Number crunching with the human masticatory system

Human jaw joint hypermobility: Diagnosis and biomechanical modelling

Patients with hypermobility disorders of the jaw joint experience joint sounds and jerky movements of the jaw. In severe cases, a subluxation or luxation can occur. Clinically, hypermobility disorders should be differentiated from disc displacements. With biomechanical modelling, we previously identified the anterior slope angle of the eminence and the orientation of the jaw closers to potentially contribute to hypermobility disorders. Using cone-beam computed tomography (CBCT), we constructed patient-specific models of the masticatory system to incorporate these aspects. It is not known whether the clinical diagnosis of hypermobility disorders is associated with the prediction of hypermobility by a patient-specific biomechanical model. Fifteen patients and eleven controls, matched for gender and age, were enrolled in the study. Clinical diagnosis was performed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and additional testing to differentiate hypermobility from disc displacements. Forward simulations with patient-specific biomechanical models were performed for maximum opening and subsequent closing of the jaw. This predicted a hypermobility disorder (luxation) or a control (normal closing). We found no association between the clinical diagnosis and predictions of hypermobility disorders. The biomechanical models overestimated the number of patients, yielding a low specificity. The role of the collagenous structures remains unclear; therefore, the articular disc and the ligaments should be modelled in greater detail. This also holds for the fanned shape of the temporalis muscle. However, for the osseous structures, we determined post hoc that the anterior slope angle of the articular eminence is steeper in patients than in controls.

Reverse engineering of mandible and prosthetic framework: Effect of titanium implants in conjunction with titanium milled full arch bridge prostheses on the biomechanics of the mandible

This study aimed at investigating the effects of titanium implants and different configurations of full-arch prostheses on the biomechanics of edentulous mandibles. Reverse engineered, composite, anisotropic, edentulous mandibles made of a poly(methylmethacrylate) core and a glass fibre reinforced outer shell were rapid prototyped and instrumented with strain gauges. Brånemark implants RP platforms in conjunction with titanium Procera one-piece or two-piece bridges were used to simulate oral rehabilitations. A lateral load through the gonion regions was used to test the biomechanical effects of the rehabilitations. In addition, strains due to misfit of the one-piece titanium bridge were compared to those produced by one-piece cast gold bridges. Milled titanium bridges had a better fit than cast gold bridges. The stress distribution in mandibular bone rehabilitated with a one-piece bridge was more perturbed than that observed with a two-piece bridge. In particular the former induced a stress concentration and stress shielding in the molar and symphysis regions, while for the latter design these stresses were strongly reduced. In conclusion, prosthetic frameworks changed the biomechanics of the mandible as a result of both their design and manufacturing technology.

Effect of Pre-Stress on the Dynamic Tensile Behavior of the TMJ Disc

Previous dynamic analyses of the temporomandibular joint (TMJ) disc have not included a true preload, i.e., a step stress or strain beyond the initial tare load. However, due to the highly nonlinear stress-strain response of the TMJ disc, we hypothesized that the dynamic mechanical properties would greatly depend on the preload, which could then, in part, account for the large variation in the tensile stiffnesses reported for the TMJ disc in the literature. This study is the first to report the dynamic mechanical properties as a function of prestress. As hypothesized, the storage modulus (E′) of the disc varied by a factor of 25 in the mediolateral direction and a factor of 200 in the anteroposterior direction, depending on the prestress. Multiple constant strain rate sweeps were extracted and superimposed via strain-rate frequency superposition (SRFS), which demonstrated that the strain rate amplitude and strain rate were both important factors in determining the TMJ disc material properties, which is an effect not typically seen with synthetic materials. The presented analysis demonstrated, for the first time, the applicability of viscoelastic models, previously applied to synthetic polymer materials, to a complex hierarchical biomaterial such as the TMJ disc, providing a uniquely comprehensive way to capture the viscoelastic response of biological materials. Finally, we emphasize that the use of a preload, preferably which falls within the linear region of the stress-strain curve, is critical to provide reproducible results for tensile analysis of musculoskeletal tissues. Therefore, we recommend that future dynamic mechanical analyses of the TMJ disc be performed at a controlled prestress corresponding to a strain range of 5–10%.

