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Allam A, Ahmed B, Ab Rahman N. Why does maxillary skeletal expansion work with some adults and fail with Others?: A narrative review. Saudi Dent J 2024; 36:984-989. [PMID: 39035558 PMCID: PMC11255948 DOI: 10.1016/j.sdentj.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 07/23/2024] Open
Abstract
Maxillary skeletal expansion is considered a challenging treatment modality in adult ages. Mini-screw-assisted rapid palatal expansion (MARPE) is considered a pioneer in providing a solution for maxillary deficiency in adults away from any surgical interventions. If we consider patient cooperation and motivation, together with operator skills, as constant factors during MARPE, and exclude all hygiene and soft tissue complications that jeopardise the appliance's stability, there is a percentage of expansion failure recorded in different studies with no emphasis on what makes mid-facial diastema appear in some, rather than others. Electronic databases including PubMed, Scopus, Google Scholar, and Web of Science, were searched for literature published in English till 2023. Failure was related in some literature to different criteria, as of yet, no verifiable indicators would allow us to determine success or failure in advance. This review highlighted the most common reasons for failure discussed in different literature: Chronological Age, Mid-palatal suture maturation, Bone density, Sex, Race, Appliance design, and Expansion technique used. This study could be considered an attempt to make candidate selection for non-surgical maxillary skeletal expansion at this old age easier, time-saving, and cost less.
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Affiliation(s)
- Amira Allam
- School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
- Teaching Assistant at King Salman International University (KSIU), Tur Sinai, Egypt
| | - Basaruddin Ahmed
- Biostatistics and Dental Public Health Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Norma Ab Rahman
- Orthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Suresh A, Velath AV, Sarika K, Prabha RD, Varma NKS. Effect of Different Mini Implant Assisted Rapid Palatal Expansion (MARPE) Designs on Maxillary Protraction in Skeletal Class III malocclusion: An FEM Study. Contemp Clin Dent 2024; 15:27-34. [PMID: 38707668 PMCID: PMC11068238 DOI: 10.4103/ccd.ccd_428_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/29/2023] [Accepted: 12/19/2023] [Indexed: 05/07/2024] Open
Abstract
Background Four different designs of mini-implant-assisted rapid palatal expansion (MARPE) and protraction in nasomaxillary complex and mid-palatal sutures in late adolescent skeletal Class III malocclusion were compared using a three-dimensional finite element analysis. Methods A finite element model of skull and related sutures was constructed using the computed tomography scan of a 16-year-old female patient with skeletal Class III and ANB of -2°. Four appliance designs: Type I: MARPE with palatal force, Type II: MARPE with buccal force, Type III: Hybrid hyrax with palatal force, and Type IV: Hybrid hyrax with buccal force. Protraction vectors were and analyzed using Ansys software (ANSYS 2021 R2). The displacement pattern of the nasomaxillary structures and the stress distribution in the sutures were examined in all four appliance designs. Results All the appliance designs resulted in a forward movement of the maxilla, while Type I and III, which used palatal protraction force, caused the greatest forward displacement. In Type I, II, and III, along with forward movement, a clockwise rotation of maxilla was observed, while in Type IV, an anticlockwise rotation of maxilla was observed. Type I, II, and III resulted in higher stress distribution around the superior structures, while Type IV resulted in less stress distribution around the superior structures of maxilla. Conclusion The forward displacement was enhanced when palatal plates were used to protract the maxilla. The effective appliance design for skeletal class III with open bite case was Type I, II, and III and Type IV for deep bite cases.
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Affiliation(s)
- Ashik Suresh
- Department of Orthodontics and Dentofacial Orthopedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ajith Vallikat Velath
- Department of Orthodontics and Dentofacial Orthopedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K. Sarika
- Department of Orthodontics and Dentofacial Orthopedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rahul Damodaran Prabha
- Department of Orthodontics and Dentofacial Orthopedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - N. K. Sapna Varma
- Department of Orthodontics and Dentofacial Orthopedics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Gupta V, Rai P, Tripathi T, Kanase A. Stress distribution and displacement with four different types of MARPE on craniofacial complex: A three-dimensional finite element analysis. Int Orthod 2023; 21:100813. [PMID: 37776697 DOI: 10.1016/j.ortho.2023.100813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Various designs of mini-implants assisted rapid palatal expander (MARPE) appliances can impact treatment effectiveness through their biomechanical effects. The purpose of the study was to study the stress distribution and displacement with four different designs of the MARPE appliance on the craniofacial complex. METHODS A 3D finite element model of the craniofacial complex was created from CBCT DICOM data, comprising four distinct groups. Each group consisted of one 4-hole expansion screw positioned between the second premolar and first molar in all models. Group 1 used four single-cortical mini-implants (1.5×8mm) engaging only the palatal cortex. Group 2 employed four mini-implants (1.5×11mm) engaging both the palatal and nasal cortices. Group 3 had monocortical implants on the palatal slopes, while Group 4 was similar to group 3 with implants in the acrylic wings. Comparisons between groups were made for anchorage (groups 1 and 2), mini-implant position (groups 1 and 3) and surface effect (groups 3 and 4). Von Mises stresses and displacements at various skeletal and dental points were evaluated using ANSYS software. RESULTS The highest stresses were observed in the maxillary, pterygoid and zygomatic bones, as well as in the mid- palatal suture in all four groups. Downward and forward rotation of the craniofacial complex was noted. Group 2 showed greater skeletal expansion than group 1. Among groups 1 and 3, group 3 showed a better stress distribution. Group 4 showed less dentoalveolar rotation than group 3. CONCLUSIONS The MARPE appliances had an impact on the craniofacial complex with stresses on the mid-palatal suture, maxillary bone, pterygoid bones and anterior teeth. Clockwise rotation of the maxilla, zygomatic bones and dentition was noted, while the pterygoid bones and pterygoid suture were displaced backwards. MARPE with bicortical anchorage produces better skeletal expansion. Placing implants on the palatal slopes with acrylic wings results in better skeletal expansion with less clockwise rotation of the dentition.
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Affiliation(s)
- Veenita Gupta
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India
| | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India.
