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Bilginaylar K, Ayali A. Biomechanical behavior of carbon fiber-reinforced polyetheretherketone as a dental implant material in implant-supported overdenture under mandibular trauma: A finite element analysis study. Niger J Clin Pract 2023; 26:1538-1546. [PMID: 37929532 DOI: 10.4103/njcp.njcp_239_23] [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] [Indexed: 11/07/2023]
Abstract
Context Implant-supported overdentures are well-known and widely accepted treatment modality to increase retention which is a crucial factor for determining patient satisfaction. The placement of two implants in the anterior region can be selected as a first-line treatment in patients with the atrophic mandibular ridge. Aims The purpose of this research was to assess the biomechanical effects of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) implant-supported overdenture in the event of 2,000 N forefront trauma to an atrophic edentulous mandible by using the finite element analysis method. Materials and Methods Three types of mandible models were simulated; the first one was an edentulous atrophic mandible model; in the second model, 3.5 × 11.5 mm CFR-PEEK implants; and in the third model, 4.3 × 11.5 mm CFR-PEEK implants were positioned in the region of the lateral incisor of the identical edentulous atrophic mandible. Results Maximum Von Misses stresses 979.261 MPa, 1,454.69 MPa, and 1,940.71 MPa and maximum principal stresses 1,112.74 MPa, 1,249.88 MPa, and 1,251.33 MPa have been detected at the condylar neck area and minimum principal stresses - 1,203.38 MPa, -1,503.21 MPa, and - 1,990.34 MPa have been recorded at the symphysis and corpus regions from M1 to M3, respectively. In addition, the M2 and M3 models showed low-stress distributions around the implant-bone interface, particularly where the implants were in contact with cancellous bone. Conclusions The results showed that the insertion of different diameters of CFR-PEEK implants led to low and homogenous stress distribution all around the implant-bone interface and stresses transferred directly to the condylar neck areas. Therefore, it was observed that CRF-PEEK implants did not change the basic behavior of the mandibula in response to frontal stresses.
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Affiliation(s)
- K Bilginaylar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Final International University, Nicosia, Mersin, Turkey
| | - A Ayali
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, European University of Lefke, Cyprus, 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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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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Seeley-Hacker BL, Holmgren EP, Harper CW, Lauer CS, Van Citters DW. An Anatomic Predisposition to Mandibular Angle Fractures. J Oral Maxillofac Surg 2020; 78:2279.e1-2279.e12. [PMID: 32649890 DOI: 10.1016/j.joms.2020.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate a predisposition to mandibular angle fractures, a retrospective study was performed in which fractured mandibles were compared with healthy mandibles with no history of fracture. Other investigations of angle fracture risk have exclusively studied patients with existing fractures. In addition, the risk has not been comprehensively explained in conjunction with the specific features of mandibular anatomy. We sought to characterize any anatomic variations between the jaws that had fractured and those that had never fractured. MATERIALS AND METHODS Healthy mandibles with no history of fracture were physically measured at the William M. Bass Skeletal Collection at the University of Tennessee, Knoxville and compared with fractured mandibles from computed tomography (CT) scans at the Dartmouth Hitchcock Medical Center. A total of 52 healthy mandibles and 44 CT scans were evaluated. MATLAB machine learning algorithms (MathWorks, Natick, MA) were used to compare the study populations and isolate those anatomic features that differed between healthy and fractured mandibles. RESULTS Machine learning classifiers were able to differentiate between male and female jaws, with the condylion-gnathion distance the most distinguishing feature. The 6 most common anatomic features that differed between healthy and fractured mandibles were the 1) retromolar space, 2) perimeter of the cross-section just proximal to the second molar, 3) breadth of the ramal cross-section, 4) thickness of the oblique ridge, 5) transgonial angle, and 6) location of the ipsilateral mental foramen. The presence of third molars was also related to fracture risk, with third molars present in 72.7% of the fractured mandibles versus 26.9% of unfractured mandibles. Of the fractured mandibles with third molars present, 87.5% had the fracture running directly through the tooth or its socket. CONCLUSIONS The results from the present study have provided evidence that anatomic differences exist between mandibles that sustain angle fractures and those that do not. Although much of the morphology was found to be interdependent, the fracture risk could be accurately predicted using 6 anatomic features. Understanding these mandibular variations and identifying patients vulnerable to mandibular fracture could provide clinicians with additional objective information. Furthermore, using the methods demonstrated in our study, future research could focus on developing an algorithm that includes these unique anatomic features in the hope of assisting surgeons in providing tailored treatment for mandibular angle fractures according to patient-specific morphology.
