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Krennmair S, Malek M, Stehrer R, Stähler P, Otto S, Postl L. The effect of frontal trauma on the edentulous mandible with four different interforaminal implant-prosthodontic anchoring configurations. A 3D finite element analysis. Eur J Med Res 2023; 28:608. [PMID: 38115128 PMCID: PMC10729383 DOI: 10.1186/s40001-023-01580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE The present three-dimensional (3D) finite element analysis (FEA) was aimed to assess the biomechanical effects and fracture risks of four different interforaminal implant-prosthodontic anchoring configurations exposed to frontal trauma. MATERIAL AND METHODS A symphyseal frontal trauma of 1 MPa was applied to four dental implant models with different configurations (two unsplinted interforaminal implants [2IF-U], two splinted interforaminal implants [2IF-S], four unsplinted interforaminal implants[ 4IF-U], four splinted interforaminal implants [4IF-S]. By using a 3D-FEA analysis the effective cortical bone stress values were evaluated in four defined regions of interest (ROI) (ROI 1: symphyseal area; ROI 2: preforaminal area; ROI 3: mental foraminal area; and ROI 4: condylar neck) followed by a subsequent intermodel comparison. RESULTS In all models the frontal traumatic force application revealed the highest stress values in the condylar neck region. In both models with a four-implant configuration (4IF-U, 4IF-S), the stress values in the median mandibular body (ROI 1) and in the condylar neck region (ROI 4) were significantly reduced (P <0.01) compared with the two-implant models (2IF-U, 2IF-S). However, in ROI 1, the model with four splinted implants (4IF-S) showed significantly (P < 0.01) reduced stress values compared to the unsplinted model (4IF-U). In addition, all models showed increased stress patterns in the area adjacent to the posterior implants, which is represented by increased stress values for both 2IF-U and 2IF-S in the preforaminal area (ROI 3) and for the four implant-based models (4IF-U, 4IF-S) in the mental foraminal area. CONCLUSION The configuration of four splinted interforaminal implants showed the most beneficial distribution of stress pattern representing reduced stress distribution and associated reduced fracture risk in anterior symphysis, condylar neck and preforaminal region.
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Affiliation(s)
- Stefan Krennmair
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
| | - Raphael Stehrer
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
| | - Philip Stähler
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Lukas Postl
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria.
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany.
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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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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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An Y, Xie L, Liu Y, Wu P, Li H, Jiang J, Zhang Z, Yang S. Research on skull trauma biomechanical stress distribution in case of dental implants existence. Technol Health Care 2022; 31:821-829. [PMID: 36442219 DOI: 10.3233/thc-220148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND: When the jaw bone is subjected to an external force, the stress is transmitted from the force point along the alveolar bone to the skull and skull base. In the case of a dental implant, the stress distribution is mainly dependent on the implant position, type, and mechanical properties. OBJECTIVE: To investigate the dental implant position influence on the stress distribution and transmission in case of facial frontal trauma. Furthermore, the correlation between facial trauma and skull trauma in the case of a dental implant exists. METHODS: In this study, a Finite Element Method (FEM) model was constructed based on a real skull shape, size, and anatomy. Dental implants were modeled based on imported CAD Data. Five cases were investigated including no dental implant and the replacement of teeth no. 18, 19 20 and 21. Facial trauma was mimicked by applying an external load on the lower frontal jaw. Finally, the stress distribution based on the bone geometry and implant position were evaluated and compared. RESULTS: Results suggested that a dental implant could significantly influence the stress distribution in the skull in case of facial trauma. In addition, the dental position greatly affects stress transmission from the mandible to the skull bones through the zygomatic arch. CONCLUSION: The position of the dental implant could have a significant role in stress transmission and distribution in case of facial or even brain trauma. Thus, increasing the possibility of a correlation between facial and brain trauma.