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India
| | - Anup Kanase
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, 110002 New Delhi, India
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Shyagali TR, Patidar R, Gupta A, Kapoor S, Tiwari A. Evaluation of stresses and displacement in the craniofacial region as a reaction to bone-anchored maxillary protraction in conjugation with posterior bite plane and rapid maxillary expansion in patients with Class III malocclusion: A finite element analysis study. Am J Orthod Dentofacial Orthop 2023; 164:253-264. [PMID: 36959013 DOI: 10.1016/j.ajodo.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Treating a Class III malocclusion is often challenging for orthodontists. Bone-anchored maxillary protraction (BAMP) is known for achieving a significant maxillary protraction. The study aimed to evaluate the stress distribution and displacement of craniofacial bones as a reaction to the forces of BAMP, along with rapid maxillary expander and the posterior bite plane, in growing patients with skeletal Class III malocclusion using a finite element method. METHODS An finite element model was constructed from the spiral computed tomographic images of a skull from an 11-year-old growing patient with skeletal Class III malocclusion along with BAMP, rapid maxillary expander, and the posterior bite plane. The created model had 105,189 nodes and 481,066 elements. After assigning the appropriate material properties and the boundary condition, 800 g of transverse force per side and a Class III intraoral elastic 250 g of force per side were applied to the model, and after the postprocessing, the results were obtained in the form of color bands. RESULTS The maxilla and the attached structures were displaced and expanded transversely. The maxilla was displaced anteriorly by 0.692 mm, and the mandible was displaced backward by 0.204 mm in the sagittal direction. The anterior region of the maxilla and mandible, dentition, and nasal bone were rotated counterclockwise. Displacement in an upward direction was greatest at the symphysis region of the mandible. The stresses experienced by most of the bones were tensile, with the maxilla and maxillary dentition experiencing the maximum. CONCLUSIONS Favorable changes were appreciated with maxillary forward and mandibular backward displacement, with appreciable tensile stresses in all the bones.
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Affiliation(s)
- Tarulatha R Shyagali
- Department of Orthodontics and Dentofacial Orthopedics, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India.
| | - Rahul Patidar
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Abhishek Gupta
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Shanya Kapoor
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Anil Tiwari
- Department of Orthodontics and Dentofacial Orthopedics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
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Ortún-Terrazas J, Cegoñino J, Pérez Del Palomar A. In silico approach towards neuro-occlusal rehabilitation for the early correction of asymmetrical development in a unilateral crossbite patient. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3688. [PMID: 36726272 DOI: 10.1002/cnm.3688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 05/13/2023]
Abstract
Neuro-occlusal rehabilitation (N.O.R.) is a discipline of the stomatognathic medicine that defends early treatments of functional malocclusions, such as unilateral crossbite, for the correction of craniofacial development, avoiding surgical procedures later in life. Nevertheless, N.O.R.'s advances have not been proved analytically yet due to the difficulties of evaluate the mechanical response after the treatment. This study aims to evaluate computationally the effect of N.O.R.'s treatments during childhood. Therefore, bilateral chewing and maximum intercuspation occlusion were modelled through a detailed finite element model of a paediatric craniofacial complex, before and after different selective grinding-alternatives. This model was subjected to the muscular forces derived from a musculoskeletal model and was validated by the occlusal contacts recorded experimentally. This approach yielded errors below 2% and reproduced successfully the occlusal, muscular, functional and mechanical imbalance before the therapies. Treatment strategies balanced the occlusal plane and reduced the periodontal overpressure (>4.7 kPa) and the mandibular over deformation (>0.002 ε) on the crossed side. Based on the principles of the mechanostat theory of bone remodelling and the pressure-tension theory of tooth movement, these findings could also demonstrate how N.O.R.'s treatments correct the malocclusion and the asymmetrical development of the craniofacial complex. Besides, N.O.R.'s treatments slightly modified the stress state and functions of the temporomandibular joints, facilitating the chewing by the unaccustomed side. These findings provide important biomechanical insights into the use of N.O.R.'s treatments for the correction of unilateral crossbite, but also encourage the application of computing methods in biomedical research and clinical practise.
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Affiliation(s)
- Javier Ortún-Terrazas
- Escuela Superior de Ingeniería y Tecnología (ESIT), Universidad Internacional de La Rioja (UNIR), Logroño, La Rioja, Spain
- Instituto Tecnológico de Aragón (ITAINNOVA), Zaragoza, Zaragoza, Spain
| | - José Cegoñino
- Instituto Tecnológico de Aragón (ITAINNOVA), Zaragoza, Zaragoza, Spain
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Balakrishnan R, Sengottuvel N, Altaf SK, Bhandari PK, Kumaragurubaran P, Antony M. Three-Dimensional Finite Element Analysis of Maxillary Protraction Using Diverse Modes of Rapid Palatal Expansion. Cureus 2023; 15:e36328. [PMID: 37077604 PMCID: PMC10108977 DOI: 10.7759/cureus.36328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Three-dimensional finite elemental analysis (FEA) is a contemporary research instrument for the numeric simulation of a real physical system's mechanical process. FEA can be used as a very effective tool to analyze and compare various aspects of rapid palatal expanders and to determine the stress distribution in maxillofacial bones and displacement and the biomechanical effects it has on the circummaxillary sutures. This study evaluates the effects of different modes of rapid palatal expansion on maxillary protraction as a treatment modality in skeletal Class III malocclusion by determining the stress and displacement along the circummaxillary sutures using the FEA. MATERIALS AND METHODS Initially, a three-dimensional finite element simulation of the maxillofacial skeleton and sutures was obtained by Mimics software (Leuven, Belgium) from the cone-beam computed tomography (Dentsply Sirona, USA) images of a 30-year-old adult with normal occlusion. A geometrical preparation of the three expansion appliances, (A) hybrid MARPE (miniscrew-assisted rapid palatal expander) appliance (Fav anchor, India), (B) tooth-borne HYRAX (hygenic rapid expander) appliance (Welcare orthodontics, Kerela), and (C) bone-borne modified MARPE appliance (Biomaterials, Korea), was transferred to ANSYS WORKBENCH, 2020 R1 software (ANSYS, Inc., USA), and three finite element models with each appliance were prepared. A protraction force of 500g was applied to the occlusal plane that is directed 20 degrees inferiorly. The tensile stress, compressive stress, and the amount of displacement on the circummaxillary sutures were assessed and compared in all the three appliances. Young's modulus (kg/mm2) and Poisson's ratio (V) were used to calculate the stress and displacement in sutures adjacent to the maxilla in different aspects. RESULTS On analyzing the stress distribution, the tensile stress was found to be maximum in the medial aspect of the frontomaxillary suture of the bone-borne modified MARPE appliance (C), and the minimum tensile stress was found in the lateral aspect of the sphenozygomatic suture in hybrid MARPE (A). Again, the compressive stress distribution was found to be maximum in the medial aspect of the frontomaxillary suture in all three simulations and the minimum compressive stress in the superior aspect of the internasal suture in hybrid MARPE (A) along with the frontonasal suture at its medial aspect for tooth-borne HYRAX (B) and bone-borne modified MARPE (C). Displacement of the maxilla in all the planes was observed to be the largest for the bone-borne modified MARPE (C) appliance. On the contrary, the minimum displacement was found in the tooth-borne HYRAX (B) appliance. Conclusion: The findings reveal that all three modes of rapid palatal expanders produced stress and displacement along the circummaxillary sutures on the application of protraction force with bone-borne modified MARPE being more effective in treating posterior crossbites thereby correcting the skeletal Class III malocclusions successfully.