Lateral impingements of the temporomandibular joint: a classification system and MRI imaging characteristics

Finite element analysis of dynamic temporomandibular joint (TMJ) loading reveals a predominance of localization of loading laterally towards the collateral ligament regions and disc/capsule attachments to the mandibular condyle. A previous publication (Kirk, Kirk. OMS Clin North Am 2006;18:345-68) introduced biomechanical principles for surgeons to consider in the diagnostic phase of management as well as initial surgical procedure selection. The concept of impingements and their impact with development of derangement is presented in this paper with an expanded collection of imaging characteristics. Diagnostic coronal imaging using a dual photon imaging technique is presented. This technique is superior to traditional T1 and T2 weighted imaging sequences when sagittal imaging is employed. Coronal imaging using this technique adds a new dimension to preoperative imaging. Impingement presence and the discernment of early lateral disc/capsule rupture from the condyle of the mandible is superior with the dual photon technique. Images and a classification of degrees of impingement are presented. The biomechanical importance of diagnosis of impingement is discussed.

Biomechanical properties of the mandibular condylar cartilage and their relevance to the TMJ disc

Mandibular condylar cartilage plays a crucial role in temporomandibular joint (TMJ) function, which includes facilitating articulation with the TMJ disc, reducing loads on the underlying bone, and contributing to bone remodeling. To improve our understanding of the TMJ function in normal and pathological situations, accurate and validated three-dimensional (3-D) finite element models (FEMs) of the human TMJ may serve as valuable diagnostic tools as well as predictors of thresholds for tissue damage resulting from parafunctional activities and trauma. In this context, development of reliable biomechanical standards for condylar cartilage is crucial. Moreover, biomechanical characteristics of the native tissue are important design parameters for creating functional tissue-engineered replacements. Towards these goals, biomechanical characteristics of the condylar cartilage have been reviewed here, highlighting the structure-function correlations. Structurally, condylar cartilage, like the TMJ disc, exhibits zonal and topographical heterogeneity. Early structural investigations of the condylar cartilage have suggested that the tissue possesses a somewhat transversely isotropic orientation of collagen fibers in the fibrous zone. However, recent tensile and shear evaluations have reported a higher stiffness of the tissue in the anteroposterior direction than in the mediolateral direction, corresponding to an anisotropic fiber orientation comparable to the TMJ disc. In a few investigations, condylar cartilage under compression was found to be stiffer anteriorly than posteriorly. As with the TMJ disc, further compressive characterization is warranted. To draw inferences for human tissue using animal models, establishing stiffness-thickness correlations and regional evaluation of proteoglycan/glycosaminoglycan content may be essential. Efforts directed from the biomechanics community for the characterization of TMJ tissues will facilitate the development of reliable and accurate 3-D FEMs of the human TMJ.

Regional Dynamic Tensile Properties of the TMJ Disc

Although the TMJ disc has been well-characterized under tension and compression, dynamic viscoelastic regional and directional variations have heretofore not been investigated. We hypothesized that the intermediate zone under mediolateral tension would exhibit lower dynamic moduli compared with the other regions of the disc under either mediolateral or anteroposterior tension. Specimens were prepared from porcine discs (3 regions/direction), and dynamic tensile sweeps were performed at 1% strain over a frequency range of 0.1 to 100 rad/sec. Generally, the intermediate zone possessed the lowest storage and loss moduli, and the highest loss tangent. This study further accentuates the known distinct character of the intermediate zone by showing for the first time that these differences also extend to dynamic behavior, perhaps implicating the TMJ disc as a structure primarily exposed to predominantly anteroposterior tension via anterior and posterior attachments, with a need for great distension mediolaterally across the intermediate zone.

