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Krennmair S, Malek M, Stehrer R, Stähler P, Otto S, Postl L. The effect of frontal trauma on the edentulous mandible with four different interforaminal implant-prosthodontic anchoring configurations. A 3D finite element analysis. Eur J Med Res 2023; 28:608. [PMID: 38115128 PMCID: PMC10729383 DOI: 10.1186/s40001-023-01580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE The present three-dimensional (3D) finite element analysis (FEA) was aimed to assess the biomechanical effects and fracture risks of four different interforaminal implant-prosthodontic anchoring configurations exposed to frontal trauma. MATERIAL AND METHODS A symphyseal frontal trauma of 1 MPa was applied to four dental implant models with different configurations (two unsplinted interforaminal implants [2IF-U], two splinted interforaminal implants [2IF-S], four unsplinted interforaminal implants[ 4IF-U], four splinted interforaminal implants [4IF-S]. By using a 3D-FEA analysis the effective cortical bone stress values were evaluated in four defined regions of interest (ROI) (ROI 1: symphyseal area; ROI 2: preforaminal area; ROI 3: mental foraminal area; and ROI 4: condylar neck) followed by a subsequent intermodel comparison. RESULTS In all models the frontal traumatic force application revealed the highest stress values in the condylar neck region. In both models with a four-implant configuration (4IF-U, 4IF-S), the stress values in the median mandibular body (ROI 1) and in the condylar neck region (ROI 4) were significantly reduced (P <0.01) compared with the two-implant models (2IF-U, 2IF-S). However, in ROI 1, the model with four splinted implants (4IF-S) showed significantly (P < 0.01) reduced stress values compared to the unsplinted model (4IF-U). In addition, all models showed increased stress patterns in the area adjacent to the posterior implants, which is represented by increased stress values for both 2IF-U and 2IF-S in the preforaminal area (ROI 3) and for the four implant-based models (4IF-U, 4IF-S) in the mental foraminal area. CONCLUSION The configuration of four splinted interforaminal implants showed the most beneficial distribution of stress pattern representing reduced stress distribution and associated reduced fracture risk in anterior symphysis, condylar neck and preforaminal region.
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Affiliation(s)
- Stefan Krennmair
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
| | - Raphael Stehrer
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
| | - Philip Stähler
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Lukas Postl
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria.
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany.
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Zhao L, Long Y, Xu G, Long J. Assessment of relationships between condylar fracture pattern and mandibular third molar position by panoramic radiography and computed tomography: A retrospective comparative study. Dent Traumatol 2023; 39:575-585. [PMID: 37529916 DOI: 10.1111/edt.12874] [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: 04/10/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND/AIM Although previous studies have revealed the influence of the mandibular third molar (M3) on mandibular condylar fracture risk and that the presence of M3 could result in different incidences of condylar and angle fractures, there have been no analyses of the influence of M3 on fracture patterns. Moreover, evaluations of M3 position using panoramic radiography have shown insufficient accuracy. This study investigated the relationship between condylar fracture patterns and M3 position using panoramic radiography and computed tomography. MATERIALS AND METHODS This retrospective study included 280 patients with unilateral mandibular condylar fractures and ipsilateral M3 admitted to West China Hospital of Stomatology between January 2016 and June 2022. Patient medical records, panoramic radiographs, and computed tomography images were collected. The vertical and horizontal positions of M3 were classified using the Pell and Gregory system. M3 angulation was defined as the angle between the long axis of M3 and the mandibular occlusal plane. Condylar fracture patterns were classified as intracapsular (Types A-C) or extracapsular (neck and base). Data were analyzed using McNemar-Bowker test, Pearson chi-squared test, and Fisher's exact test. RESULTS Classification of M3 position differed significantly between panoramic radiography and computed tomography images (p < .05). There was a significant association between the mandibular condylar fracture pattern and M3 horizontal position on computed tomography (p < .05). Class I M3 position on computed tomography was associated with a higher incidence of intracapsular than extracapsular fractures, along with a higher incidence of Type B than base fractures; the opposite relationships were observed for Class II. No such association was identified on panoramic radiography. CONCLUSIONS Mandibular condylar fracture patterns were presumably influenced by M3 horizontal position on computed tomography. The imaging modality affected the classification of M3 position and subsequent analyses. Computed tomography is recommended for future studies to improve accuracy and reliability.
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Affiliation(s)
- Luyang Zhao
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Yifei Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Guikun Xu
- Department of Oral and Maxillofacial Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
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Demir O, Uslan I, Buyuk M, Salamci MU. Development and validation of a digital twin of the human lower jaw under impact loading by using non-linear finite element analyses. J Mech Behav Biomed Mater 2023; 148:106207. [PMID: 37922761 DOI: 10.1016/j.jmbbm.2023.106207] [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: 07/09/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
Mandibular fractures are one of the most frequently observed injuries within craniofacial region mostly due to tumor-related problems and traumatic events, often related to non-linear effects like impact loading. Therefore, a validated digital twin of the mandible is required to develop the best possible patient-specific treatment. However, there is a need to obtain a fully compatible numerical model that can reflect the patients' characteristics, be available and accessible quickly, require an acceptable level of modeling efforts and knowledge to provide accurate, robust and fast results at the same time under highly non-linear effects. In this study, a validated simulation methodology is suggested to develop a digital twin of mandible, capable of predicting the non-linear response of the biomechanical system under impact loading, which then can be utilized to design treatment strategies even for multiple fractures of the mandibular system. Using Computed Tomography data containing cranial (skull) images of a patient, a 3-dimensional mandibular model, which consists cortical and cancellous bones, disks and fossa is obtained with high accuracy that is compatible with anatomical boundaries. A Finite Element Model (FEM) of the biomechanical system is then developed for a three-level validation procedure including (A) modal analysis, (B) dynamic loading and (C) impact loading. For the modal analysis stage: Free-free vibration modes and frequencies of the system are validated against cadaver test results. For the dynamic loading stage: Two different regions of the mandible are loaded, and maximum stress levels of the system are validated against finite element analyses (FEA) results, where the first loading condition (i) transfers a 2000 N force acting on the symphysis region and, the second loading condition (ii) transfers a 2000 N force acting on the left body region. In both cases, equivalent muscle forces dependent on time are applied. For the impact loading stage: Thirteen different human mandibular models with various tooth deficiencies are used under the effects of traumatic impact forces that are generated by using an impact hammer with different initial velocities to transfer the impulse and momentum, where contact forces and fracture patterns are validated against cadaver tests. Five different anatomical regions are selected as the impact site. The results of the analyzes (modal, dynamic and impact) performed to validate the digital twin model are compared with the similar FEA and cadaver test results published in the literature and the results are found to be compatible. It has been evaluated that the digital twin model and numerical models are quite realistic and perform well in terms of predicting the biomechanical behavior of the mandible. The three-level validation methodology that is suggested in this research by utilizing non-linear FEA has provided a reliable road map to develop a digital twin of a biomechanical system with enough confidence that it can be utilized for similar structures to offer patient-specific treatments and can help develop custom or tailor-made implants or prosthesis for best compliance with the patient even considering the most catastrophic effects of impact related trauma.
