse and TMJ dysfunctions were considered. The most frequently repeated study variables were: short-term changes, Class III malocclusion, yaw rotation, 3D cephalometry measurements. Quantitative data might be useful in the evaluation of patterns and range of condylar displacements for specific treatment conditions. Available literature concerning the analysed topic is characterized by great heterogeneity with regards to the purpose and methodologies of the studies. More systematic approaches and long-term considerations are needed in future research.
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Affiliation(s)
- Dominik Pachnicz
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - António Ramos
- TEMA, Biomechanics Research Team, Mechanical Engineering Department, University of Aveiro, Aveiro, Portugal
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12
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Ueki K, Yoshizawa K, Saito Y, Takayama A, Baba N, Kimura Y, Koizumi M, Fujimoto K, Iguchi R, Sato M, Osada AH, Moroi A. Evaluation of condylar surface CT values related to condylar height reduction after orthognathic surgery. J Craniomaxillofac Surg 2021; 49:639-648. [PMID: 33994298 DOI: 10.1016/j.jcms.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
This study was performed to evaluate the relationship between condylar height reduction and changes in condylar surface computed tomography (CT) values in jaw deformity patients following orthognathic surgery. Mandibular advancement by sagittal split ramus osteotomy (SSRO) with Le Fort I osteotomy was performed in class II patients, and mandibular setback by SSRO with Le Fort I osteotomy was performed in class III patients. The maximum CT values (pixel values) at five points on the condylar surface and the condylar height, ramus height, condylar square, ramus angle, and gonial angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement (ADD) or other types by using magnetic resonance imaging (MRI). Ninety-two condyles of 46 female patients were prepared for this study. Their temporomandibular joints (TMJs) were divided into two groups based on class (46 joints in class II and 46 joints in class III) and two groups based on the findings (25 joints with ADD and 67 joints with other findings). ADD with and without reduction was observed in two joints in the class III group and in 23 joints in the class II group. The distribution of ADD incidence had not changed 1 year after surgery. Condylar height decreased 1 year after surgery in both class II patients (mandibular advancement) (p < 0.0001) and class III patients (mandibular setback) (p = 0.0306). Similarly, condylar height decreased 1 year after surgery both in patients who showed ADD (p = 0.0087) and those with other types (p = 0.0023). Significant postoperative increases at all angle sites on the condylar surface were found in the class II (p < 0.05) and ADD (p < 0.05) groups. This study showed that an enhanced condylar surface CT value might be one sign of condylar height reduction related to sequential condylar resorption, in combination with ADD.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan.
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Yuki Saito
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Nana Baba
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Yujiro Kimura
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Mai Koizumi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Kana Fujimoto
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Ran Iguchi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Momoko Sato
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Asami Hotta Osada
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
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Ji YD, Resnick CM, Peacock ZS. Idiopathic condylar resorption: A systematic review of etiology and management. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:632-639. [DOI: 10.1016/j.oooo.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/21/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022]
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Ma H, Shu J, Wang Q, Teng H, Liu Z. Effect of sagittal split ramus osteotomy on stress distribution of temporomandibular joints in patients with mandibular prognathism under symmetric occlusions. Comput Methods Biomech Biomed Engin 2020; 23:1297-1305. [PMID: 32696672 DOI: 10.1080/10255842.2020.1796984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sagittal split ramus osteotomy (SSRO) is the representative orthognathic surgery for the patients with mandibular prognathism. It is essential to understand the biomechanical environment of temporomandibular joint (TMJ) to analyse the effects of SSRO. This study aimed to investigate the influence of SSRO on the stress distributions in the TMJs of the patients with mandibular prognathism under symmetric occlusions. Thirteen patients with mandibular prognathism and ten asymptomatic volunteers were recruited. Finite element models of the asymptomatic, preoperative, and postoperative subjects were established, based on the CT of the asymptomatic volunteers and preoperative and postoperative scans of patients with mandibular prognathism. Contact was used to simulate the interactions between discs and articular surfaces, and between the upper and lower dentition. Muscle forces and boundary conditions corresponding to the centric and anterior occlusions were applied on the models. Under both occlusions, the maximum and minimum principal stresses of the articular disc and condyle in the preoperative group were significantly greater than those in the control group. After SSRO, the maximum and minimum principal stresses of the articular disc and condyle of the patients under both occlusions were greatly reduced, but the principal stresses of the articular disc were not significantly higher than those in the control group. Mandibular prognathism led to excessive stress on the TMJ. Severe asymmetric compression between the TMJs on both sides might cause temporomandibular disorder (TMD) symptoms. SSRO could improve the stress distribution of the TMJ and partially relieve the symptoms of TMD.