Predicting skull loading: applying multibody dynamics analysis to a macaque skull

Evaluating stress and strain fields in anatomical structures is a way to test hypotheses that relate specific features of facial and skeletal morphology to mechanical loading. Engineering techniques such as finite element analysis are now commonly used to calculate stress and strain fields, but if we are to fully accept these methods we must be confident that the applied loading regimens are reasonable. Multibody dynamics analysis (MDA) is a relatively new three dimensional computer modeling technique that can be used to apply varying muscle forces to predict joint and bite forces during static and dynamic motions. The method ensures that equilibrium of the structure is maintained at all times, even for complex statically indeterminate problems, eliminating nonphysiological constraint conditions often seen with other approaches. This study describes the novel use of MDA to investigate the influence of different muscle representations on a macaque skull model (Macaca fascicularis), where muscle groups were represented by either a single, multiple, or wrapped muscle fibers. The impact of varying muscle representation on stress fields was assessed through additional finite element simulations. The MDA models highlighted that muscle forces varied with gape and that forces within individual muscle groups also varied; for example, the anterior strands of the superficial masseter were loaded to a greater extent than the posterior strands. The direction of the muscle force was altered when temporalis muscle wrapping was modeled, and was coupled with compressive contact forces applied to the frontal, parietal and temporal bones of the cranium during biting.

A complete finite element model of a mandibular implant-retained overdenture with two implants: Comparison between rigid and resilient attachment configurations

PURPOSE

The aim of this study was to evaluate the influence of the retention mechanism on the behavior of a mandibular implant-retained overdenture (IRO) during the simulation of mastication. Therefore, a complete three-dimensional finite element model of a mandible with its IRO was developed.

MATERIALS AND METHODS

The geometry of the edentulous mandible and overdenture was generated from computed tomography. Two MKIII implants (Nobel Biocare) with ball abutments and Dalbo Plus (Cendres et Métaux) attachments were placed in the canine areas. Three foodstuff positions were analyzed for two retention mechanisms, "resilient" or "rigid". Special attention was given to the modeling of the mandibular environment and of the existing contact between the different components. A probable muscular action was determined following the minimal work principle.

RESULTS

The food-crushing force was provided by masseters with a two-third/one-third ratio between working and non-working sides. The "resilient" configuration provided a wider contact area between the mucosa of the denture bearing area and the prosthesis. An increase of the mastication force transiting through the mucosa was also noted and lower stresses were observed in the bone surrounding implants.

CONCLUSION

Resilient attachments allowed for an increase of the mastication load transiting through denture bearing surface. Furthermore, this study proposed an accurate model of the mandibular IRO, including its environment and faithful behavior reproduction.

A call to action for bioengineers and dental professionals: directives for the future of TMJ bioengineering

The world's first TMJ Bioengineering Conference was held May 25-27, 2006, in Broomfield, Colorado. Presentations were given by 34 invited speakers representing industry, academics, government agencies such as NIH, and private practice, which included surgeons, engineers, biomedical scientists, and patient advocacy leaders. Other attendees included documentary film makers and FDA officials. The impetus for the conference was that the field of TMJ research has been lacking continuity, with no open forum available for surgeons, scientists, and bioengineers to exchange scientific and clinical ideas and identify common goals, strengths, and capabilities. The goal was thus to plant the seeds for establishing a forum for multidisciplinary and interdisciplinary interactions. The collective wisdom and interactions brought about by a melting pot of these diverse individuals has been pooled and is disseminated in this article, which offers specific directives to bioengineers, basic scientists, and medical and dental professionals including oral and maxillofacial surgeons, pain specialists, orthodontists, prosthodontists, endocrinologists, rheumatologists, immunologists, radiologists, neurologists, and orthopaedic surgeons. A primary goal of this article was to attract researchers across a breadth of research areas to lend their expertise to a significant clinical problem with a dire need for new talent. For example, researchers with expertise in finite element modeling will find an extensive list of clinically significant problems. Specific suggestions for TMJ research were presented by the leading organizations for TMJ surgeons and TMJ patients, and further research needs were identified in a series of group discussions. The specific needs identified at the conference and presented here will be essential for those who endeavor to engage in TMJ research, especially in the areas of tissue engineering and biomechanics. Collectively, it is our hope that many of the questions and directives presented here find their way into the proposals of multidisciplinary teams across the world with new and promising approaches to diagnose, prevent and treat TMJ disorders.