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Affiliation(s)
- Osman Demir
- Gulhane Medical Design and Manufacturing Application and Research Center-SBU-METUM, University of Health Sciences, 06010, Ankara, Turkey; Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey.
| | | | - Murat Buyuk
- Department of Engineering Sciences, Middle East Technical University, 06800, Ankara, Turkey.
| | - Metin Uymaz Salamci
- Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey; Additive Manufacturing Technologies Research and Application Center-EKTAM, Gazi University, 06980, Ankara, Turkey.
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Sancar B, Çetiner Y, Dayı E. Evaluation of the pattern of fracture formation from trauma to the human mandible with finite element analysis. Part 2: The corpus and the angle regions. Dent Traumatol 2023; 39:437-447. [PMID: 36942890 DOI: 10.1111/edt.12841] [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: 02/11/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND/AIMS Although the mandible is the largest and strongest bone of the facial skeleton, it is frequently broken. The fracture location in the mandible depends on the biomechanical features, direction and angle of the trauma, and masticatory muscles. This study aimed to evaluate the stresses caused by trauma to the corpus and angle regions from different angles. MATERIALS AND METHODS After computer-based mandible models were created using finite element analysis, a force of 2000 Newton(N) was simulated with the mouth open or closed to the corpus and the angle. To the corpus: at 90° (Model 1) in the lateromedial direction, 45° (Model 2) in the lateromedial-inferosuperior direction, and 90° (Model 3) in the inferosuperior direction. To angle: 90° (Model 4) in the lateromedial direction and 45° (Model 5) in the lateromedial-inferosuperior direction. The resulting stress intensity was assessed using FEA. RESULTS Following the simulated forces, the maximum stress in the mandible occurred in the condylar region, except in Model 3 (Left(L)Corpus2[36 megapascals(MPa)]) in the mouth-closed condition. After traumas in Model 1 (open-mouth: LCondyle2[547 MPa]) and Model 4 (closed-mouth: LCondyle2[607 MPa]), higher stress values occurred in the condyle. In the mouth open-closed state, there was no significant stress change in the condyle region in Model 1 (open-mouth: LCondyle2[547 MPa], closed-mouth:LCondyle2[546 MPa]) or in Model 2 (open mouth: Right(R)Condyle2[431 MPa], closed-mouth:LCondyle2[439 MPa]). In Model 3, lower stress values occurred in the closed-mouth rather than the open-mouth (LCondyle1[167 MPa]) state. In Models 4 and 5, the stress values increased in the mouth-closed condition compared with the mouth-open condition. CONCLUSIONS Stress in the mandible is affected by the location of the trauma and the angle of incidence of the blow. In trauma to both the corpus and the angle, the most common area to be fractured is the condyle.
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Affiliation(s)
- Bahadır Sancar
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Yunus Çetiner
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Ertunç Dayı
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Ataturk University, Erzurum, Turkey
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Graillon N, Foletti JM, Godio-Raboutet Y, Guyot L, Varazzani A, Thollon L. Mandibular Titanium Miniplates Change the Biomechanical Behaviour of the Mandible in the Case of Facial Trauma: A Three-Dimensional Finite Element Analysis. Bioengineering (Basel) 2023; 10:994. [PMID: 37760096 PMCID: PMC10525150 DOI: 10.3390/bioengineering10090994] [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: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.
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Affiliation(s)
- Nicolas Graillon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Jean-Marc Foletti
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Yves Godio-Raboutet
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
| | - Laurent Guyot
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Andrea Varazzani
- Maxillo-Facial Surgery, Facial Plastic Surgery, Stomatology and Oral Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital—Claude-Bernard Lyon 1 University, 69310 Pierre-Benite, France;
| | - Lionel Thollon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
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Sancar B, Çetiner Y, Dayı E. Evaluation of the pattern of fracture formation from trauma to the human mandible with finite element analysis. Part 1: Symphysis region. Dent Traumatol 2023. [PMID: 36807491 DOI: 10.1111/edt.12825] [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: 10/13/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND/AIM The mandible is the largest, strongest bone in the maxillofacial region. When a fracture occurs in the mandible, its location depends on several factors: the direction of the trauma, the angle of the trauma, masticatory muscles and the quality of the bone. The aim of this study was to evaluate the stresses caused by trauma to the symphysis region from different angles. MATERIALS AND METHODS Computer-based mandible models were created, and a 2000 N force was applied to the symphysis at three different angles using finite element analysis. Six trauma situations were simulated with the mouth open or closed. Forces were applied to the symphysis at 90° (Model 1) in the anteroposterior direction, 45° (Model 2) in the anteroposterior-inferosuperior direction and 90° (Model 3) in the inferosuperior direction, when the mouth was open or closed. The resulting stress intensity was assessed using finite element analysis. RESULTS As a result of trauma applied to the symphysis region, maximum stresses were found where the impact originated and at the condyle region (Model 2, open mouth: condyle 1 [1172 MPa]). The open mouth position caused higher stress values than the closed mouth position (Model 2, open mouth: condyle 1 [1172 MPa]; closed mouth: symphysis 4 [82 MPa]). The Model 2, open-mouth state (Model 2, open mouth: condyle 1 [1172 MPa]) sustained higher stresses than all the other models. CONCLUSION The stress values in the mandible were affected by the force applied to the symphysis region, the angle of impact arrival and the open or closed state of the mouth. Keeping the mouth closed at the time of trauma reduced the stress value. A closed mouth during trauma directed at the symphysis reduced the possibility of mandible fractures.