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Affiliation(s)
- Brett L Seeley-Hacker
- Student and Research Fellow, Thayer School of Engineering, Dartmouth College, Hanover, NH; and Medical Student, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Eric P Holmgren
- Assistant Clinical Professor, Department of Otolaryngology and Oral/Maxillofacial Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH.
| | - Christopher W Harper
- Resident, Department of Otolaryngology, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - Caroline S Lauer
- Graduate Engineering Student, Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Douglas W Van Citters
- Professor, Department of Mechanical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, NH
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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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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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Does an Association Exist Between the Presence of Lower Third Molar and Mandibular Angle Fractures?: A Meta-Analysis. J Oral Maxillofac Surg 2017; 76:34-45. [PMID: 28688821 DOI: 10.1016/j.joms.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The current data suggest that the presence of lower third molars predisposes the patient to a greater risk of mandibular angle fracture. Thus, the present review sought to determine whether an association exists between the presence of a lower third molar and the occurrence of a mandibular angle fracture in adults and to assess the influence of third molar position according to the Pell and Gregory classification. MATERIALS AND METHODS The present study was a systematic review and meta-analysis of analytical observational studies. The present review included all reports of the relationship between mandibular angle fractures and lower third molars. No restriction regarding year, language, or publication status was used. The review protocol was registered at the PROSPERO database (registration no. CRD42016047057). Electronic searches unrestricted for publication period and language were performed in the PubMed, Scopus, SciELO, and Latin American and Caribbean Health Sciences databases. Google Scholar and OpenGrey databases were used to search the "gray literature," avoiding selection and publication biases. The entire search was performed by 2 eligibility reviewers. Association and proportion meta-analyses were planned for the studies with sufficient data. The primary predictor variable was the relationship between the presence of a lower third molar and the development of mandibular angle fractures. The secondary outcome variables were the vertical and horizontal positions of the lower third molar, according to the Pell and Gregory classification and their relationship to the susceptibility to developing a mandibular angle fracture. RESULTS The search strategies resulted in 411 studies, from which 16 were selected for qualitative and quantitative review. The association meta-analysis included all the selected studies and showed that patients with lower third molars are 3.16 times more likely to develop mandibular angle fractures. The proportion meta-analysis included 5 studies and showed that the overall rate of mandibular angle fractures was 51.58% and that positions III and C are more likely to result in fracture, with a rate of 59.84 and 63.67%, respectively. CONCLUSIONS The results of the present study have shown that the presence of impacted third molars increases by 3.16 times the risk of mandibular angle fractures in adults, with the greatest risk present when third molars are classified as IIIC according to Pell and Gregory. The available evidence is not sufficiently robust to determine whether third molar presence or the level of impaction is the main causative factor for the occurrence of mandibular angle fractures.
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Ayali A, Bilginaylar K. Evaluating the biomechanical effects of implant diameter in case of facial trauma to an edentulous atrophic mandible: a 3D finite element analysis. Head Face Med 2017; 13:5. [PMID: 28464946 PMCID: PMC5414147 DOI: 10.1186/s13005-017-0139-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/25/2017] [Indexed: 11/04/2022] Open
Abstract
Background Rehabilitation using an implant supported overdenture with two implants inserted in the interforaminal region is the easiest and currently accepted treatment modality to increase prosthetic stabilization and patient satisfaction in edentulous patients. The insertion of implants to the weakend mandibular bone decreases the strength of the bone and may lead to fractures either during or after implant placement. The aim of this three dimensional finite element analysis (3D FEA) study was to evaluate the biomechanical effects of implant diameter in case of facial trauma (2000 N) to an edentulous atrophic mandible with two implant supported overdenture. Methods Three 3D FEA models were simulated; Model 1 (M1) is edentulous atrophic mandible, Model 2 (M2), 3.5x11.5 mm implants were inserted into lateral incisors area of same edentulous atrophic mandible, Model 3 (M3), 4.3x11.5 mm implants were inserted into lateral incisors area of same edentulous atrophic mandible. Results In M1 and M2 highest stress levels were observed in condylar neck, whereas highest stress values in M3 were calculated in symphyseal area. Conclusions To reduce the risk of bone fracture and to preserve biomechanical behavior of the atrophic mandible from frontal traumatic loads, implants should be inserted monocortically into spongious bone of lateral incisors area.