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Affiliation(s)
- Hedi Ma
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Jingheng Shu
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Quanyi Wang
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Haidong Teng
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Zhan Liu
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
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15
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Kita S, Fujita K, Imai H, Aoyagi M, Shimazaki K, Yonemitsu I, Omura S, Ono T. Postoperative stability of conventional bimaxillary surgery compared with maxillary impaction surgery with mandibular autorotation for patients with skeletal class II retrognathia. Br J Oral Maxillofac Surg 2020; 58:57-61. [DOI: 10.1016/j.bjoms.2019.10.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
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16
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He Z, Ji H, Du W, Xu C, Luo E. Management of condylar resorption before or after orthognathic surgery: A systematic review. J Craniomaxillofac Surg 2019; 47:1007-1014. [DOI: 10.1016/j.jcms.2019.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
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Shu J, Zhang Y, Liu Z. Biomechanical comparison of temporomandibular joints after orthognathic surgery before and after design optimization. Med Eng Phys 2019; 68:11-16. [DOI: 10.1016/j.medengphy.2019.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/26/2022]
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18
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Ueki K, Yoshizawa K, Moroi A, Tsutsui T, Hotta A, Hiraide R, Takayama A, Tsunoda T, Saito Y, Sato M, Baba N. Relationship between occlusal force and condylar morphology in class II and III after bi-maxillary osteotomy. J Craniomaxillofac Surg 2018; 46:2103-2107. [DOI: 10.1016/j.jcms.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/15/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022] Open
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19
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Zhang YL, Liu Y, Shu JH, Xu XC, Liu Z. Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling. Br J Oral Maxillofac Surg 2018; 56:925-930. [DOI: 10.1016/j.bjoms.2018.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/08/2018] [Indexed: 12/01/2022]
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20
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Liu Z, Shu J, Zhang Y, Fan Y. The Biomechanical Effects of Sagittal Split Ramus Osteotomy on Temporomandibular Joint. Comput Methods Biomech Biomed Engin 2018; 21:617-624. [DOI: 10.1080/10255842.2018.1504034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Zhan Liu
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Jingheng Shu
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Yuanli Zhang
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Yubo Fan
- Beijing key laboratory of rehabilitation engineering for elderly, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100191, China
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21
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Gomes LR, Soares Cevidanes LH, Gomes MR, Carlos de Oliveira Ruellas A, Obelenis Ryan DP, Paniagua B, Wolford LM, Gonçalves JR. Three-dimensional quantitative assessment of surgical stability and condylar displacement changes after counterclockwise maxillomandibular advancement surgery: Effect of simultaneous articular disc repositioning. Am J Orthod Dentofacial Orthop 2018; 154:221-233. [PMID: 30075924 DOI: 10.1016/j.ajodo.2017.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In this study, we quantitatively assessed 3-dimensional condylar displacement during counterclockwise maxillomandibular advancement surgery (CMMA) with or without articular disc repositioning, focusing on surgical stability in the follow-up period. METHODS The 79 patients treated with CMMA had cone-beam computed tomography scans taken before surgery, immediately after surgery, and, on average, 15 months postsurgery. We divided the 142 condyles into 3 groups: group 1 (n = 105), condyles of patients diagnosed with symptomatic presurgical temporomandibular joint articular disc displacement who had articular disc repositioning concomitantly with CMMA; group 2 (n = 23), condyles of patients with clinical verification of presurgical articular disc displacement who had only CMMA; and group 3 (n = 14), condyles of patients with healthy temporomandibular joints who had CMMA. Presurgical and postsurgical 3-dimensional models were superimposed using voxel-based registration on the cranial base. Three-dimensional cephalometrics and shape correspondence were applied to assess surgical and postsurgical displacement changes. RESULTS Immediately after surgery, the condyles moved mostly backward and medially and experienced lateral yaw, medial roll, and upward pitch in the 3 groups. Condyles in group 1 showed downward displacement, whereas the condyles moved upward in groups 2 and 3 (P ≤0.001). Although condylar displacement changes occurred in the 3 groups, the overall surgical procedure appeared to be fairly stable, particularly for groups 1 and 3. Group 2 had the greatest amount of relapse (P ≤0.05). CONCLUSIONS CMMA has been shown to be a stable procedure for patients with healthy temporomandibular joints and for those who had simultaneous articular disc repositioning surgery.