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Affiliation(s)
- Bahadır Sancar
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Yunus Çetiner
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Ertunç Dayı
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Ataturk University, Erzurum, Turkey
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Venkatachalam V, Pandiarajan R. Does the Impacted Mandibular Third Molar Increase the Risk of Angle Fracture to Prevent the Incidence of Condylar Fracture? - A Retrospective Analysis. Ann Maxillofac Surg 2022; 12:185-189. [PMID: 36874779 PMCID: PMC9976849 DOI: 10.4103/ams.ams_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/09/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction This study aimed to retrospectively analyse the influence of the presence or absence of third molars and its position on the incidence of angle and condylar fractures of mandible. Methodology A retrospective cross-sectional analysis of 148 patients with mandibular fractures was done. A complete analysis of their clinical records and their radiological data was done. The primary predictor variable was the presence or absence of third molars and their positional status (Pell and Gregory's classification) if present. The outcome variable was the type of fracture and other predictor variables included age, gender and fracture aetiology. Data were subjected to statistical analysis. Results We observed that out of 48 patients with angle fractures, third molar was present in 67.34% and in 51.35% of 37 patients with condylar fractures, and there existed a positive correlation between the both. A significant association between the position of the teeth (Class II, III and Position B), angle fractures and (Class I, II, Position A) and condylar fractures was observed. Conclusion Angular fractures were associated with superficial and deep impactions and condylar fractures were associated with superficial impactions. No association was observed with the age, gender or mechanism of injury to the pattern of fractures. Impacted mandibular molars increase the risk of angle fracture, thereby preventing the force transmission to the condyle, and the absence or a fully erupted tooth increases the risk of condylar fractures.
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Affiliation(s)
- Vaishali Venkatachalam
- Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - Rajesh Pandiarajan
- Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
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周 伟, 安 金, 荣 起, 张 益. [Three-dimensional finite element analysis of traumatic mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:983-989. [PMID: 34650306 PMCID: PMC8517683 DOI: 10.19723/j.issn.1671-167x.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyze the biomechanical mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures using finite element analysis (FEA). METHODS Maxillofacial CT scans and temporomandibular joint (TMJ) MRI were performed on a young male with normal mandible, no wisdom teeth and no history of TMJ diseases. The three-dimensional finite element model of mandible was established by Mimics and ANSYS based on the CT and MRI data. The stress distributions of mandible with different angles of traumatic loads applied on the symphyseal region were analyzed. Besides, two models with or without disc, two working conditions in occlusal or non-occlusal status were established, respectively, and the differences of stress distribution between them were compared. RESULTS A three-dimensional finite element model of mandible including TMJ was established successfully with the geometry and mechanical properties to reproduce a normal mandibular structure. Following a blow to the mandibular symphysis with different angles, stress concentration areas were mainly located at condyle, anterior border of ramus and symphyseal region under all conditions. The maximum equivalent stress always appeared on condylar articular surface. As the angle between the external force and the horizontal plane gradually increased from 0° to 60°, the stress on the mandible gradually concentrated to symphysis and bilateral condyle. However, when the angle between the external force and the horizontal plane exceeded 60°, the stress tended to disperse to other parts of the mandible. Compared with the condition without simulating the disc, the stress distribution of articular surface and condylar neck decreased significantly when the disc was present. Compared with non-occlusal status, the stress on the mandible in occlusal status mainly distributed on the occlusal surface, and no stress concentration was found in other parts of the mandible. CONCLUSION When the direction of external force is 60° from the horizontal plane, the stress distribution mainly concentrates on symphyseal region and bilateral condylar surface, which explains the occurrence of symphyseal fracture and intracapsular condylar fracture. The stress distribution of condyle (including articular surface and condylar neck) decreases significantly in the presence of arti-cular disc and in stable occlusal status when mandibular symphysis is under traumatic force.
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Affiliation(s)
- 伟 周
- 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - 金刚 安
- 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - 起国 荣
- 北京大学工学院力学与工程科学系,北京 100871Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
| | - 益 张
- 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
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Xu X, Cheng KJ, Liu YF, Fan YY, Wang JH, Wang R, Baur DA, Jiang XF, Dong XT. Experimental validation of finite element simulation of a new custom-designed fixation plate to treat mandibular angle fracture. Biomed Eng Online 2021; 20:15. [PMID: 33546713 PMCID: PMC7866451 DOI: 10.1186/s12938-021-00851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to validate biomechanical characteristics of a 3D-printed, novel-designated fixation plate for treating mandibular angle fracture, and compare it with two commonly used fixation plates by finite element (FE) simulations and experimental testing. METHODS A 3D virtual mandible was created from a patient's CT images as the master model. A custom-designed plate and two commonly used fixation plates were reconstructed onto the master model for FE simulations. Modeling of angle fracture, simulation of muscles of mastication, and defining of boundary conditions were integrated into the theoretical model. Strain levels during different loading conditions were analyzed using a finite element method (FEM). For mechanical test design, samples of the virtual mandible with angle fracture and the custom-designed fixation plates were printed using selective laser sintering (SLS) and selective laser melting (SLM) printing methods. Experimental data were collected from a testing platform with attached strain gauges to the mandible and the plates at different 10 locations during mechanical tests. Simulation of muscle forces and temporomandibular joint conditions were built into the physical models to improve the accuracy of clinical conditions. The experimental vs the theoretical data collected at the 10 locations were compared, and the correlation coefficient was calculated. RESULTS The results show that use of the novel-designated fixation plate has significant mechanical advantages compared to the two commonly used fixation plates. The results of measured strains at each location show a very high correlation between the physical model and the virtual mandible of their biomechanical behaviors under simulated occlusal loading conditions when treating angle fracture of the mandible. CONCLUSIONS Based on the results from our study, we validate the accuracy of our computational model which allows us to use it for future clinical applications under more sophisticated biomechanical simulations and testing.