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GARG D, RAI P, TRIPATHI T, KANASE A. Effects of different force directions of intra-oral skeletally anchored maxillary protraction on craniomaxillofacial complex, in Class III malocclusion: a 3D finite element analysis. Dental Press J Orthod 2023; 27:e2220377. [PMID: 36629626 PMCID: PMC9829108 DOI: 10.1590/2177-6709.27.5.e2220377.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/25/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The intra-oral skeletally anchored maxillary protraction (I-SAMP) has been found to be an effective treatment for skeletal Class III malocclusion. OBJECTIVE This in-silico study explored the influence of different force directions of intra-oral skeletally anchored Class III elastics on the changes in craniomaxillofacial complex, using finite element analysis. METHODS A 3-dimensional (3D) finite element model of the craniomaxillofacial bones including circummaxillary sutures was constructed with high biological resemblance. A 3D assembly of four miniplates was designed and fixed on the maxilla and mandible of the finite element model. The model was applied with 250g/force at the miniplates at three angulations (10°, 20°, and 30°) from the occlusal plane, to measure stress and displacement by using the ANSYS software. RESULTS The zygomaticotemporal, zygomaticomaxillary, and sphenozygomatic sutures played significant roles in the forward displacement and counterclockwise rotation of maxilla and zygoma, irrespective of the angulation of load application. The displacements and rotations of the zygomatico-maxillary complex decreased gradually with an increase in the angle of load application between miniplates from 10° to 30°. The mandible showed negligible displacement, with clockwise rotation. CONCLUSIONS The treatment effects of I-SAMP were corroborated, with insight of displacement patterns and sutures involved, which were lacking in the previously conducted 2D and 3D imaging studies. The prescribed angulation of skeletally anchored Class III elastics should be as low as possible, since the displacement of zygomatico-maxillary complex increases with the decrease in angulation of the elastics.
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Affiliation(s)
- Dhiraj GARG
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
| | - Priyank RAI
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
| | - Tulika TRIPATHI
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
| | - Anup KANASE
- Maulana Azad Institute of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics (New Delhi, India)
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Wilmes B, Drescher D. CAD-CAM workflows for palatal TAD anchored appliances. Semin Orthod 2023. [DOI: 10.1053/j.sodo.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Roberts WE, Chang CH, Chen J, Brezniak N, Yadav S. Integrating skeletal anchorage into fixed and aligner biomechanics. J World Fed Orthod 2022; 11:95-106. [DOI: 10.1016/j.ejwf.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
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Wang L, Fu ZH, Hu ZH, Li M, Qiu LH, Gao Z. Biomechanical behaviour of implant prostheses and adjacent teeth according to bone quality: A finite element analysis. Eur J Oral Sci 2022; 130:e12863. [PMID: 35342996 DOI: 10.1111/eos.12863] [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: 10/25/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
The contribution of biomechanical factors in the formation of proximal contact loss has been observed, but there is little research on the mechanisms by which they contribute. Using finite element analysis, this study aimed to analyse the impact of bone quality on the biomechanical behaviour of a dentition consisting of implant prostheses and adjacent teeth. The occlusal load was applied on the implant/tooth crown. In the mesiodistal direction, the adjacent natural tooth mesially to the implant denture had the tendency for mesial movement, while the distal adjacent natural tooth had the tendency for distal movement. For the supporting bone around the mesial adjacent tooth, the maximum/minimum principal stress and strain values on the mesial side of the bone were higher than those on the distal side of the bone. Stress and strain values on the mesial side of the supporting bone around the distal adjacent tooth were lower than those on the distal side. With decreasing bone density, displacements of teeth and the implant denture, principal stresses and equivalent strains on tooth supporting bone increased. Studies on biomechanical behaviours of a tooth-implant dentition may provide a deeper understanding of implant-induced dental adaptive processes such as proximal contact loss.
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Affiliation(s)
- Lan Wang
- Department of Stomatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Hui Fu
- Department of Stomatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Hui Hu
- School of Electronic Science and Engineering, Xiamen University, Xiamen, China
| | - Min Li
- Department of Stomatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Hua Qiu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi Gao
- Department of Stomatology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Dento-Skeletal Class III Treatment with Mixed Anchored Palatal Expander: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094646] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bone-anchored appliances for the treatment of Class III malocclusions have recently been found to reduce the dentoalveolar effects caused by conventional tooth-borne devices while also improving orthopaedic outcomes in growing patients. The goal of this systematic review was to compare the outcomes of skeletal Class III interceptive treatment with dental anchoring devices to those achieved with mixed anchored palatal expanders. The inclusion criteria were as follows: patients who were treated with hybrid anchored palatal expanders and different maxillary advancement appliances. Study quality was estimated using the Newcastle–Ottawa scale. A search on the Pubmed, Scopus, Embase and Cochrane Library databases yielded 350 papers. Following the initial abstract selection, 65 potentially acceptable papers were thoroughly examined, resulting in a final selection of 9 articles. The results in the short-term showed that combined tooth-borne and bone-borne appliances for rapid maxillary expansion might be recommended in protocols of skeletal Class III treatment to obtain more skeletal effects and reduce side effects on the upper teeth.