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Affiliation(s)
- Aysa Ayali
- Department of Oral and Maxillofacial Surgery, Near East University, Faculty of Dentistry, Near East Boulevard, Nicosia Cyprus, 99138, Mersin 10, Turkey.
| | - Kani Bilginaylar
- Department of Oral and Maxillofacial Surgery, Near East University, Faculty of Dentistry, Near East Boulevard, Nicosia Cyprus, 99138, Mersin 10, Turkey
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Panneerselvam E, Prasad PJ, Balasubramaniam S, Somasundaram S, Raja KVB, Srinivasan D. The Influence of the Mandibular Gonial Angle on the Incidence of Mandibular Angle Fracture-A Radiomorphometric Study. J Oral Maxillofac Surg 2016; 75:153-159. [PMID: 27643630 DOI: 10.1016/j.joms.2016.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this radiomorphometric study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture. MATERIALS AND METHODS A retrospective analysis of medical records and radiographs of patients treated for mandibular fractures was performed. The exposure studied was the presence of a high gonial angle and the outcome was fracture of the mandibular angle. The mandibular gonial angle and mandibular height at the angle were measured using Facad software (Ilexis AB, Linköping, Sweden). Data obtained were analyzed using SPSS 16 (IBM Corp, Armonk, NY). RESULTS The study sample was comprised of 210 mandibular fractures (70 mandibular angle fractures and 140 non-angle fractures). The mean gonial angle in patients with mandibular angle fractures was 126.8 ± 7.9°, which was 4.5° larger than in patients with other mandibular fractures (P = .0001). Patients with a high gonial angle were 11.77 times more likely to sustain an angle fracture than those with normal or low gonial angles (adjusted odds ratio = 11.77; 95% confidence interval, 3.65-37.94; P < .001). There also was a statistically significant decrease in mandibular height at the angle in patients with a high gonial angle (P = .0001). CONCLUSION This study shows that people with a high gonial angle are at an increased risk for angle fracture and presents the related clinical implications.
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Affiliation(s)
- Elavenil Panneerselvam
- Reader, Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India.
| | - Pooja J Prasad
- Intern, Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - Sasikala Balasubramaniam
- Reader, Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | | | - Krishnakumar V B Raja
- Professor and Department Head, Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - Dilip Srinivasan
- Professor, Department of Orthodontics and Dentofacial Orthopedics, SRM Dental College and Hospital, Ramapuram, Chennai, India
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Influence of Trabecular Bone on Peri-Implant Stress and Strain Based on Micro-CT Finite Element Modeling of Beagle Dog. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3926941. [PMID: 27403424 PMCID: PMC4923539 DOI: 10.1155/2016/3926941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/22/2016] [Indexed: 11/18/2022]
Abstract
The objective of this investigation is to analyze the influence of trabecular microstructure modeling on the biomechanical distribution of the implant-bone interface. Two three-dimensional finite element mandible models, one with trabecular microstructure (a refined model) and one with macrostructure (a simplified model), were built. The values of equivalent stress at the implant-bone interface in the refined model increased compared with those of the simplified model and strain on the contrary. The distributions of stress and strain were more uniform in the refined model of trabecular microstructure, in which stress and strain were mainly concentrated in trabecular bone. It was concluded that simulation of trabecular bone microstructure had a significant effect on the distribution of stress and strain at the implant-bone interface. These results suggest that trabecular structures could disperse stress and strain and serve as load buffers.