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Affiliation(s)
- Xu Xu
- Department of Stomatology, People's Hospital of Quzhou, Quzhou, 324000, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Ying-Ying Fan
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Joanne H Wang
- Department of Orthopedic Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Ave., Cleveland, OH, 44016, USA
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Dale A Baur
- Department of Oral Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Xing-Tao Dong
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
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10
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A retrospective analysis of the impaction status of mandibular third molars as a risk factor for fractures of angle or condylar region of the mandible. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Krennmair S, Hunger S, Postl L, Winterhalder P, Holberg S, Malek M, Rudzki I, Holberg C. Edentulous mandible with four splinted interforaminal implants exposed to three different situations of trauma: A preliminary three‐dimensional finite element analysis. Dent Traumatol 2020; 36:607-617. [DOI: 10.1111/edt.12575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Stefan Krennmair
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Stefan Hunger
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Lukas Postl
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Philipp Winterhalder
- Department of Oral and Maxillofacial Surgery RWTH Aachen University Aachen Germany
| | - Svenia Holberg
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Ingrid Rudzki
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Christof Holberg
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
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12
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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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13
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Soós B, Janovics K, Tóth Á, Di Nardo MD, Szalma J. Association Between Third Molar Impaction Status and Angle or Condylar Fractures of the Mandible: A Retrospective Analysis. J Oral Maxillofac Surg 2020; 78:1162.e1-1162.e8. [PMID: 32151652 DOI: 10.1016/j.joms.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of our study was to evaluate the correlations between mandibular third molar impaction status and mandibular angle and condylar fractures. MATERIALS AND METHODS This retrospective cross-sectional study included patients with unilateral and isolated angle or condylar fractures. Patient records and panoramic radiographs were evaluated. The predictor variables included the presence, impaction status (Pell and Gregory [P&G] classification), and angulation (Winter classification) of the third molar. The outcome variable was the type of fracture, whereas other predictor variables included demographic factors such as age, gender, and fracture etiology. Bivariate (χ2 test) and logistic regression analyses were conducted to estimate the associations between variables and the outcome. RESULTS The sample was composed of 164 angle fracture (mean age, 31.6 ± 12.3 years; 83.5% male) and 115 condylar fracture (mean age, 41.9 ± 16.8 years; 76.5% male) patients. A third molar was present in 72.6% of the angle fracture group and 54.8% of the condylar fracture group (P = .002). Deep impactions (classes IC, IIC, IIIB, and IIIC) exhibited an odds ratio (OR) of 3.60 for angle fractures (P < .001). No association was found between tooth angulations and the type of fracture. According to logistic regression analysis, older age (adjusted OR, 1.05; 95% confidence interval [CI], 1.03 to 1.07), P&G class I impaction (OR, 1.86; 95% CI, 1.09 to 3.20), and P&G class A impaction (OR, 1.91; 95% CI, 1.12 to 3.24) were significantly associated with condylar fractures whereas the presence of a third molar (OR, 0.46; 95% CI, 0.28 to 0.76) or P&G class B impaction (OR, 0.287; 95% CI, 0.12 to 0.69) was associated with angular fractures. CONCLUSIONS P&G class II or III and class B impaction status was significantly associated with angle fractures, whereas missing or fully erupted (class IA) third molars significantly correlated with condylar fractures.
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Affiliation(s)
- Balázs Soós
- PhD Student and Assistant Lecturer, Department of Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Kata Janovics
- Assistant Lecturer, Department of Conservative Dentistry and Periodontology, University of Pécs, Pécs, Hungary
| | - Ákos Tóth
- Assistant Professor, Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | | | - József Szalma
- Associate Professor and Department Head, Department of Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary.
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14
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Krennmair S, Winterhalder P, Hunger S, Rupperti S, Holberg C. The Effects of Frontal Trauma on 4 Interforaminal Dental Implants: A 3-Dimensional Finite Element Analysis Comparing Splinted and Unsplinted Implant Configurations. J Oral Maxillofac Surg 2020; 78:961-972. [PMID: 31951811 DOI: 10.1016/j.joms.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE With increased implant-prosthodontic rehabilitation for mandibular edentulism together with the increased life expectancy and activity of the elderly population, a greater number of implant patients may be at risk of facial trauma. The aim of this 3-dimensional (3D) finite element analysis (FEA) was to evaluate the biomechanical effects of the edentulous mandible (EM) with and without implants exposed to frontal facial trauma including assessment of the fracture risk of different mandibular areas. MATERIALS AND METHODS By use of a 3D FEA, our experimental study design comprised 3 different models (model A, EM; model B, EM with 4 unsplinted interforaminal implants; and model C, EM with 4 splinted interforaminal implants) exposed to application of symphyseal frontal trauma of 2 MPa. In 3 defined regions of interest (ROIs) (ROI 1, symphyseal area; ROI 2, mental foraminal area; and ROI 3, condylar neck), the effective stress was measured at predefined sites in the superficial cortical mandibular area. The stress values of all ROIs evaluated were compared within each model (intramodel) as well as between the 3 models (intermodel). RESULTS For all models evaluated, a frontal traumatic load generated the highest stress levels in the condylar neck. However, for both models with implants (models B and C), the stress values were reduced significantly (P < .01) in the condylar neck region (ROI 3) but increased significantly (P < .001) in the mental foraminal area (ROI 2) compared with the EM model without implants. For the symphyseal area (ROI 1) evaluated, the unsplinted 4-implant model (model B) presented significantly (P < .001) higher stress values than the splinted implant model (model C) when frontal forces were applied. CONCLUSIONS Regardless of splinting or lack of splinting of 4 interforaminal implants, force absorption or transmission may shift the predominant risk factor from the condylar neck to the corpus or foramen mandibulae. However, splinting of 4 interforaminal implants may be beneficial in reducing the risk of bone fracture by providing protection for anterior risk situations.