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Hollander Z, Fraser A, Paredes N, Bui J, Chen Y, Moon W. Nonsurgical maxillary orthopedic protraction treatment for an adult patient with hyperdivergent facial morphology, Class III malocclusion, and bilateral crossbite. Am J Orthod Dentofacial Orthop 2022; 162:264-278. [DOI: 10.1016/j.ajodo.2021.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 11/01/2022]
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Wilmes B. “Appliance First” or “Bone First” for miniscrew assisted rapid palatal expansion? APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_57_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sevillano MGC, Kemmoku DT, Noritomi PY, Fernandes LQP, Capelli Junior J, Quintão C. New highlights on effects of rapid palatal expansion on the skull base: a finite element analysis study. Dental Press J Orthod 2021; 26:e2120162. [PMID: 34932710 PMCID: PMC8690457 DOI: 10.1590/2177-6709.26.6.e2120162.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of this study was to evaluate the effect of the rapid palatal expansion (RPE) on the pterygoid process (PP), spheno-occipital synchondrosis (SOS) and sella turcica (ST) in the skull of a patient with transversal maxillary collapse, and identify the distribution of mechanical stresses and displacement, by finite element analysis (FEA). Methods: Cone-beam computed tomography (CBCT) was employed to examine the skull of a patient in this study. The patient was a 13-year-old boy, with Class II skeletal relationship due to transverse atresia and maxillary protrusion. The computer-aided design (CAD) geometry of skull was imported into the SimLab v. 13.1 software, to build the finite element mesh. For the simulation, a displacement of 1 mm, 3 mm and 5 mm in a transverse direction was defined at the midpalatal suture, thereby representing the RPE. For the analysis of results, maximum principal stress (MPS) and displacements were evaluated by identifying different nodes, which were represented by the points as per the areas of interest in the study. Results: In MPS, the maximum tensile stress was found at point 2 (366.50 MPa) and point 3 (271.50 Mpa). The maximum compressive stress was found at point 8 (-5.84 Mpa). The higher displacements in the transversal plane and the lateral segment were located at point 1 (2.212 mm), point 2 (0.903 mm) and point 3 (0.238 mm). Conclusions: RPE has a direct effect on PP, SOS and ST in the Class II model skeletal relationship with a transversal maxillary collapse. PP supported a higher tensile stress and displacement.
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Affiliation(s)
- Manuel Gustavo Chávez Sevillano
- Universidad Nacional Mayor de San Marcos, Facultad de Odontología, Departamento de Estomatologia Pediatrica (Lima, Peru).,Universidade do Estado do Rio de Janeiro, Departamento de Ortodontia (Rio de Janeiro/RJ, Brazil)
| | - Daniel Takanori Kemmoku
- Centro de Tecnologia da Informação Renato Archer, Núcleo de Tecnologias Tridimensionais (Campinas/SP, Brazil)
| | - Pedro Yoshito Noritomi
- Centro de Tecnologia da Informação Renato Archer, Núcleo de Tecnologias Tridimensionais (Campinas/SP, Brazil)
| | | | - Jonas Capelli Junior
- Universidade do Estado do Rio de Janeiro, Departamento de Ortodontia (Rio de Janeiro/RJ, Brazil)
| | - Cátia Quintão
- Universidade do Estado do Rio de Janeiro, Departamento de Ortodontia (Rio de Janeiro/RJ, Brazil)
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Rai P, Garg D, Tripathi T, Kanase A, Ganesh G. Biomechanical effects of Skeletally anchored Class III elastics on the maxillofacial complex: a 3D finite element analysis. Prog Orthod 2021; 22:36. [PMID: 34693469 PMCID: PMC8542527 DOI: 10.1186/s40510-021-00375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although, the outcomes and changes in the maxillofacial complex after the application of intraoral bone anchored Class III elastics, have been reported by multiple clinical studies, there was no finite element study to assess and evaluate the stress pattern and displacement on maxillomandibular complex with bimaxillary anchorage. The present study aims to evaluate the biomechanical effects on maxillomandibular complex of Skeletally anchored Class III elastics with varying angulations using the 3D finite element analysis. Methodology Two 3-dimensional analytical models were developed using the Mimics 8.11 (Materialise: Leuven, Belgium) and ANSYS software Version 12.1 (ANSYS Inc, Canonsburg, PA, USA) from sequential computed tomography images taken from a Skeletal Class III subject. The models were meshed into 465,091 tetrahedral elements and 101,247 nodes. Intraoral mechanics for skeletally anchored maxillary protraction (I-SAMP) were applied on two models i.e. A and B (without and with maxillary expansion respectively) between miniplates on maxilla and mandible on both right and left sides with three different angulations of forces—10°, 20° and 30°). Results Although the craniomaxillary complex in both the models (A and B) displaced forward while demonstrating rotations in opposite directions, the displacements and rotations decreased gradually with the increase of the angle of load application from 10° to 30°. The mandible rotated clockwise in both the simulations, but the displacement of mandibular surface landmarks was higher in Simulation A. However, the antero-inferior displacement of the glenoid fossa was higher in Simulation B than in A. Conclusion Significant displacement of maxillofacial sutures and structures was witnessed with I-SAMP with maxillary expansion and Class III elastics for correction of Skeletal Class III with maxillary retrognathism. Thus, I-SAMP with maxillary expansion is a desired protocol for treatment of maxillary retrognathism. However, the prescribed angulation of the Class III elastics should be as low as possible to maximise the desired effects.
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Affiliation(s)
- Priyank Rai
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Dhiraj Garg
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Anup Kanase
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Gayatri Ganesh
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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Oliveira PLE, Soares KEM, Andrade RMD, Oliveira GCD, Pithon MM, Araújo MTDS, Sant'anna EF. Stress and displacement of mini-implants and appliance in Mini-implant Assisted Rapid Palatal Expansion: analysis by finite element method. Dental Press J Orthod 2021; 26:e21203. [PMID: 34468562 PMCID: PMC8405139 DOI: 10.1590/2177-6709.26.4.e21203.oar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: In this study, simulations were performed by the finite element method (FEM) to determine the tension and displacement in mini-implants and in expander appliance during rapid maxillary expansion, by varying the number and location of the mini-implants. Methods: For the computational simulation, a three-dimensional mesh was used for the maxilla, mini-implants and expander appliance. Comparisons were made on six different Mini-implant Assisted Rapid Palatal Expander (MARPE) configurations, by varying the amount and location of mini-implants. A closed suture was design and received two activations of 0.25 mm, and an open suture had a 0.5-mm aperture that received 20 activations, also of 0.25 mm. Results: For the closed suture, the maximum displacement values in the mini-implants were between 0.253 and 0.280 mm, and stress was between 1,348.9 and 2,948.2 MPa; in the expander appliance, the displacement values were between 0.256 and 0.281 mm, and stress was between 738.52 and 1,207.6 MPa. For the open suture, the maximum displacement values in the mini-implants were between 2.57 and 2.79 mm, and stress was between 5,765.3 and 10,366 MPa; in the appliance, the maximum displacements was between 2.53 and 2.89 mm, and stress was between 4,859.7 and 9,157.4 MPa. Conclusions: There were higher stress concentrations in the mini-implant than in the expander arm. In the simulations with a configuration of three mini-implants, stress overload was observed in the isolated mini-implant. Displacements of the mini-implants and arms of the appliance were similar in all simulations.