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13
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Abbassy MA, Watari I, Bakry AS, Ono T, Hassan AH. Calcitonin and vitamin D3 have high therapeutic potential for improving diabetic mandibular growth. Int J Oral Sci 2016; 8:39-44. [PMID: 27025264 PMCID: PMC4822182 DOI: 10.1038/ijos.2015.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 11/25/2022] Open
Abstract
The goal of this study was to assess the effect of the intermittent combination of an antiresorptive agent (calcitonin) and an anabolic agent (vitamin D3) on treating the detrimental effects of Type 1 diabetes mellitus (DM) on mandibular bone formation and growth. Forty 3-week-old male Wistar rats were divided into four groups: the control group (normal rats), the control C+D group (normal rats injected with calcitonin and vitamin D3), the diabetic C+D group (diabetic rats injected with calcitonin and vitamin D3) and the diabetic group (uncontrolled diabetic rats). An experimental DM condition was induced in the male Wistar rats in the diabetic and diabetic C+D groups using a single dose of 60 mg·kg−1 body weight of streptozotocin. Calcitonin and vitamin D3 were simultaneously injected in the rats of the control C+D and diabetic C+D groups. All rats were killed after 4 weeks, and the right mandibles were evaluated by micro-computed tomography and histomorphometric analysis. Diabetic rats showed a significant deterioration in bone quality and bone formation (diabetic group). By contrast, with the injection of calcitonin and vitamin D3, both bone parameters and bone formation significantly improved (diabetic C+D group) (P < 0.05). These findings suggest that these two hormones might potentially improve various bone properties.
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Affiliation(s)
- Mona A Abbassy
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.,Alexandria University, Alexandria, Egypt
| | - Ippei Watari
- Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ahmed S Bakry
- Conservative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,Cariology and Operative Dentistry Department, Graduate School of Medical and Dental Sciences, Tokyo Medical & Dental University, Tokyo, Japan.,Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Takashi Ono
- Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ali H Hassan
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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14
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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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15
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Elavenil P, Mohanavalli S, Sasikala B, Prasanna RA, Krishnakumar RVB. Isolated bilateral mandibular angle fractures: an extensive literature review of the rare clinical phenomenon with presentation of a classical clinical model. Craniomaxillofac Trauma Reconstr 2015; 8:153-8. [PMID: 26000089 PMCID: PMC4428726 DOI: 10.1055/s-0034-1393738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022] Open
Abstract
Bilateral angle fractures are a rare clinical phenomenon in contrast to the incidence of unilateral angle fractures. However, the rarity has garnered less attention in spite of the uniqueness of fracture pattern and distinctive biomechanics. This article is a detailed review on the etiology, clinical presentation, and management of bilateral angle fractures with the presentation of an interesting case. The bilateral angle fracture reported is a untreated, malunited fracture representing an ideal clinical model to study its biomechanics. The clinical features were anterior open bite, increased facial height, and temporomandibular joint tenderness. The management included osteotomy at the malunion and miniplate osteosynthesis. Bilateral angle fracture presents mandible in three independent fragments (left angle, right angle, and intermediate corpus), each with strong muscles acting in different vectors. This makes the fracture vulnerable to severe displacing forces and unfavorable to achieve the optimal reduction, stability, and healing. This necessitates comprehension of the biomechanical forces involved to avoid malunion following fixation. The article details the complex biomechanics of mandibular angle and its clinical implications in the rare event of bilateral angle fractures. It describes the necessity for a systematic approach and ideal osteosynthesis principles to achieve maximal treatment outcomes and minimal complications.
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Affiliation(s)
- P. Elavenil
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - S. Mohanavalli
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - B. Sasikala
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - R. Ashok Prasanna
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Raja V. B. Krishnakumar
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, India
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16
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Impact of the lower third molar presence and position on the fragility of mandibular angle and condyle: A Three-dimensional finite element study. J Craniomaxillofac Surg 2015; 43:870-8. [PMID: 25939313 DOI: 10.1016/j.jcms.2015.03.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/10/2015] [Accepted: 03/23/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of the present study was to investigate the influences of the presence and position of a lower third molar (M3) on the fragility of mandibular angle and condyle, using finite element analysis. From computed tomographic scans of a human mandible with normally erupted M3, two additional virtual models were generated: a mandibular model with partially impacted M3 and a model without M3. Two cases of impact were considered: a frontal and a lateral blow. The results are based on the chromatic analysis of the distributed von Mises and principal stresses, and calculation of their failure indices. In the frontal blow, the angle region showed the highest stress in the case with partially impacted M3, and the condylar region in the case without M3. Compressive stresses were dominant but caused no failure. Tensile stresses were recorded in the retromolar areas, but caused failure only in the case with partially impacted M3. In the lateral blow, the stress concentrated at the point of impact, in the ipsilateral and contralateral angle and condylar regions. The highest stresses were recorded in the case with partially impacted M3. Tensile stresses caused the failure on the ipsilateral side, whereas compressive stresses on the contralateral side.