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Affiliation(s)
- Stefan Krennmair
- Research Fellow, NumBioLab, Department of Orthodontics, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Philipp Winterhalder
- Resident, Department of Oral Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Stefan Hunger
- Resident, Department of Oral Maxillofacial Surgery, Johannes Kepler University Linz, Linz, Austria
| | - Stefan Rupperti
- Research Fellow, NumBioLab, Department of Orthodontics, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christof Holberg
- Professor, Head of NumBioLab, Department of Orthodontics, Ludwig Maximilian University of Munich, Munich, Germany
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15
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Tuchtan L, Godio-Raboutet Y, Delteil C, Léonetti G, Piercecchi Marti MD, Thollon L. Study of cerebrospinal injuries by force transmission secondary to mandibular impacts using a finite element model. Forensic Sci Int 2019; 307:110118. [PMID: 31869653 DOI: 10.1016/j.forsciint.2019.110118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
Brain and cervical injuries are often described after major facial impacts but rarely after low-intensity mandibular impacts. Force transmission to the brain and spinal cord from a mandibular impact such as a punch was evaluated by the creation and validation of a complete finite element model of the head and neck. Anteroposterior uppercut impacts on the jaw were associated with considerable extension and strong stresses at the junction of the brainstem and spinal cord. Hook punch impacts transmitted forces directly to the brainstem and the spinal cord without extension of the spinal cord. Deaths after this type of blow with no observed histological lesions may be related to excessive stressing of the brainstem, through which pass the sensory-motor pathways and the vagus nerve and which is the regulatory center of the major vegetative functions. Biological parameters are different in each individual, and by using digital modeling they can be modulated at will (jaw shape, dentition…) for a realistic approach to forensic applications.
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Affiliation(s)
- Lucile Tuchtan
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Yves Godio-Raboutet
- Aix Marseille Univ, IFSTTAR, LBA, Marseille, France; iLab-Spine (International Laboratory - Spine Imaging and Biomechanics), France
| | - Clémence Delteil
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Georges Léonetti
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marie-Dominique Piercecchi Marti
- Forensic Department, APHM, Hôpital de la Timone, 13385 Marseille, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix Marseille Univ, IFSTTAR, LBA, Marseille, France; iLab-Spine (International Laboratory - Spine Imaging and Biomechanics), France
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Mehra A, Anehosur V, Kumar N. Impacted Mandibular Third Molars and Their Influence on Mandibular Angle and Condyle Fractures. Craniomaxillofac Trauma Reconstr 2019; 12:291-300. [PMID: 31719954 DOI: 10.1055/s-0039-1685459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 02/07/2019] [Indexed: 10/27/2022] Open
Abstract
The aim of this study is to retrospectively analyze the effect unerupted or partially erupted third molars have on the angle and condyle fracture patterns of the mandible. It also focuses on evaluating the type of impaction that causes angle fracture and the level at which the condyle most commonly fractures. The study involves all the patients who had undergone treatment for condylar and angle of the mandible fractures from 2010 to 2017 in our craniofacial center. The case records and orthopantomograms of each patient were taken into consideration and a correlation was established based on gender, age, etiology, presence of third molars, position of third molars, angulation, and root development of third molars. Of the 150 angle fracture patients, 146 had third molars and 4 did not, whereas of the 130 condyle fractures, third molar was present in 54 patients and absent in 76. The prevalence of angle fractures was statistically significant when a third molar was present, whereas the prevalence of condyle fractures was higher when third molar was absent. The results of age, etiology, angulation, position, and root development of third molars were also statistically significant. However, sex of the patient did not influence the fracture pattern. The presence of an impacted third molar or a completely erupted one has a definite influence on the fracture pattern of the mandible. The occurrence of angle and condyle fractures was mostly affected by the continuity of the cortical bone at the angle of the mandible. Hence, prophylactic removal of mandibular third molars does increase the risk of condyle fractures.
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Affiliation(s)
- Anhad Mehra
- Department of Oral and Maxillofacial Surgery, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Venkatesh Anehosur
- Department of Oral and Maxillofacial Surgery, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Niranjan Kumar
- SDM Craniofacial Unit and Research Centre, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Craniofacial Morphometric Features Associated With Pericondylar Fractures of the Mandible. J Craniofac Surg 2019; 30:2065-2068. [PMID: 31490441 DOI: 10.1097/scs.0000000000005960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The research aimed at investigating potential correlations between craniofacial morphological measurements and mandibular pericondylar fractures, based on a retrospective study of 380 mandible fractures treated in our department, during 2010 to 2017. Predictors included morphological measurements and features. Primary outcome was presence of pericondylar fracture; 133 pericondylar fractures were found, including subcondylar, condylar neck, and condylar head fractures. Condylar neck fractures showed negative correlations with condylar neck width (5.7 mm versus 6.7 mm sagittaly, and 6.1 mm versus 6.8 mm coronally, respectively). Gonial angle (117.3 degrees versus 128.7), and mandibular length 106.2 mm versus 110.4 mm, respectively) showed negative correlation with all pericondylar fractures. Ramus height correlated positively with pericondylar fractures (53.6 mm versus 51.2 mm, respectively). Thus, our results showed condylar neck width was a predictor for condylar neck fractures. In addition, individuals suffering from pericondylar fractures had significantly smaller gonial angles, longer ramus height, and shorter mandibular length. These morphologic features are characteristic of individuals with decreased anterior facial height. Our results corroborated a previous study we had conducted, which suggested that increased anterior vertical growth correlates with angle fractures.
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18
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Liu YF, Wang R, Baur DA, Jiang XF. A finite element analysis of the stress distribution to the mandible from impact forces with various orientations of third molars. J Zhejiang Univ Sci B 2018; 19:38-48. [PMID: 29308606 DOI: 10.1631/jzus.b1600552] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the stress distribution to the mandible, with and without impacted third molars (IM3s) at various orientations, resulting from a 2000-Newton impact force either from the anterior midline or from the body of the mandible. MATERIALS AND METHODS A 3D mandibular virtual model from a healthy dentate patient was created and the mechanical properties of the mandible were categorized to 9 levels based on the Hounsfield unit measured from computed tomography (CT) images. Von Mises stress distributions to the mandibular angle and condylar areas from static impact forces (Load I-front blow and Load II left blow) were evaluated using finite element analysis (FEA). Six groups with IM3 were included: full horizontal bony, full vertical bony, full 450 mesioangular bony, partial horizontal bony, partial vertical, and partial 450 mesioangular bony impaction, and a baseline group with no third molars. RESULTS Von Mises stresses in the condyle and angle areas were higher for partially than for fully impacted third molars under both loading conditions, with partial horizontal IM3 showing the highest fracture risk. Stresses were higher on the contralateral than on the ipsilateral side. Under Load II, the angle area had the highest stress for various orientations of IM3s. The condylar region had the highest stress when IM3s were absent. CONCLUSIONS High-impact forces are more likely to cause condylar rather than angular fracture when IM3s are missing. The risk of mandibular fracture is higher for partially than fully impacted third molars, with the angulation of impaction having little effect on facture risk.