Biomechanical effects of titanium implants with full arch bridge rehabilitation on a synthetic model of the human jaw

A composite model of the mandible, constituted by an inner polymeric core and a glass fibre reinforced outer shell, has been developed and equipped with six ITI titanium implants and a full gold alloy arch bridge prosthesis. The effects of this oral rehabilitation on the biomechanics of the mandible are investigated through a simulation of the lateral component of the pterygoid muscles. These muscles are involved as the mouth is opened and closed, hence their activity is very frequent. An increase of the mandible stiffness due to the prosthesis is observed; moreover, the coupling of the relatively stiff rehabilitation devices with the natural tissue analogue leads to stress-shielding and stress-concentration in the incisal and molar regions, respectively. Although the amplitude of the force generated by pterygoid muscles is quite small, high strains over the incisal region are measured. A stress-shielding effect, of about 20%, is observed at the symphysis as the full arch bridge prosthesis is fixed on the implants. Therefore, the presence of the prosthesis leads to significant modification of the stress field experienced by the mandible, and this may be relevant in relation to the biomechanics of mandibular bone remodelling.

Human jaw and muscle modelling

Dynamic mathematical modelling is an invaluable method to help understand the biomechanics of the anatomically and functionally complex masticatory system. It provides insight into variables which are impossible to measure directly such as joint loads and individual muscle tensions, and into physical relationships between jaw structure and function. Individual parameters can be modified easily to understand their influence on function. Our models are constructed with best available structural and functional data, and evaluated against human jaw behaviour. Image data provide hard and soft tissue morphology and the jaw's inertial properties. The drive to the system is provided by actuators which simulate active and passive jaw muscle properties. In whole-jaw modelling, muscle models which behave plausibly rather than mimic the ultra-structural cross-bridge interactions are common since they are computationally feasible. Whole-jaw models have recently incorporated flexible finite-elements to explore tissue distortion in the temporomandibular joint and tongue movements. Furthermore, the jaw has been integrated with laryngeal models to explore complex tasks such as swallowing. These dynamic models have helped better understand joint loading, movement constraints and muscle activation strategies. Future directions will include further incorporation of rigid and flexible model dynamics and the creation of subject-specific models to better understand the functional implications of pathology.

An experimental and theoretical composite model of the human mandible

The purpose is to design and manufacture a composite mandible replicate suitable for testing the influence of prosthetic materials on the stress distribution of bone. Composite mandibles made of a poly(methylmethacrylate) core and a glass reinforced outer shell are manufactured and characterised through mechanical tests assisted by the finite element analysis. The mandible replicate has been conveniently equipped with strain gauges, moreover a video extensometer has also been used in order to measure the arch width change during loading. A close agreement is found between the experimental data and the theoretical predictions. By laterally loading the mandibles the maximum values of stress and strain take place in the premolar-incisal region. By varying technological parameters such as the fiber volume fraction and orientation, it is easy to replicate the behaviour of mandibles having different stiffnesses. The results obtained by laterally loading the composite mandibles through the condyles or through the gonion regions are consistent with literature data relative to the arch width decrease of natural jaws during opening and closing. This novel synthetic system coupled with the Finite Element model constitutes an experimental-theoretical model suitable to investigate the biomechanical effects of oral rehabilitations on mandibular bone.