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17
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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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Yadav S, Tyagi S, Puri N, Kumar P, Kumar P. Qualitative and quantitative assessment of relationship between mandibular third molar and angle fracture on North Indian population: A clinico-radiographic study. Eur J Dent 2014; 7:212-217. [PMID: 24883029 PMCID: PMC4023186 DOI: 10.4103/1305-7456.110188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the relationship between impacted mandibular third molar presence and the risk for mandibular angle fracture with the effect of various positions of mandibular third molar and the risk of mandibular angle fracture. Materials and Methods: In the North Indian territory, a total of 289 patients with mandibular angle fractures were studied and evaluated for the possible relationship with impacted third molar on the basis of clinical and panoramic radiographical findings. Results: Results that confirmed the highest risk for mandibular angle fracture was associated with mesioangular angulations (45.42%) followed by vertical (26.34%), distoangular in sequence and least risk was found with bucco-version angulations (2.67%) according to Winter's classification. Additionally, the highest risk of mandibular angle fracture was reported with partially erupted third molar (47.75%), followed by erupted (23.53%) and unerupted third molar (19.38%). Conclusion: The risk for mandibular angle fracture is not only affected by status of eruption, angulations, position, number of roots present in third molar but also by the distance of mandibular third molar from inferior border of mandible and the percentage of remaining amount of bone at the mandibular angle region.
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Affiliation(s)
- Suresh Yadav
- Departments of Oral and Maxillofacial Surgery, Kalka Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Shallu Tyagi
- Departments of Pedodontics and Preventive Dentistry, Kalka Dental College and Hospital Meerut, Uttar Pradesh, India
| | - Naveen Puri
- Departments of Oral Pathology, Kalka Dental College and Hospital Meerut, Uttar Pradesh, India
| | - Prince Kumar
- Departments of Prosthodontics, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, India
| | - Puneet Kumar
- Departments of Public Health Dentistry, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, India
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19
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Fractals in dentistry. J Dent 2011; 39:273-92. [DOI: 10.1016/j.jdent.2011.01.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 12/13/2022] Open
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20
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Long J, Li P, Du HM, Liu L, Zheng XH, Lin YF, Wang H, Jing W, Tang W, Chen WH, Tian WD. Effects of bone morphogenetic protein 2 gene therapy on new bone formation during mandibular distraction osteogenesis at rapid rate in rabbits. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2010; 112:50-7. [PMID: 21194991 DOI: 10.1016/j.tripleo.2010.09.065] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/08/2010] [Accepted: 09/22/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We investigated the effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) on new bone formation during rapid-rate mandibular distraction osteogenesis. We also explored the feasibility of using local BMP-2 gene therapy to compensate for bad callus formation caused by a rapid distraction rate. STUDY DESIGN Bone marrow mesenchymal stem cells (MSCs) from Japanese rabbits were transfected with adenovirus (adv)-BMP-2. The right mandibles of the rabbits were distracted after corticotomy. The distraction rate in group A was 0.8 mm/d. The distraction rate in group B was 2.4 mm/d, and the distraction gap was injected with adv-lacZ-transfected bone marrow MSCs. The distraction rate in group C was 2.4 mm/d, and the distraction gap was injected with adv-BMP-2-transfected bone marrow MSCs. New generation bone tissue in the distraction gap was analyzed by plain radiograph examinations, microfocus computerized tomography (micro-CT) examinations, and biomechanical tests at weeks 2, 4, and 8 of the consolidation period. RESULTS Radiographic and micro-CT examinations showed a better bone quality in group C compared with group A at weeks 2 and 4 of the consolidation period. There was no obvious new bone formation in group B. The trabecular parameters (trabecular thickness, trabecular number, volumetric bone mineral density at tissue, and bone volume fraction) were significantly higher in group C than in group A at weeks 2 and 4. At week 8, no significant difference were detected for all parameters except trabecular number between groups A and C. All biomechanical stress parameters were significantly higher in group C than in group A at week 4, and only peak stress was significantly different at week 8. CONCLUSIONS Gene therapy using rhBMP-2-modified MSCs promoted new bone formation during mandibular distraction osteogenesis, and effectively compensated for the detrimental effect of rapid distraction rate on new bone formation.