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Affiliation(s)
- Liliane Rosas Gomes
- Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil.
| | | | | | | | | | - Beatriz Paniagua
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Larry Miller Wolford
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Baylor University Medical Center, Dallas, Tex
| | - João Roberto Gonçalves
- Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
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Mousoulea S, Kloukos D, Sampaziotis D, Vogiatzi T, Eliades T. Condylar resorption in orthognathic patients after mandibular bilateral sagittal split osteotomy: a systematic review. Eur J Orthod 2018; 39:294-309. [PMID: 27334905 DOI: 10.1093/ejo/cjw045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To systematically search the literature and assess the available evidence regarding the incidence and quantification of condylar resorption following bilateral sagittal split osteotomy (BSSO) of the mandible in orthognathic patients. Search methods Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies. Selection criteria Randomized clinical trials (RCTs), prospective, and retrospective studies with patients of any age that underwent BSSO were included. Data collection and analysis Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Results One RCT, 3 prospective, and 10 retrospective studies were included in this review. The lack of standardized protocols and the high amount of heterogeneity precluded a valid interpretation of the actual results through pooled estimates. There was a substantial consistency among studies, however, that young, female patients with mandibular deficiency and high mandibular plane angle, submitted to surgical counterclockwise rotation of mandibular segments, were more prone to a higher risk for condylar resorption after BSSO. The level of evidence was found to be low given the high/serious risk of bias in all included studies. Conclusions Condylar resorption should be taken into account as a potential postsurgical complication after BSSO. However, its incidence and quantification need precautious interpretation owing to the low level of evidence and the high heterogeneity of studies. Additional high-quality prospective research assisted by 3D imaging technology is needed to allow more definitive conclusions. Registration Study not registered. Conflict of interest None.
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Affiliation(s)
- Sophia Mousoulea
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force General Hospital, Athens, Greece.,Department of Orthodontics and Dentofacial Orthopedics, Faculty of Medicine, University of Bern, Switzerland
| | - Dimitrios Sampaziotis
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force General Hospital, Athens, Greece
| | | | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
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Shu JH, Yao J, Zhang YL, Chong DY, Liu Z. The influence of bilateral sagittal split ramus osteotomy on the stress distributions in the temporomandibular joints of the patients with facial asymmetry under symmetric occlusions. Medicine (Baltimore) 2018; 97:e11204. [PMID: 29924045 PMCID: PMC6023726 DOI: 10.1097/md.0000000000011204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints (TMJs) of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy (BSSRO) under the symmetric occlusions using the three-dimensional (3D) finite element method.Ten facial asymmetry patients (Preoperative group, age 24.6 ± 4.8 years) and 10 asymptomatic subjects (Control group, age 26.8 ± 4.9 years) were recruited. After the patients underwent BSSRO, they were further assigned as the Postoperative group. 3D geometries of the finite element models of the mandible, disc, maxilla, and teeth were reconstructed according to cone-beam computed tomography (CBCT) image data. Contact elements were used to simulate the interaction of the disc-condyle, disc-temporal bone, and upper-lower dentition. The muscle forces and boundary conditions corresponding to the central and anterior occlusions were applied on the models of the 3 groups. The finite element models were validated with experimental data showing the accuracy of the simulation results.The simulation predicted preoperative significant differences of stresses between non-deviated sides and deviated sides were disappeared after the surgery under the central and anterior occlusions (P < .05). Almost all stresses in the patient models had significantly decreased after BSSRO, leveling it to the stress values of the normal subjects. Moreover, the simulation results coincided with the clinical cases which showed that BSSRO had helped to release or remove the signs and symptoms of temporomandibular disorders (TMD).In conclusion, BSSRO could correct the asymmetric stress distributions of TMJs and decrease the magnitude of the stresses for the patients with facial asymmetry. Those decreases also associated with the recovery of TMD.