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Affiliation(s)
- Pedro Lima Emmerich Oliveira
- Universidade Federal do Rio de Janeiro, Departamento de Ortodontia e Odontologia Pediátrica (Rio de Janeiro/RJ, Brazil)
| | | | | | | | - Matheus Melo Pithon
- Universidade Estadual do Sudoeste da Bahia, Departamento de Ortodontia e Odontologia Pediátrica (Vitória da Conquista/BA, Brazil)
| | - Mônica Tirre de Souza Araújo
- Universidade Federal do Rio de Janeiro, Departamento de Ortodontia e Odontologia Pediátrica (Rio de Janeiro/RJ, Brazil)
| | - Eduardo Franzotti Sant'anna
- Universidade Federal do Rio de Janeiro, Departamento de Ortodontia e Odontologia Pediátrica (Rio de Janeiro/RJ, Brazil)
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Moradi H, Beh Aein R, Youssef G. Multi-objective design optimization of dental implant geometrical parameters. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3511. [PMID: 34302714 DOI: 10.1002/cnm.3511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/23/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
In-silico investigations are becoming an integral part of the development of novel biomedical devices, including dental implants. Using computer simulations can streamline the process by tuning different geometrical and structural features, emphasizing the osseointegration of the implant design a priori, leading to the optimal designs in preparation for in-vivo trails. This research aims to elucidate the interrelationship between 12 geometrical variables that holistically define the shape of the implant. The approach to achieve optimality hinged on coupling the finite element analysis results with the fractional factorial design method. The latter was used to determine the most influential variables during the screening process, followed by the parameter optimization process using the response surface method, regarding four different objectives, namely: bone-implant contact area, volume of trabecular bone dead cells, volume of cortical bone dead cells, and axial displacement. This resulted in reducing the number of virtual experiments and substantially decreasing the computational cost without compromising the accuracy of the solution. It was found that the optimized values improved the performance significantly. The validity of all models was verified by comparing optimized responses with simulation results. A sensitivity analysis was performed on all five optimized models to address the effect of friction coefficient on the implant-bone joint interaction. It was shown that the mechanical behavior of implant-bone would be independent in higher friction coefficients. The significance of this study is demonstrated in determining the most effective and optimized values of all possible geometrical parameters considering their singular or interactive effects.
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Affiliation(s)
- Hamidreza Moradi
- Department of Mechanical Engineering and Engineering Science, The University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Roozbeh Beh Aein
- D.M.D. Department of Dentistry, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - George Youssef
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, California, USA
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Wilmes B, Tarraf N, Drescher D. Treatment of maxillary transversal deficiency by using a mini-implant-borne rapid maxillary expander and aligners in combination. Am J Orthod Dentofacial Orthop 2021; 160:147-154. [PMID: 33906772 DOI: 10.1016/j.ajodo.2020.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
Bone-borne rapid maxillary expansion distraction devices are used to achieve a more skeletal expansion and to avoid dental side effects of conventional expanders such as tipping of anchorage teeth. In this article, we report the use of a prefabricated expander fixed on 2 mini-implants in the anterior palate. This allows for the insertion of the mini-implants and the expander to occur without the need for an impression or any laboratory procedures. Especially when aligners are going to be used, the use of a mini-implant-borne expander seems to be reasonable because the expander can be left in place as a skeletal retainer during the aligner finishing.
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Affiliation(s)
- Benedict Wilmes
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany.
| | - Nour Tarraf
- Private practice, Sydney, Australia, and Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
| | - Dieter Drescher
- Department of Orthodontics, University of Duesseldorf, Duesseldorf, Germany
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Lee DW, Park JH, Moon W, Seo HY, Chae JM. Effects of bicortical anchorage on pterygopalatine suture opening with microimplant-assisted maxillary skeletal expansion. Am J Orthod Dentofacial Orthop 2021; 159:502-511. [PMID: 33495061 DOI: 10.1016/j.ajodo.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objectives of this study were to evaluate the effects of bicortical engagement by microimplants with maxillary skeletal expanders on pterygopalatine sutures opening and to analyze the postexpansion skeletal changes associated with it. METHODS Eighteen subjects treated with maxillary skeletal expanders were examined for pterygopalatine suture openings. Eight subjects who showed no evidence of the suture opening were assigned to the nonsplit group (NG), whereas 10 subjects with opened sutures were assigned to the split group (SG). Preexpansion and postexpansion cone-beam computed tomography images were superimposed for each group, and the changes in the 2 groups were compared. Finally, cone-beam computed tomography volumes were reoriented along the axis of each microimplant to check the bicortical engagement of the 4 microimplants. RESULTS There was a significant correlation between the bicortical engagement of the orthodontic microimplants and the pterygopalatine suture opening (P = 0.0003). In the NG, the average amount of transverse expansion measured at the center of resistance of the maxillary first molars, anterior nasal spine, and posterior nasal spine (PNS) was 4.33 mm, 2.22 mm, and 1.58 mm, respectively, whereas the transverse expansion in the SG was 5.29 mm, 2.21 mm, and 2.46 mm, respectively. The magnitude of transverse expansion at PNS was significantly higher in the SG than in the NG (P = 0.036). The PNS also showed a significant anterior displacement in the SG (0.89 mm) compared with the NG (0.06 mm) (P = 0.033). CONCLUSIONS Bicortical microimplant anchorage is essential for pterygopalatine suture opening in microimplant-assisted maxillary skeletal expansion, which may result in further skeletal expansion and forward movement in the posterior part of the palatomaxillary complex.
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Affiliation(s)
- Dong-Wook Lee
- Private Practice, Seoul, South Korea; Former Student, Predoctoral Program, College of Dentistry, University of Wonkwang, Iksan, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Won Moon
- Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Calif
| | - Hye Young Seo
- School of Big Data and Financial Statistics, College of Natural Sciences, Wonkwang University, Iksan, South Korea
| | - Jong-Moon Chae
- Department of Orthodontics, Wonkwang Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, South Korea; Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz.