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Affiliation(s)
- Jie Long
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
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21
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Abbassy MA, Watari I, Soma K. The effect of diabetes mellitus on rat mandibular bone formation and microarchitecture. Eur J Oral Sci 2010; 118:364-9. [DOI: 10.1111/j.1600-0722.2010.00739.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Subhashraj K. A study on the impact of mandibular third molars on angle fractures. J Oral Maxillofac Surg 2009; 67:968-72. [PMID: 19375005 DOI: 10.1016/j.joms.2008.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 08/12/2008] [Accepted: 09/05/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE This study evaluated the relationship between the status and position of mandibular third molars and angle fractures. MATERIALS AND METHODS In a total of 2,033 patients with a mandibular fracture, 532 (26%) had angle fractures, and 1,466 (72%) had retained their lower third molars. The most frequent cause for mandibular fracture was road traffic accident (64%), followed by assault (19%). RESULTS Of 341 patients with an unerupted third molar, mandibular angle fracture was evident in 249 patients (73%). Only 62 patients (9.4%) with a completely erupted third molar had angle fractures, whereas 83 patients (17.6%) with partially erupted third molars had angle fractures. CONCLUSIONS Our study confirmed an increased risk of angle fractures in the presence of a lower third molar, as well as a variable risk for angle fracture, depending on the third molar's position.
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Affiliation(s)
- Krishnaraj Subhashraj
- Department of Oral and Maxillofacial Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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23
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Watanabe PCA, Alonso MBCC, Monteiro SAC, Tiossi R, Issa JPM. Morphodigital study of bone quality in the mandibular angle in patients with third molar impacted. Anat Sci Int 2009; 84:246-52. [PMID: 19326188 DOI: 10.1007/s12565-009-0030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 12/25/2008] [Indexed: 10/20/2022]
Abstract
The aim of this study was to analyze if the presence of impacted third molars, and their positions in the mandibular angle, can change the bone quality in this area, considering the measure of the cortical thickness in this region as representative or not for mandible fracture risk. Software was used to analyze 50 digital images from panoramic radiographs of patients who had one or two impacted third molars in the mandible, and 30 digital images of patients with agenesis of the mandibular third molar. The thickness of the cortical region of the mandible was measured; it was possible to draw a parallel line to the posterior portion of the mandible and a parallel line to the body of this bone on each side of the image. At the intersection of these lines near the distal portion of the second molar, another line was set up to serve as reference in the cortical thickness measurement. It could be concluded that the cortical thickness of the mandibular angle in male patients without impacted third molars was greater than the thickness in patients with these teeth, and no difference in thickness was found for the female group.
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Affiliation(s)
- Plauto Christopher Aranha Watanabe
- Department of Morphology, Stomathology and Physiology, Faculty of Dentistry, University of São Paulo, Avenida do Café S/N, Ribeirão Preto, São Paulo, 14040-904, Brazil
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Nishimura F, Sekiguchi H, Hara A, Yakushiji M. Morphological characteristics on the mandibular fused deciduous anterior teeth with Micro-CT. PEDIATRIC DENTAL JOURNAL 2009. [DOI: 10.1016/s0917-2394(09)70148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Hara A, Sekiguchi H, Yakushiji M. Three dimensional observation of the occlusal grooves in the maxillary first and second deciduous molars with micro-CT. PEDIATRIC DENTAL JOURNAL 2008. [DOI: 10.1016/s0917-2394(08)70128-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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