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Affiliation(s)
- Jing-Heng Shu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu
| | - Jie Yao
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yuan-Li Zhang
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu
| | - Desmond Y.R. Chong
- Engineering Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu
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Savoldelli C, Chamorey E, Bettega G. Computer-assisted teaching of bilateral sagittal split osteotomy: Learning curve for condylar positioning. PLoS One 2018; 13:e0196136. [PMID: 29694423 PMCID: PMC5918964 DOI: 10.1371/journal.pone.0196136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
Bilateral sagittal split osteotomy (BSSO) is a widely-performed procedure in orthognathic surgery for the correction of dentofacial deformity. Condylar positioning is a critical step during BSSO to maximize functional and morphological results. The unsuitable positioning of condyles represents one of the causative mechanisms that may induce temporomandibular joint noxious effects after BSSO. Repositioning devices can assist surgeons in maintaining the preoperative condylar position; however, empirical repositioning methods based on experience gained are still commonly used. Trainee learning curves are difficult to assess. The aim of this study was to evaluate the relevance of computer-assisted surgery in the acquisition of condylar positioning skills. Forty-eight patients underwent BSSO performed by six maxillofacial trainees (four junior residents and two senior experienced residents). A condyle positioning system (CPS) was used by a senior surgeon to record a condylar position score during the procedure. Firstly, scores were recorded when the trainee manually positioned the condyle without access to the CPS score (phase 1) and then when the trainee positioned the condyle and performed osteosynthesis with visual access to the CPS score (phase 2). Six parameters describing condylar three-dimensional motions were assessed: translational motion from top to bottom (TB), back to front (BF), and left to right (LR), axial rotation (AR), sagittal rotation (SR), frontal rotation (FR), and a total score (TS). There were no significant differences between junior and senior residents in condyle positioning without access to the CPS. Condyles were significantly better positioned during phase 2 with access to the CPS (p<0.001). Over time, use of the CPS (phase 2) produced significantly quicker improvements in scores (p = 0.042). For those teaching surgeries to trainees, computer-assisted devices can potentially result in more rapid learning curves than traditional "observations-imitation" models. Use of a CPS by trainees facilitated condylar repositioning that resulted in an accurate occlusal result and avoidance of adverse effects on the temporomandibular joint.
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Affiliation(s)
- Charles Savoldelli
- Department of Oral and Maxillofacial Surgery, Head and Neck Institute, University Hospital of Nice, Nice, France
| | | | - Georges Bettega
- Department of Oral and Maxillofacial surgery, Centre Hospitalier Annecy-Genevois, Metz-Tessy, France.,Plastic and Maxillofacial Surgery Department, Grenoble University Hospital, BP, Grenoble, France
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Counterclockwise maxillomandibular advancement surgery and disc repositioning: can condylar remodeling in the long-term follow-up be predicted? Int J Oral Maxillofac Surg 2017; 46:1569-1578. [PMID: 28728709 DOI: 10.1016/j.ijom.2017.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/21/2017] [Indexed: 11/23/2022]
Abstract
This study investigated predictive risk factors of condylar remodeling changes after counterclockwise maxillomandibular advancement (CCW-MMA) and disc repositioning surgery. Forty-one female patients (75 condyles) treated with CCW-MMA and disc repositioning had cone beam computed tomography (CBCT) scans taken pre-surgery, immediately after surgery, and at an average 16 months post-surgery. Pre- and post-surgical three-dimensional models were superimposed using automated voxel-based registration on the cranial base to evaluate condylar displacements after surgery. Regional registration was performed to assess condylar remodeling in the follow-up period. Three-dimensional cephalometrics, shape correspondence (SPHARM-PDM), and volume measurements were applied to quantify changes. Pearson product-moment correlations and multiple regression analysis were performed. Highly statistically significant correlation showed that older patients were more susceptible to overall condylar volume reduction following CCW-MMA and disc repositioning (P≤0.001). Weak but statistically significant correlations were observed between condylar remodeling changes in the follow-up period and pre-surgical facial characteristics, magnitude of the surgical procedure, and condylar displacement changes. After CCW-MMA and disc repositioning, the condyles moved mostly downwards and medially, and were rotated medially and counterclockwise; displacements in the opposite direction were correlated with a greater risk of condylar resorption. Moreover, positional changes with surgery were only weakly associated with remodeling in the follow-up period, suggesting that other risk factors may play a role in condylar resorption.