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20
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Gonzalez J, Nacy S, Youssef G. Finite element analysis of human skull bone adaptation to mechanical loading. Comput Methods Biomech Biomed Engin 2020; 24:1-12. [PMID: 33241705 DOI: 10.1080/10255842.2020.1850703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 01/28/2023]
Abstract
Bones self-optimize their mechanical behavior in response to mechanical stimulus. The objective of this research was to develop an integrated bone remodeling and stress binning algorithms into a finite element environment to elucidate the evolution of the bone properties as a function of loading. The bone remodeling algorithm was used to calculate the change in the density and elastic modulus based on the strain energy stimulus. The stress-binning procedure seeks to assign the properties to each element based on the levels of stress from the previous cycle, eliminating pseudo-lazy-zoning and stress dilation effects. The developed algorithms were used to analyze the response skull to loading associated with orthodontic devices. Specifically, a load was applied between the roots of the canine teeth and the first premolars while constraining the foramen magnum. Full-field contours of the displacement, strain, and strain energy were extracted after each remodeling cycle at nine commonly cephalometric landmarks. The results indicate that the overall mechanical response and the associated properties reached a steady-state behavior after nearly 50 cycles of applying the algorithm, where different zones within the skull exhibited unique evolution based on the locations from the loading and boundary sites. When approaching this steady-state condition, it was found that the upper incisor displacement is reduced by 72%, and the density is reduced by almost 7.5%. The finite element approach can be used in defining the treatment process by dynamically changing the loads. Future research will focus on integrating the time-dependent behavior of the bone.
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Affiliation(s)
- Jose Gonzalez
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, San Diego, CA, USA
| | - Somer Nacy
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, San Diego, CA, USA
- University of Baghdad, Baghdad, Iraq
| | - George Youssef
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, San Diego, CA, USA
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Parveen S, Husain A, Gosla Reddy S, Mascarenhas R, Shenoy S. Three-dimensional finite element analysis of initial displacement and stress on the craniofacial structures of unilateral cleft lip and palate model during protraction therapy with variable forces and directions. Comput Methods Biomech Biomed Engin 2020; 23:1360-1376. [PMID: 32873066 DOI: 10.1080/10255842.2020.1803844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Maxillary protraction and expansion is recommended to treat midfacial deficiency in patients with cleft lip and palate (CLP), where amount and direction of forces can change displacement and stress. This study assessed the initial displacement and stresses using Facemask and Maxgym forces with and without RME at +20∘, 0∘, and -20∘ angulation using a finite element (FE) model of unilateral cleft lip and palate (UCCLP). The Initial displacement and stress were more for protraction with expansion as compared to only protraction. Asymmetric displacement was observed with more on cleft than on noncleft side and more on dental than skeletal structures. Palatal plane rotated less upward, increased arch width and decreased arch length was observed with protraction with expansion.
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Affiliation(s)
- Shahistha Parveen
- Department of Orthodontics and Dentofacial Orthopedics, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Akhter Husain
- Department of Orthodontics and Dentofacial Orthopedics, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Srinivas Gosla Reddy
- GSR Institute of Craniomaxillofacial and Facial Plastic Surgery, Hyderabad, Telangana, India
| | - Rohan Mascarenhas
- Department of Orthodontics and Dentofacial Orthopedics, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India.,Manipal Institute of Technology, Department of Aeronautical & Automobile Engineering, MAHE (Deemed to be University), Manipal, Karnataka, India
| | - Satish Shenoy
- Manipal Institute of Technology, Department of Aeronautical & Automobile Engineering, MAHE (Deemed to be University), Manipal, Karnataka, India
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Cantarella D, Savio G, Grigolato L, Zanata P, Berveglieri C, Lo Giudice A, Isola G, Del Fabbro M, Moon W. A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:93-106. [PMID: 32256130 PMCID: PMC7090180 DOI: 10.2147/mder.s247751] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/04/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures. METHODS A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported. RESULTS The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6° clockwise. CONCLUSION The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphology of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions.
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Affiliation(s)
- Daniele Cantarella
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Correspondence: Daniele Cantarella Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, Milan, Italy Email
| | - Gianpaolo Savio
- Department of Civil, Environmental and Architectural Engineering ICEA, University of Padova, Padova, Italy
| | - Luca Grigolato
- Department of Civil, Environmental and Architectural Engineering ICEA, University of Padova, Padova, Italy
| | | | | | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Catania, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, Messina, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Catania, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Won Moon
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Los Angeles, CA, USA
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Krishnaswamy NR. Expansion in the absence of crossbite – rationale and protocol. APOS TRENDS IN ORTHODONTICS 2019. [DOI: 10.25259/apos_115_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transverse maxillomandibular discrepancies are a major component of several malocclusions. Clinically, posterior crossbite is a common and valid indicator of maxillary transverse problems and orthopedic and orthodontic forces are routinely used to correct maxillary transverse deficiency. However, crossbite and transverse discrepancies are not a homologous group but must be viewed as a continuum with varying degree of abnormality. The etiology, diagnostic protocol, rationale, and procedures employed for correcting maxillary transverse discrepancy in the absence of crossbite are discussed in the article.
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Karamanli BD, Kılıçoğlu H, Karamanli AF. Evaluation of the Effects of the Dental and Skeletal Anchored Face Mask Therapies on the Craniofacial System by Using Nonlinear Finite Element Analysis. APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/apos.apos_50_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims
The aim of this study was to evaluate the biomechanical effects on the craniofacial complex of skeletal anchorage and dental anchorage during face mask therapy.
Subjects and Methods
Two nonlinear finite element (FE) simulations were performed using a three-dimensional FE model. Face mask therapy with dental anchorage in the upper canines and face mask therapy with skeletal anchorage in the piriform apertures of the maxilla were simulated. In both simulations, the magnitude of the applied force was 750 g per side, and the force direction was 30° forward and downward relative to the occlusal plane.
Results
The circummaxillary sutures showed greater and more uniform stresses in the skeletal anchorage model than the dental anchorage model. This is the result of the more parallel forward movement of the maxilla in the skeletal anchorage model.
Conclusions
In Class III malocclusions with maxillary deficiency, for improved effects on the maxilla, choosing skeletal anchorage may be more effective in face mask therapies
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Affiliation(s)
| | - Hülya Kılıçoğlu
- Department of Orthodontics, Istanbul University, Istanbul, Turkey
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Lee RJ, Moon W, Hong C. Effects of monocortical and bicortical mini-implant anchorage on bone-borne palatal expansion using finite element analysis. Am J Orthod Dentofacial Orthop 2017; 151:887-897. [PMID: 28457266 DOI: 10.1016/j.ajodo.2016.10.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bone-borne palatal expansion relies on mini-implant stability for successful orthopedic expansion. The large magnitude of applied force experienced by mini-implants during bone-borne expansion may lead to high failure rates. Use of bicortical mini-implant anchorage rather than monocortical anchorage may improve mini-implant stability. The aims of this study were to analyze and compare the effects of bicortical and monocortical anchorages on stress distribution and displacement during bone-borne palatal expansion using finite element analysis. METHODS Two skull models were constructed to represent expansion before and after midpalatal suture opening. Three clinical situations with varying mini-implant insertion depths were studied in each skull model: monocortical, 1-mm bicortical, and 2.5-mm bicortical. Finite element analysis simulations were performed for each clinical situation in both skull models. Von Mises stress distribution and transverse displacement were evaluated for all models. RESULTS Peri-implant stress was greater in the monocortical anchorage model compared with both bicortical anchorage models. In addition, transverse displacement was greater and more parallel in the coronal plane for both bicortical models compared with the monocortical model. Minimal differences were observed between the 1-mm and the 2.5-mm bicortical models for both peri-implant stress and transverse displacement. CONCLUSIONS Bicortical mini-implant anchorage results in improved mini-implant stability, decreased mini-implant deformation and fracture, more parallel expansion in the coronal plane, and increased expansion during bone-borne palatal expansion. However, the depth of bicortical mini-implant anchorage was not significant.