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Affiliation(s)
- Yun-Feng Liu
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou 310014, China
| | - Russell Wang
- Department of Comprehensive Care, School of Dental Medicine, Case Western Reserve University, 2124 Cornell Rd. Cleveland, OH 44106-4905, USA
| | - Dale A Baur
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, 2124 Cornell Rd. Cleveland, OH 44106-4905, USA
| | - Xian-Feng Jiang
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou 310014, China
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Kılınç Y, Zor ZF, Tümer MK, Erkmen E, Kurt A. Does the angulation of the mandibular third molar influence the fragility of the mandibular angle after trauma to the mandibular body? A three-dimensional finite-element study. Comput Methods Biomech Biomed Engin 2018; 21:488-497. [PMID: 29969292 DOI: 10.1080/10255842.2018.1482282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The relationship between mandibular third molar (M3) angulation and mandibular angle fragility is not well established. The aim of this study was to evaluate the impact of M3 angulation on the mandibular angle fragility when submitted to a trauma to the mandibular body region. A three-dimensional (3D) mandibular model without M3 (Model 0) was obtained by means of finite-element analysis (FEA). Four models were generated from the initial model, representing distoangular (Model D), horizontal (Model H), mesioangular (Model M) and vertical (Model V) angulations. A blunt trauma with a magnitude of 2000 N was applied perpendicularly to the sagittal plane in the mandibular body. Maximum principal stress (Pmax) (tensile stress) values were calculated in the bone. The lowest Pmax stress values were noted in Model 0. When the M3 was present extra stress fields were found around marginal bone of second molar and M3. Comparative analysis of the models with M3 revealed that the highest level of stress was found in Model V, whereas Model D showed the lowest stress values. The angulation of M3 affects the stress levels in the mandibular angle and has an impact on mandibular fragility. The mandibular angle becomes more fragile in case of vertical impaction when submitted to a trauma to the mandibular body region.
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Affiliation(s)
- Yeliz Kılınç
- a Department of Oral and Maxillofacial Surgery, Faculty of Dentistry , Gazi University , Ankara , Turkey
| | - Zeynep Fatma Zor
- a Department of Oral and Maxillofacial Surgery, Faculty of Dentistry , Gazi University , Ankara , Turkey
| | - Mehmet Kemal Tümer
- b Department of Oral and Maxillofacial Surgery, Faculty of Dentistry , Gaziosmanpaşa University , Tokat , Turkey
| | - Erkan Erkmen
- a Department of Oral and Maxillofacial Surgery, Faculty of Dentistry , Gazi University , Ankara , Turkey
| | - Ahmet Kurt
- c Department of Manufacturing Engineering, Faculty of Engineering , Atılım University , Ankara , Turkey
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20
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Liu YF, Fan YY, Dong HY, Zhang JX. An Investigation of Two Finite Element Modeling Solutions for Biomechanical Simulation Using a Case Study of a Mandibular Bone. J Biomech Eng 2018; 139:2650612. [PMID: 28816344 DOI: 10.1115/1.4037633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/08/2022]
Abstract
The method used in biomechanical modeling for finite element method (FEM) analysis needs to deliver accurate results. There are currently two solutions used in FEM modeling for biomedical model of human bone from computerized tomography (CT) images: one is based on a triangular mesh and the other is based on the parametric surface model and is more popular in practice. The outline and modeling procedures for the two solutions are compared and analyzed. Using a mandibular bone as an example, several key modeling steps are then discussed in detail, and the FEM calculation was conducted. Numerical calculation results based on the models derived from the two methods, including stress, strain, and displacement, are compared and evaluated in relation to accuracy and validity. Moreover, a comprehensive comparison of the two solutions is listed. The parametric surface based method is more helpful when using powerful design tools in computer-aided design (CAD) software, but the triangular mesh based method is more robust and efficient.
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Affiliation(s)
- Yun-Feng Liu
- Key Laboratory of E&M, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310014, China e-mail:
| | - Ying-Ying Fan
- Key Laboratory of E&M, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310014, China
| | - Hui-Yue Dong
- Key Laboratory of Advanced Manufacturing Technology of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou 310007, China
| | - Jian-Xing Zhang
- Department of Stomatology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
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21
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Armond ACV, Martins CC, Glória JCR, Galvão EL, Dos Santos CRR, Falci SGM. Influence of third molars in mandibular fractures. Part 2: mandibular condyle-a meta-analysis. Int J Oral Maxillofac Surg 2017; 46:730-739. [PMID: 28259600 DOI: 10.1016/j.ijom.2017.02.1265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/25/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle-Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case-control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17-0.40, I2=87.8%; case-control studies: OR 0.30, 95% CI 0.16-0.58, I2=91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09-1.61, I2=0%) and class I (OR 1.37, 95% CI 1.05-1.77, I2=32.8%). Class B (OR 0.69, 95% CI 0.49-0.97, I2=56.0%) and class II (OR 0.71, 95% CI 0.57-0.87, I2=0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors.
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Affiliation(s)
- A C V Armond
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhona e Mucuri (UFVJM), Diamantina, MG, Brazil
| | - C C Martins
- Department of Paediatric Dentistry and Orthodontics, Universidade Federal de Minas Gerais (UFMG), Pampulha, Belo Horizonte, MG, Brazil
| | - J C R Glória
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhona e Mucuri (UFVJM), Diamantina, MG, Brazil
| | - E L Galvão
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - C R R Dos Santos
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhona e Mucuri (UFVJM), Diamantina, MG, Brazil
| | - S G M Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhona e Mucuri (UFVJM), Diamantina, MG, Brazil.