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Affiliation(s)
- Yang An
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
| | - Ling Xie
- Department of Stomatology, People’s Hospital of Tianfu New District, Chengdu, Sichuan, China
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
| | - Yu Liu
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
| | - Po Wu
- Department of Stomatology, People’s Hospital of Tianfu New District, Chengdu, Sichuan, China
| | - Hao Li
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
| | - Ji Jiang
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
| | - Zhengrui Zhang
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
| | - Shuyong Yang
- General Hospital of the Western War Zone of the Chinese People’s Liberation Army, Chengdu, Sichuan, China
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Three-Dimensional Biomechanical Finite Element Analysis of Lumbar Disc Herniation in Middle Aged and Elderly. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7107702. [PMID: 35075391 PMCID: PMC8783749 DOI: 10.1155/2022/7107702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022]
Abstract
Lumbar intervertebral disc protrusion disease refers to the degeneration of intervertebral disc, rupture of fibrous ring, nucleus pulpous protrusion and stimulation or compression of nerve root. The import command in Mimics medical 3D reconstruction software was used to erase the irrelevant image data and obtain vertebral body images. The original 3D model of each vertebral body was built by 3D computing function. A three-dimensional finite element model was established to analyze the effect of different surgical methods on the mechanical distribution of the spine after disentomb. The stress distribution of the spine, intervertebral disc, and left and right articular cartilage at L4/L5 stage and the position shift of the fourth lumbar vertebra were analyzed under 7 working conditions of vertical, forward flexion, extension, left and right flexion, and left and right rotation. The results showed that the established model was effective, and the smaller the area of posterior laminar decompression was, the lesser the impact on spinal stability was. The PELD treatment of lumbar disc herniation had little impact on spinal biomechanics and could achieve good long-term biomechanical stability. Combining the clinical experiment method and finite element simulation, using the advantages of finite element software to optimize the design function can provide guidance for the design and improvement of medical devices and has important significance for the study of clinical mechanical properties and biomechanics.
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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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Biomechanical comparison of the All-on-4, M-4, and V-4 techniques in an atrophic maxilla: A 3D finite element analysis. Comput Biol Med 2020; 123:103880. [PMID: 32768041 DOI: 10.1016/j.compbiomed.2020.103880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with severely atrophied jaws can be challenging in implantology. The All-on-4 treatment concept eliminates advanced augmentation procedures in highly resorbed ridges by preserving the relevant anatomic structures. In addition, the inclination of the distal implants enables the placement of longer implants. Hence, tilting the anterior implants allows longer implant placement, in line with the distal implants of the All-on-4 concept. This study compared the biomechanical aspects of the standard All-on-4 treatment concept with the M-4 and V-4 techniques. METHODS A three-dimensional model of an edentulous maxilla was created to perform three-dimensional finite element analysis. Three different configurations (All-on-4, M-4, and V-4) were modeled by changing the tilt angle of the anterior implants. In each model, to simulate a foodstuff, a solid spherical material was placed on the midline of the incisors and the right first molar region, separately applying an occlusal load of 100 Newtons. The maximum principal stress and minimum principal stress values were acquired for cortical bone, and von Mises stress values were obtained for ductile materials. RESULTS According to the present study's findings, although there were no considerable differences among the models, in general, the All-on-4 group demonstrated slightly higher stresses and the M-4 and V-4 group showed lower stresses. CONCLUSION M-4 or V-4 configurations may be used in cases of severely atrophied anterior maxillae to achieve better primary stabilization.
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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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Brucoli M, Boffano P, Romeo I, Corio C, Benech A, Ruslin M, Forouzanfar T, Rodríguez-Santamarta T, de Vicente JC, Tarle M, Dediol E, Pechalova P, Pavlov N, Daskalov H, Doykova I, Kelemith K, Tamme T, Kopchak A, Shumynskyi I, Corre P, Bertin H, Bourry M, Guyonvarc'h P, Dovšak T, Vozlič D, Birk A, Aničić B, Konstantinovic VS, Starch-Jensen T. The epidemiology of edentulous atrophic mandibular fractures in Europe. J Craniomaxillofac Surg 2019; 47:1929-1934. [DOI: 10.1016/j.jcms.2019.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/01/2019] [Accepted: 11/20/2019] [Indexed: 11/16/2022] Open
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