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Affiliation(s)
- Robert J Lee
- Division of Orthodontics, University of California at San Francisco, San Francisco, Calif
| | - Won Moon
- Section of Orthodontics, University of California at Los Angeles, Los Angeles, Calif
| | - Christine Hong
- Section of Orthodontics, University of California at Los Angeles, Los Angeles, Calif.
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Shu R, Ai D, Bai D, Song J, Zhao M, Han X. The effects of SOST on implant osseointegration in ovariectomy osteoporotic mice. Arch Oral Biol 2016; 74:82-91. [PMID: 27918899 DOI: 10.1016/j.archoralbio.2016.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/15/2016] [Accepted: 11/20/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Osteoporosis is a risk factor for implant fixation failure. The inhibition of sclerostin effectively improves bone formation and bone remodeling. Therefore, this study investigated whether SOST deficiency enhances the osseointegration of implants in a mouse model of osteoporosis induced by ovariectomy (OVX). DESIGN Osteoporosis was induced in female C57BL/6 and SOST deficient mice by OVX. Titanium implants were placed in the bilateral distal aspects of the femurs. Implants underwent sandblasting and acid-etching after which the structure, surface roughness and chemical components were investigated using scanning electron microscopy (SEM) and energy spectrum analyses. Undecalcified slices, μ-CT, histology analyses and mechanical tests were used to evaluate the osseointegration of implants. The results were compared using one-way ANOVA between four groups. RESULTS Sandblasting and acid-etching increased the roughness of the implants. OVX surgery reduced bone formation around the implants in both WT and SOST-/- mice. However, implant osseointegration was significantly improved in the SOST-/- OVX mice compared to the WT OVX mice. CONCLUSIONS Inhibition of the SOST gene improved implant fixation in the OVX osteoporotic mice, which suggests a strategy for enhancing implant osseointegration in clinical patients with osteoporosis.
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Affiliation(s)
- Rui Shu
- Department of Orthodontics and Pediatric Dentistry, State Key Laboratory of Oral Disease, West China School of Stomatology, Sichuan University, 14, 3rd Sec, Renminnan Rd, Chengdu, Sichuan 610041, China.
| | - Dongqing Ai
- Department of Orthodontics, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China.
| | - Ding Bai
- Department of Orthodontics and Pediatric Dentistry, State Key Laboratory of Oral Disease, West China School of Stomatology, Sichuan University, 14, 3rd Sec, Renminnan Rd, Chengdu, Sichuan 610041, China.
| | - Jinlin Song
- Department of Orthodontics, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China.
| | - Mengyuan Zhao
- Department of Orthodontics and Pediatric Dentistry, State Key Laboratory of Oral Disease, West China School of Stomatology, Sichuan University, 14, 3rd Sec, Renminnan Rd, Chengdu, Sichuan 610041, China.
| | - Xianglong Han
- Department of Orthodontics and Pediatric Dentistry, State Key Laboratory of Oral Disease, West China School of Stomatology, Sichuan University, 14, 3rd Sec, Renminnan Rd, Chengdu, Sichuan 610041, China.
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Kumar A, Ghafoor H, Khanam A. A comparison of three-dimensional stress distribution and displacement of naso-maxillary complex on application of forces using quad-helix and nickel titanium palatal expander 2 (NPE2): a FEM study. Prog Orthod 2016; 17:17. [PMID: 27245236 PMCID: PMC4896894 DOI: 10.1186/s40510-016-0131-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/19/2016] [Indexed: 11/14/2022] Open
Abstract
Background Our objectives are to analyse and to compare the stress distribution and displacement of the craniofacial structures, following the application of forces from quad-helix and Nickel Titanium Palatal Expander-2 (NPE2) using finite element analysis. Methods Three-dimensional finite element models of young dried human skull, quad-helix appliance and NPE2 were constructed, and the initial activation of the expanders was stimulated to carry out the analysis and to evaluate the Von Misses stresses and displacement. Results Both the models demonstrated the highest stresses at the mid-palatal suture, with maximum posterior dislocation. The second highest stress was recorded at the fronto-zygomatic suture. The pattern of stress distribution was almost similar in both the groups, but NPE2 revealed lower magnitude stresses than quad-helix. The only exception being quad-helix model showed high stress levels around pterygo-maxillary suture whereas minimal stress around pterygo-maxillary suture was noticed after NPE2 activation. The cusp of the erupting canine and the erupting mesiobuccal cusp of the second molar showed outward, backward and downward displacement signifying increase in their eruption pattern following maxillary expansion. Conclusions Maxillary expansion using quad-helix and NPE2 can be used in posterior crossbite correction in cases where maximum skeletal changes are desirable at a younger age; it is furthermore effective in treating young patients with impacted or displaced teeth. Quad-helix and NPE2 produced acceptable forces for orthopaedic treatment even after being orthodontic appliances; their clinical application should be correctly planned as the effects of these appliances are largely age dependent.
