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Helmer LML, Klop C, Lobbezoo F, Lange JD, Koolstra JH, Dubois L. Changes in load distribution after unilateral condylar fracture: A finite element model study. Arch Oral Biol 2023; 155:105791. [PMID: 37598527 DOI: 10.1016/j.archoralbio.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Premature dental contact on the fractured side and a contralateral open bite are signs of a unilaterally fractured condyle of the temporomandibular joint (TMJ). The lateral pterygoid muscle pulls the condyle inwards, causing angulation of the fractured part and shortening of the ramus. This imbalance after fracture might change the load in both TMJs and consequently induce remodeling. The present study aimed to calculate this change in load. It is hypothesized to decrease on the fractured side and increase on the non-fractured side. DESIGN For these calculations, a finite element model (FEM) was used. In the FEM, shortening of the ramus varied from 2 mm to 16 mm; angulation, from 6.25° to 50°. RESULTS After fracture, load on the non-fractured side increased, but only at maximal mouth opening (MMO). Simultaneously, load on the fractured side decreased, at both timepoints, i.e., MMO and closed mouth. When comparing all simulations at those time points, i.e., from 2 mm and 6.25° to 16 mm and 50°, the load in the fractured condyle declines steadily. However, for both timepoints, a threshold stands out around 6 mm shortening and 18.75° angulation: visualization of the fractured condyle showed, apart from load on the condylar head, a second point of load more medial in the TMJ which was most evident in the 6 mm - 18.75° simulation. CONCLUSIONS These findings could implicate that the balance between both TMJs is more difficult to restore after a fracture with more than 6 mm shortening and more than 18.75° angulation.
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Affiliation(s)
- Loreine M L Helmer
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan Harm Koolstra
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Helmer LML, Klop C, Lobbezoo F, de Lange J, Harm Koolstra J, Dubois L. Contact stress distribution after unilateral condylar fracture with angulation of the fractured part: A finite element model study. J Biomech 2023; 159:111769. [PMID: 37683378 DOI: 10.1016/j.jbiomech.2023.111769] [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: 12/22/2022] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
After a fracture of the condyle, the head of the condyle is often pulled inwards, which causes the fractured part to angulate medially. This change can cause a disbalance in the masticatory system. The disbalance could lead to contact stress differences within the temporomandibular joints (TMJs) which might induce remodelling within the TMJ to restore the balance. The contact stress in the fractured condyle during open and closing movements is expected to decrease, while the contact stress in the non-fractured condyle will increase. In a clinical situation this is hard to investigate. Therefore, a finite element model (FEM) was used. In the FEM a fractured right condyle with an angulation was induced, which was placed at different degrees, varying from 5° to 50° in steps of 5°. This study shows only minor differences in amount of contact stress between the fractured and the non-fractured condyle. The amount of contact stress in the condyles does not increase with a higher degree of angulation. However, with larger angulations, the contact stress within the fractured condyle is more centralized. Clinically, this more centralized area could be associated with complaints, such as pain. In conclusion, due to the more centralized contact stress in the fractured condyle, one would expect some minor remodelling on the fractured side with more angulation.
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Affiliation(s)
- Loreine M L Helmer
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan Harm Koolstra
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Helmer LML, Klop C, Lobbezoo F, de Lange J, Koolstra JH, Dubois L. Load distribution after unilateral condylar fracture with shortening of the ramus: a finite element model study. Head Face Med 2023; 19:27. [PMID: 37422658 DOI: 10.1186/s13005-023-00370-5] [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: 02/01/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVES After a fracture of the condyle, the fractured ramus is often shortened, which causes premature dental contact on the fractured side and a contralateral open bite. The imbalance could change the load in the temporomandibular joints (TMJs). This change could lead to remodelling of the TMJs to compensate for the imbalance in the masticatory system. The load in the non-fractured condyle is expected to increase, and the load in the fractured condyle to decrease. MATERIALS AND METHODS These changes cannot be measured in a clinical situation. Therefore a finite element model (FEM) of the masticatory system was used. In the FEM a fractured right condyle with shortening of the ramus was induced, which varied from 2 to 16 mm. RESULTS Results show that, with a larger shortening of the ramus, the load in the fractured condyle decreases and the load in the non-fractured condyle increases. In the fractured condyle during closed mouth a major descent in load, hence a cut-off point, was visible between a shortening of 6 mm and 8 mm. CONCLUSIONS In conclusion, the change of load could be associated with remodelling on both condyles due to shortening of the ramus. CLINICAL RELEVANCE The cut-off point implies that shortening over 6 mm could present more difficulty for the body to compensate.