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Xi T, de Koning M, Bergé S, Hoppenreijs T, Maal T. The role of mandibular proximal segment rotations on skeletal relapse and condylar remodelling following bilateral sagittal split advancement osteotomies. J Craniomaxillofac Surg 2015; 43:1716-22. [DOI: 10.1016/j.jcms.2015.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/30/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022] Open
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27
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Moroi A, Yoshizawa K, Iguchi R, Ikawa H, Kosaka A, Hotta A, Tsutsui T, Saida Y, Ueki K. The amount of mandibular setback influence on occlusal force following sagittal split ramus osteotomy. J Craniomaxillofac Surg 2015; 43:1743-8. [PMID: 26431610 DOI: 10.1016/j.jcms.2015.08.015] [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: 04/02/2015] [Revised: 07/15/2015] [Accepted: 08/18/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the influence between the magnitude of setback in sagittal split ramus osteotomy (SSRO) and occlusal contact area and bite force without relapse after surgery. PATIENTS AND METHODS Sixty female patients with a diagnosis of mandibular prognathism were divided into 3 groups according to the magnitude of setback: group 1 (≤5 mm), group 2 (>5 mm but <10 mm), and group 3 (≥10 mm). All patients underwent skeletal analysis by lateral and frontal cephalogrammetry and measured the occlusal contact area and bite force by the pressure-sensitive system (Dental Prescale, Dental Occlusion Pressuregraph FDP-705; Fuji Photo Film Co., Tokyo, Japan) preoperatively and postoperatively at 1 month, 3 months, 6 months, and 1 year. RESULTS There were no significant differences in occlusal contact area and bite force between the 3 groups. Only group 3 showed a significant difference in occlusal contact area and bite force between the preoperative and 1-year measurements. CONCLUSION The results indicate that the magnitude of setback did not influence the bite force or occlusal contact area in SSRO.
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Affiliation(s)
- Akinori Moroi
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
| | - Kunio Yoshizawa
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Ran Iguchi
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Hiroumi Ikawa
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Akihiko Kosaka
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Asami Hotta
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Takamitsu Tsutsui
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Yuriko Saida
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
| | - Koichiro Ueki
- Department of Oral & Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan
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Dicker GJ, Castelijns JA, Tuinzing DB, Stoelinga PJW. Do the changes in muscle mass, muscle direction, and rotations of the condyles that occur after sagittal split advancement osteotomies play a role in the aetiology of progressive condylar resorption? Int J Oral Maxillofac Surg 2015; 44:627-31. [PMID: 25636702 DOI: 10.1016/j.ijom.2015.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/22/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Abstract
Changes in cross-sectional area (CSA), volume (indicating muscle strength), and direction of the masseter and medial pterygoid muscles after surgical mandibular advancement were measured, along with the rotation of the condyles after bilateral sagittal split osteotomies (BSSOs) to advance the mandible. Measurements were done on magnetic resonance images obtained before and 2 years after surgery. CSA and volume were measured in five short-face and seven long-face patients (five males, seven females). Muscle direction was calculated in eight short-face and eight long-face patients (eight males, eight females). Short-face patients underwent BSSO only; long-face patients underwent combined BSSO and Le Fort I osteotomies. The CSA and volume decreased significantly (mean 18%) in all patients after surgery. The postoperative muscle direction was significantly more vertical (9°) in long-face patients. Rotations of the proximal segments (condyles) were minimal after 2 years. The results of this study showed that, after BSSO advancement surgery, changes in the masseter and medial pterygoid muscles are not likely to cause increased pressure on the condyles and nor are the minimal rotations of the condyles. It is concluded that neither increased muscle traction nor condylar rotations can be held responsible for progressive condylar resorption after advancement BSSO.
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Affiliation(s)
- G J Dicker
- Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Centre, Amsterdam, Netherlands; Elkerliek Hospital, Helmond, Netherlands.
| | - J A Castelijns
- Department of Radiology, VU University Medical Centre, Amsterdam, Netherlands
| | - D B Tuinzing
- Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Centre, Amsterdam, Netherlands
| | - P J W Stoelinga
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, Netherlands; Department of Cranio-maxillofacial Surgery, Maastricht University Medical Centre, Netherlands
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