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22
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Han L, Long T, Tang W, Liu L, Jing W, Tian WD, Long J. Correlation between Condylar Fracture Pattern after Parasymphyseal Impact and Condyle Morphological Features: A Retrospective Analysis of 107 Chinese Patients. Chin Med J (Engl) 2017; 130:420-427. [PMID: 28218215 PMCID: PMC5324378 DOI: 10.4103/0366-6999.199836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The treatment of the condylar fractures is difficult. Factors that result in the fractures are complex. The objective of this morphometric study was to investigate the relationship between condylar fracture patterns and condylar morphological characteristics. Methods: We conducted a retrospective analysis of 107 patients admitted to the West China Hospital of Stomatology for bilateral condylar fractures caused by parasymphyseal impact. The patients were divided into five groups according to the type of condylar fracture. Ten parameters were evaluated on three-dimensional (3D) reconstruction mandible models through the Mimics 16.0 (Materialize Leuven, Belgium) anthropometry toolkit. Each parameter of the 3D models was analyzed using multivariate analysis. Multinomial logistic regression analyses were used to examine the relationships between the five groups. Results: The results showed that the differences of condylar head width (M1), condylar neck width (M3), the ratio of condylar head width to condylar anteroposterior diameter (M1/M2), the ratio of condylar head width to condylar neck width (M1/M3), the ratio of condylar height to ramus height (M8/M7), and mandibular angle (M10) were statistically significant (p < 0.05). Type A condylar head fractures were positively associated with M1 (compared to Type B: OR =1.627, 95% CI: 1.123, 2.359; compared to Type C: OR = 1.705, 95% CI: 1.170, 2.484) and M1/M2 (compared to Type B: OR =1.034, 95% CI: 0.879, 2.484). Type B condylar head fractures were negatively associated with M10 (compared to Type C: OR = 0.909, 95% CI: 0.821, 1.007). Condylar neck fractures were negatively associated with M3 (compared to condylar head: OR = 0.382, CI: 0.203, 0.720; compared to condylar base: OR = 0.436, 95% CI: 0.218, 0.874), and positively associated with M1/M3 (compared to condylar head: OR = 1.229, 95% CI: 1.063, 1.420 compared to condylar base: OR = 1.223, 95% CI: 1.034, 1.447). Condylar base fractures were positively associated with M10 (OR = 1.095, 95% CI: 1.008, 1.189) and negatively associated with M8/M7 (OR = 0.855, 95% CI: 0.763, 0.959) as compared with condylar head fractures. Conclusions: Condylar fracture pattern is associated with the anatomical features of the condyles when a fracture occurs from parasymphyseal impact.
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Affiliation(s)
- Lu Han
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, Sichuan 610041; Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ting Long
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wei Tang
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lei Liu
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wei Jing
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wei-Dong Tian
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jie Long
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, Sichuan 610041; Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
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23
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Menon S, Kumar V, V S, Priyadarshini Y. Correlation of Third Molar Status with Incidence of Condylar and Angle Fractures. Craniomaxillofac Trauma Reconstr 2016; 9:224-8. [PMID: 27516837 DOI: 10.1055/s-0036-1584400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/20/2016] [Indexed: 10/21/2022] Open
Abstract
The mandibular angle and condylar regions are most prone to fractures and this has been attributed to the presence/absence or the position of the third molars. This retrospective study was undertaken to analyze the correlation between the third molars and incidence of condylar and angle fractures in 104 patients treated for these fractures during the period from June 2009 to December 2013. Clinical and radiographic records of these patients were studied to look for the presence and position of third molars and their relation to incidence of condylar or angle fractures. There was a definite positive relation to impacted third molars and increased incidence of angle fractures. The condylar fractures were more commonly seen when the third molars were fully erupted or missing. Third molar impactions predispose to angle fractures and missing or fully erupted third molars predispose to condylar fractures.
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Affiliation(s)
- Suresh Menon
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, Karnataka, India
| | - Veerendra Kumar
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, Karnataka, India
| | - Srihari V
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, Karnataka, India
| | - Yogitha Priyadarshini
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bangalore, Karnataka, India
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24
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Antic S, Milicic B, Jelovac DB, Djuric M. Impact of the lower third molar and injury mechanism on the risk of mandibular angle and condylar fractures. Dent Traumatol 2016; 32:286-95. [PMID: 26821987 DOI: 10.1111/edt.12259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have shown the influence of the mandibular third molar on mandibular angle and condylar fractures, but have not comparatively analyzed the impact of the injury mechanism on these fractures. The purpose of this study was to evaluate the influence of the lower third molar (M3) and injury-related factors (fracture etiology and site of impact of the traumatic force) on the risk of mandibular angle and condylar fractures. MATERIAL AND METHODS The study included 615 patients who sustained a mandibular fracture in a 13-year period (from January 2000 to December 2013). The independent variables were presence, position and the root number of the M3, fracture etiology, and site of impact of the force. The outcome variables were mandibular angle and condylar fractures. Other variables included in the study were patients' gender and age. The data were analyzed using the chi-square test. Univariate and multivariate binary logistic regression analyses were used to evaluate the relationship between angle and condylar fractures and to show potential determinants. RESULTS Angle fractures were significantly influenced by the M3, site of impact, and age, but the main predictors were the eruption status and vertical position of the M3 (classified by Pell and Gregory) and site of impact of the force. Condylar fractures were significantly influenced by the M3 and site of impact of the force, but only the last showed as a predictor. CONCLUSIONS Factors related to the M3 showed more significant influence on angle fractures than on condylar fractures.