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Affiliation(s)
- Loreine M L Helmer
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan Harm Koolstra
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam Academic Medical Centers and Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Wysocki MA, Doyle S. Enhancing biomedical data validity with standardized segmentation finite element analysis. Sci Rep 2022; 12:9860. [PMID: 35701504 PMCID: PMC9198234 DOI: 10.1038/s41598-022-13961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022] Open
Abstract
Finite element analysis is a powerful computational technique for augmenting biomedical research, prosthetics design, and preoperative surgical assessment. However, the validity of biomechanical data obtained from finite element analysis is dependent on the quality of the preceding data processing. Until now, little information was available about the effect of the segmentation process on finite element models and biomechanical data. The current investigation applied 4 segmentation approaches to 129 femur specimens, yielding a total of 516 finite element models. Biomechanical data including average displacement, pressure, stress, and strain were collected from experimental groups based on the different segmentation approaches. The results indicate that only a 5.0% variation in the segmentation process leads to statistically significant differences in all 4 biomechanical measurements. These results suggest that it is crucial for consistent segmentation procedures to be applied to all specimens within a study. This methodological advancement will help to ensure that finite element data will be more accurate and that research conclusions will have greater validity.
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Affiliation(s)
- Matthew A Wysocki
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, 14203, USA.
| | - Scott Doyle
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, 14203, USA
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Tribst JPM, Dal Piva AMDO, Bottino MA, Kleverlaan CJ, Koolstra JH. Mouthguard use and TMJ injury prevention with different occlusions: A three‐dimensional finite element analysis. Dent Traumatol 2020; 36:662-669. [DOI: 10.1111/edt.12577] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
- João Paulo Mendes Tribst
- Department of Dental Materials and Prosthodontics São Paulo State University (Unesp/SJC) São Paulo Brazil
- Department of Dental Materials Science Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
| | - Amanda Maria de Oliveira Dal Piva
- Department of Dental Materials and Prosthodontics São Paulo State University (Unesp/SJC) São Paulo Brazil
- Department of Dental Materials Science Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
| | - Marco Antonio Bottino
- Department of Dental Materials and Prosthodontics São Paulo State University (Unesp/SJC) São Paulo Brazil
| | - Cornelis Johannes Kleverlaan
- Department of Dental Materials Science Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
| | - Jan Harm Koolstra
- Department of Oral Cell Biology and Functional Anatomy Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
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Kozakiewicz M, Zieliński R, Konieczny B, Krasowski M, Okulski J. Open Rigid Internal Fixation of Low-Neck Condylar Fractures of the Mandible: Mechanical Comparison of 16 Plate Designs. MATERIALS 2020; 13:ma13081953. [PMID: 32331209 PMCID: PMC7215721 DOI: 10.3390/ma13081953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/06/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the literature, no information on plates for low-neck mandibular condylar osteosynthesis can be found, despite the fact that 30 plate designs have already been published. The aim of this study was to compare any dedicated plates for possible use in low-neck condylar fracture osteosynthesis. METHODS The force required for 1-mm displacement of the fixed fracture fragments and incidents of screw loosening were recorded on polyurethane mandibles among 16 designs of titanium plates fixed by 6-mm screws in a 2.0 system. RESULTS Double-straight plate fixation was the mechanical gold standard (15.2 ± 3.5 N), followed by A-shape Condylar Plates (14.9 ± 2.1 N), X-shape Condylar Plates (14.2 ± 1.3 N) and Auto Repositioning Plates (11.8 ± 2.4 N). Screw loosening was uncommon, as a minimum of three screws were placed into the condylar part. Fewer screws were lost from the ramus part of the fixation if the plate was attached to the condylar part by three screws. Often, the stability of the ramus screws was lost when there were only two fixing screws in the condyle (p < 0.001). CONCLUSIONS It is advisable to consider the mechanical advantages as one decides which plate to choose for open rigid internal fixation in low-neck condylar fractures, or to only be aware of the significant differences in mobility within the fracture line after fixation with different dedicated plates.
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Affiliation(s)
- Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland; (R.Z.); (J.O.)
- Correspondence:
| | - Rafał Zieliński
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland; (R.Z.); (J.O.)
| | - Bartłomiej Konieczny
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland; (B.K.); (M.K.)
| | - Michał Krasowski
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland; (B.K.); (M.K.)
| | - Jakub Okulski
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland; (R.Z.); (J.O.)
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Reiter MJ, Schwope RB, Theler JM. Postoperative CT of the Mandible Following Trauma: Review of Normal Appearances and Common Complications. Acad Radiol 2019; 26:686-698. [PMID: 30072290 DOI: 10.1016/j.acra.2018.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Surgeons aim to restore occlusion and jaw function to baseline status for patients with mandibular fractures using either closed treatment or reduction and fixation. MATERIALS AND METHODS Occlusion is defined as the relationship between the maxillary and mandibular teeth as they approach each other. RESULTS Radiologists should be familiar with the goals of repair to help identify which treatment is adequate as well as to diagnose potential complications. Some of the more common complications encountered are infection, nonunion or malunion, and malocclusion. CONCLUSION We provide a comprehensive review of both the desired and untoward CT findings after surgical repair of traumatic mandibular injuries.
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Affiliation(s)
- Michael J Reiter
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, New York.
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas; Uniformed Services University of the Health Sciences, Bethesda, Madison
| | - Jared M Theler
- Department of Otolaryngology, Brooke Army Medical Center, San Antonio, Texas
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