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Affiliation(s)
- Avinash Kumar
- Department of Orthodontics and Dentofacial Orthopedics, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India.
| | - Hajra Ghafoor
- Department of Orthodontics and Dentofacial Orthopedics, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
| | - Arifa Khanam
- Department of Orthodontics and Dentofacial Orthopedics, Al-Badar Dental College and Hospital, Gulbarga, Karnataka, India
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Maruo IT, Maruo H, Saga AY, de Oliveira DD, Argenta MA, Tanaka OM. Tridimensional finite element analysis of teeth movement induced by different headgear forces. Prog Orthod 2016; 17:18. [PMID: 27264500 PMCID: PMC4893458 DOI: 10.1186/s40510-016-0130-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/15/2016] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to simulate the actions of low-pull (LP), high-pull (HP), and combined pull (CP) headgears (HGs) and to analyze tooth movement tendencies through finite element analysis. Methods Tomographic slices of a human maxilla with complete permanent dentition were processed by reconstruction software, and the triangular surface mesh was converted into non-uniform rational B-spline (NURBS) curves. An HG facial bow was also modulated in 3D. The teeth and bone were considered to have isotropic and linear behavior, whereas the periodontal ligament was considered to have non-linear and hyperelastic behavior. Data regarding the application points, directions and magnitudes of forces were obtained from the literature and from a dolichofacial patient with class II, division 1 malocclusion, who was treated with a CP HG. Results The CP HG promoted 37.1 to 41.1 %, and the HP HG promoted 19.1 to 31.9 % of LP distalization. The HP HG presented the highest intrusion, and the LP HG presented the highest extrusion of the first molar. The LP HG contracted the distal side, and the HP and CP HGs contracted the lingual and distobuccal roots of the second molar to a lesser degree. Conclusions The LP HG promotes the greatest distalization, followed by the CP and HP HGs; the LP HG causes greater extrusion of the first molar, and the HP HG causes greater intrusion of the first molar. The LP HG causes greater contraction of the second molar than the HP HG.
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Affiliation(s)
- Ivan Toshio Maruo
- Orthodontic Graduation Program, Brazilian Dental Association (ABO) and Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Hiroshi Maruo
- Orthodontic Graduation Program, Brazilian Dental Association (ABO), Ponta Grossa, Paraná, Brazil
| | - Armando Yukio Saga
- Orthodontic Graduation Program, Brazilian Dental Association (ABO) and Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Dauro Douglas de Oliveira
- Orthodontic Graduation Program, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco André Argenta
- Post Graduation Program in Numerical Methods in Engineering, Federal University of Paraná, Curitiba, Brazil
| | - Orlando Motohiro Tanaka
- Graduate Program in Orthodontics, Pontifícia Universidade Católica do Paraná, School of Life Sciences, R. Imaculada Conceição, 1155, Curitiba, Brazil. .,Post-Doctoral fellowship at The Center for Advanced Dental Education, Saint Louis University, Saint Louis, MO, USA.
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Gerami A, Dadgar S, Rakhshan V, Jannati P, Sobouti F. Displacement and force distribution of splinted and tilted mandibular anterior teeth under occlusal loads: an in silico 3D finite element analysis. Prog Orthod 2016; 17:16. [PMID: 27245235 PMCID: PMC4887454 DOI: 10.1186/s40510-016-0129-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/06/2016] [Indexed: 12/29/2022] Open
Abstract
Background Fixed orthodontic retainers have numerous advantages, but it is not known whether they can exert pathological forces on supporting tissues around the splinted teeth. The purpose of this study was to investigate how the inclination of the lower anterior teeth can affect dental displacement and also change the direction of occlusal loads exerted to dental and its supporting tissues. Methods Four three-dimensional finite element models of the anterior part of the mandible were designed. All the models contained the incisors and canines, their periodontal ligament layers (PDLs), the supporting bone (both spongy and cortical), and a pentaflex splinting wire placed in the lingual side of the teeth. Teeth inclination was considered to be 80° (model 1), 90° (model 2), 100° (model 3), and 110° (model 4) to the horizontal plane. The lower incisors were loaded with a 187-N vertical force. Their displacement patterns and the stress in their PDLs were evaluated. Results In incisors with 80° of inclination, less than a 0.1-mm lingual displacement was seen on the incisal edge and a similar distance of displacement towards the labial was seen on their root apices. However, in models with 90°–110° of inclination, the incisal edge displaced labially between about 0.01 and 0.45 mm, while root apices displaced lingually instead. By increasing the angle of the teeth, the strain in the periodontal ligament increased from about 37 to 58 mJ. The von Mises stresses around the cervical and apical areas differed for each tooth and each model, without a similar pattern. Increasing the angle of the teeth resulted in much higher cervical stresses in the incisors, but not in the canines. In the lateral incisor, cervical stress increased until 100° of inclination but reduced to about half by increasing the angle to 110°. Apical stress increased rather consistently in the incisor and lateral incisors, by increasing the inclination. However, in the canines, apical stress reduced to about half, from the first to fourth models. Conclusions Increasing the labial inclination can mostly harm the central incisors, followed by the lateral incisors. This finding warns against long durations of splinting in patients with higher and/or patients with reduced labial bone thickness.
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Affiliation(s)
- Allahyar Gerami
- Department of Orthodontics, Dental Faculty, Tehran University of Medical University, Tehran, Iran
| | - Sepideh Dadgar
- Department of Orthodontics, Dental Faculty, Mazandaran University of Medical Sciences, PO Box: 19551-624, Sari, Iran
| | - Vahid Rakhshan
- Department of Dental Anatomy and Morphology, Dental School, Azad University, Tehran, Iran.,Iranian Tissue Engineering and Research Center, Tehran University, Tehran, Iran
| | - Puya Jannati
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farhad Sobouti
- Department of Orthodontics, Dental Faculty, Mazandaran University of Medical Sciences, PO Box: 19551-624, Sari, Iran.
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Tanaka OM, Saga AY, Pithon MM, Argenta MA. Stresses in the midpalatal suture in the maxillary protraction therapy: a 3D finite element analysis. Prog Orthod 2016; 17:8. [PMID: 26980199 PMCID: PMC4792831 DOI: 10.1186/s40510-016-0121-5] [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] [Received: 12/22/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the present work was to evaluate the stress magnitudes and directions along the midpalatal suture in the maxillary protraction therapy. Methods The geometry of the maxilla and teeth were digitally reconstructed based on computer tomography images obtained from the skull of a girl in a mixed dentition stage with skeletal and dental class III malocclusion. An appliance commonly used for rapid palatal expansion (RPE) was also digitally modeled for anchorage of the protraction force and meshed for finite element analysis. The maxillary protraction was simulated applying 600 cN (300 cN for each side) directed 30° forward and downward to the maxillary occlusal plane. Results The principal stresses, through the force application, exhibited similar distribution patterns. A higher stress area was observed in the region of the midpalatal suture located in front of the incisive canal. All the sections showed vectors of compressive nature. Conclusions Because of the compressive nature of the stresses distributed along the midpalatal suture in the maxillary protraction therapy simulation, which is opposite to the natural growth transversal tendency, maxillary expansion is advisable in clinical cases.
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Affiliation(s)
- Orlando M Tanaka
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. .,The Center for Advanced Dental Education, Saint Louis University, St. Louis, MO, USA.
| | - Amando Yukio Saga
- School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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