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Affiliation(s)
- Svetlana Antic
- Center for Radiological Diagnostics, School of Dentistry, University of Belgrade, Belgrade, Serbia.,Laboratory for Anthropology, School of Medicine, Institute of Anatomy, University of Belgrade, Belgrade, Serbia
| | - Biljana Milicic
- Department of Statistics, School of Dentistry, University of Belgrade, Belgrade, Serbia.,Department of Anesthesiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Drago B Jelovac
- Clinic of Maxillofacial Surgery, School of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology, School of Medicine, Institute of Anatomy, University of Belgrade, Belgrade, Serbia
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25
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Recent advances in the management of oral and maxillofacial trauma. Br J Oral Maxillofac Surg 2015; 53:913-21. [DOI: 10.1016/j.bjoms.2015.08.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022]
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26
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Mah DH, Kim SG, Moon SY, Oh JS, You JS. Relationship between mandibular condyle and angle fractures and the presence of mandibular third molars. J Korean Assoc Oral Maxillofac Surg 2015; 41:3-10. [PMID: 25741462 PMCID: PMC4347027 DOI: 10.5125/jkaoms.2015.41.1.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We retrospectively evaluated the impact of mandibular third molars on the occurrence of angle and condyle fractures. MATERIALS AND METHODS This was a retrospective investigation using patient records and radiographs. The sample set consisted of 440 patients with mandibular fractures. Eruption space, depth and angulation of the third molar were measured. RESULTS Of the 144 angle fracture patients, 130 patients had third molars and 14 patients did not. The ratio of angle fractures when a third molar was present (1.26 : 1) was greater than when no third molar was present (0.19 : 1; odds ratio, 6.58; P<0.001). Of the 141 condyle fractures patients, the third molar was present in 84 patients and absent in 57 patients. The ratio of condyle fractures when a third molar was present (0.56 : 1) was lower than when no third molar was present (1.90 : 1; odds ratio, 0.30; P<0.001). CONCLUSION The increased ratio of angle fractures with third molars and the ratio of condyle fractures without a third molar were statistically significant. The occurrence of angle and condyle fractures was more affected by the continuity of the cortical bone at the angle than by the depth of a third molar. These results demonstrate that a third molar can be a determining factor in angle and condyle fractures.
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Affiliation(s)
- Deuk-Hyun Mah
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Su-Gwan Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Seong-Yong Moon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Ji-Su Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Jae-Seek You
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
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27
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Antic S, Saveljic I, Nikolic D, Jovicic G, Filipovic N, Rakocevic Z, Djuric M. Does the presence of an unerupted lower third molar influence the risk of mandibular angle and condylar fractures? Int J Oral Maxillofac Surg 2014; 45:588-92. [PMID: 25448405 DOI: 10.1016/j.ijom.2014.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 10/22/2022]
Abstract
It has been suggested that unerupted lower third molars (M3) increase the fragility of the mandibular angle and simultaneously decrease the risk of condylar fracture. However, it is unknown whether this applies regardless of the direction and point of impact of the traumatic force. The aim of this study was to investigate the impact of an unerupted M3 on the fragility of the angle and condyle in terms of a force acting from different directions and affecting different regions of the mandible. Computed tomography scans of a human mandible and finite element methodology were used to obtain two three-dimensional models: a model with, and the other without an unerupted M3. A force of 2000N was applied to three different regions of the models: the symphysis, ipsilateral body, and contralateral body, respectively. When the force was applied to the mandibular body, the results revealed increased angle fragility in cases with unerupted M3. When the force was applied to the symphysis, the condyle region showed higher fragility, irrespective of the presence of an unerupted M3. In summary, fragility of the angle and condyle regions depends on the presence of an unerupted M3 and on the direction and point of impact of the force.
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Affiliation(s)
- S Antic
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - I Saveljic
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - D Nikolic
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - G Jovicic
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - N Filipovic
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - Z Rakocevic
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia
| | - M Djuric
- Laboratory for Anthropology, Institute of Anatomy, University of Belgrade - School of Medicine, Belgrade, Serbia.
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28
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Rahimi-Nedjat RK, Sagheb K, Walter C. Concomitant dental injuries in maxillofacial fractures - a retrospective analysis of 1219 patients. Dent Traumatol 2014; 30:435-41. [PMID: 24890672 DOI: 10.1111/edt.12118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIM Traumatic dental injuries are frequently combined with maxillofacial fractures, but literature addressing this topic is rare. In a retrospective study, the frequency of dental lesions in inpatients with traumatic facial injuries was analyzed. MATERIAL AND METHODS All patients referred to the Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University Mainz for inpatient treatment due to facial fractures between January 2001 and December 2007 were analyzed regarding the type of fracture, its localization, and potential concomitant dental injuries. In addition a systematic review was performed to compare the findings of this study with existing data. RESULTS Altogether 1219 facial trauma patients underwent inpatient treatment. 184 (15.87%) out of those had 451 injured teeth, and 4.9% were edentulous. The most frequent causes were assaults (25.1%), followed by falls (19.6%) and bike accidents (10.1%). Avulsion, especially of the upper incisors, occurred in most cases (27.9%). Assaults caused 1.29 dental fractures per patient, while traffic-related accidents led to three to four times higher injury-rates. CONCLUSIONS With almost every sixth patient having at least one kind of dental injury, this study shows that a thorough anamnesis and examination of the dental status are absolutely necessary, especially in patients who suffered from high-speed impacts or collisions with low-resilience surfaces.
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Affiliation(s)
- Roman K Rahimi-Nedjat
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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29
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Kumar PS, Dhupar V, Akkara F, Kumar GBA. Eruption status of third molar and its possible influence on the location of mandibular angle fracture: a retrospective analysis. J Maxillofac Oral Surg 2014; 14:243-6. [PMID: 26028842 DOI: 10.1007/s12663-014-0621-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 02/24/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION This study was designed to evaluate the influence of eruption status of mandibular third molars on the location of mandibular angle fracture. We also aimed to evaluate the incidence of damage to mandibular third molar teeth (M3) and its roots. MATERIALS AND METHODS Medical records and panoramic radiographs of 142 patient cohorts with mandibular angle fractures with third molars present were retrospectively reviewed. RESULTS Revealed that incidence of angle fracture were high in patients with fully erupted M3 when compared to unerupted group. Out of 142 patients, 108 fractures were found involving the M3 socket and 14.1 % had damage to M3. CONCLUSION The presence of erupted mandibular third molar increases the chances of angle fracture when compared to impacted M3. Involvement of the M3 socket often resulted in increased operative time and complexity of the surgical procedure with possible removal of the damaged M3.
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Affiliation(s)
| | - Vikas Dhupar
- Department of OMFS, Goa Dental College and Hospital, Bambolim, 403002 Goa India
| | - Francis Akkara
- Department of OMFS, Goa Dental College and Hospital, Bambolim, 403002 Goa India
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