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Sulaiman MY, Wicaksono S, Dirgantara T, Mahyuddin AI, Sadputranto SA, Oli'i EM. Influence of bite force and implant elastic modulus on mandibular reconstruction with particulate-cancellous bone marrow grafts healing: An in silico investigation. J Mech Behav Biomed Mater 2024; 157:106654. [PMID: 39042972 DOI: 10.1016/j.jmbbm.2024.106654] [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: 03/28/2024] [Revised: 06/27/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
This study aims to investigate tissue differentiation during mandibular reconstruction with particulate cancellous bone marrow (PCBM) graft healing using biphasic mechanoregulation theory under four bite force magnitudes and four implant elastic moduli to examine its implications on healing rate, implant stress distribution, new bone elastic modulus, mandible equivalent stiffness, and load-sharing progression. The finite element model of a half Canis lupus mandible, symmetrical about the midsagittal plane, with two marginal defects filled by PCBM graft and stabilized by porous implants, was simulated for 12 weeks. Eight different scenarios, which consist of four bite force magnitudes and four implant elastic moduli, were tested. It was found that the tissue differentiation pattern corroborates the experimental findings, where the new bone propagates from the superior side and the buccal and lingual sides in contact with the native bone, starting from the outer regions and progressing inward. Faster healing and quicker development of bone graft elastic modulus and mandible equivalent stiffness were observed in the variants with lower bite force magnitude and or larger implant elastic modulus. A load-sharing condition was found as the healing progressed, with M3 (Ti6Al4V) being better than M4 (stainless steel), indicating the higher stress shielding potentials of M4 in the long term. This study has implications for a better understanding of mandibular reconstruction mechanobiology and demonstrated a novel in silico framework that can be used for post-operative planning, failure prevention, and implant design in a better way.
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Affiliation(s)
- Muhammad Yusril Sulaiman
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Satrio Wicaksono
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia.
| | - Tatacipta Dirgantara
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Andi Isra Mahyuddin
- Dynamics and Control Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Seto Adiantoro Sadputranto
- Oral and Maxillofacial Medical Staff Group, Hasan Sadikin General Hospital, Jalan Pasteur 38, Bandung, 40161, West Java, Indonesia; Oral and Maxillofacial Department, Faculty of Dentistry, Universitas Padjajaran, Jalan Sekeloa Selatan 1, Bandung, 40132, West Java, Indonesia
| | - Eka Marwansyah Oli'i
- Oral and Maxillofacial Medical Staff Group, Hasan Sadikin General Hospital, Jalan Pasteur 38, Bandung, 40161, West Java, Indonesia; Oral and Maxillofacial Department, Faculty of Dentistry, Universitas Padjajaran, Jalan Sekeloa Selatan 1, Bandung, 40132, West Java, Indonesia; Mechanical Engineering Graduate Program, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
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Cheng KJ, Shi ZY, Wang R, Jiang XF, Xiao F, Liu YF. 3D printed PEKK bone analogs with internal porosity and surface modification for mandibular reconstruction: An in vivo rabbit model study. BIOMATERIALS ADVANCES 2023; 151:213455. [PMID: 37148594 DOI: 10.1016/j.bioadv.2023.213455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
Polyetheretherketone (PEEK) and its derivative polyetherketoneketone (PEKK) have been used as implant materials for spinal fusing and enjoyed their success for many years because of their mechanical properties similar to bone and their chemical inertness. The osseointegration of PEEKs is datable. Our strategy was to use custom-designed and 3D printed bone analogs with an optimized structure design and a modified PEKK surface to augment bone regeneration for mandibular reconstruction. Those bone analogs had internal porosities and a bioactive titanium oxide surface coating to promote osseointegration between native bone and PEKK analogs. Our workflow was 3D modeling, bone analog designing, structural optimization, mechanical analysis via finite element modeling, 3D printing of bone analogs and subsequently, an in vivo rabbit model study on mandibular reconstruction and histology evaluation. Our results showed the finite element analysis validated that the porous PEKK analogs provided a mechanical-sound structure for functional loadings. The bone analogs offered a perfect replacement for segmented bones in the terms of shape, form and volume for surgical reconstruction. The in vivo results showed that bioactive titanium oxide coating enhanced new bone in-growth into the porous PEKK analogs. We have validated our new approach in surgical mandibular reconstruction and we believe our strategy has a significant potential to improve mechanical and biological outcomes for patients who require mandibular reconstruction procedures.
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Affiliation(s)
- Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; Collaborative Innovation Center of High-end Laser Manufacturing Equipment (National "2011 Plan"), Zhejiang University of Technology, Hangzhou 310023, China
| | - Zhen-Yu Shi
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; Collaborative Innovation Center of High-end Laser Manufacturing Equipment (National "2011 Plan"), Zhejiang University of Technology, Hangzhou 310023, China
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China
| | - Fan Xiao
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; Collaborative Innovation Center of High-end Laser Manufacturing Equipment (National "2011 Plan"), Zhejiang University of Technology, Hangzhou 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, China; Collaborative Innovation Center of High-end Laser Manufacturing Equipment (National "2011 Plan"), Zhejiang University of Technology, Hangzhou 310023, China.
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Chen CF, Chen CM, Chen HS, Huang WC, Chen YC, Chang HC, Liu SH, Yang TL, Wang LL, Chen PH. The Use of Customized Three-Dimensionally Printed Mandible Prostheses with a Pressure-Reducing Device: A Finite Element Analysis in Different Chewing Positions, Biomechanical Testing, and In Vivo Animal Study Using Lanyu Pigs. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9880454. [PMID: 35342763 PMCID: PMC8942632 DOI: 10.1155/2022/9880454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 01/05/2023]
Abstract
Segmental bony defects of the mandible constitute a complete loss of the regional part of the mandible. Although several types of customized three-dimension-printed mandible prostheses (CMPs) have been developed, this technique has yet to be widely used. We used CMP with a pressure-reducing device (PRD) to investigate its clinical applicability. First, we used the finite element analysis (FEA). We designed four models of CMP (P1 to P4), and the result showed that CMP with posterior PRD deployment (P4 group) had the maximum total deformation in the protrusion and right excursion positions, and in clenching and left excursion positions, posterior screws had the minimum von Mises stress. Second, the P4 CMP-PRD was produced using LaserCUSING from titanium alloy (Ti-6Al-4V). The fracture test result revealed that the maximum static pressure that could be withstood was 189 N, and a fatigue test was conducted for 5,000,000 cycles. Third, animal study was conducted on five male 4-month-old Lanyu pigs. Four animals completed the experiment. Two animals had CMP exposure in the oral cavity, but there was no significant inflammation, and one animal had a rear wing fracture. According to a CT scan, the lingual cortex of the mandible crawled along the CMP surface, and a bony front-to-back connection was noted in one animal. A histological examination indicated that CMP was significantly less reactive than control materials (p = 0.0170). Adequate PRD deployment in CMP may solve a challenge associated with CMP, thus promoting its use in clinical practice.
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Affiliation(s)
- Chun-Feng Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Oral and Maxillofacial Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Dental Laboratory Technology, Shu Zen College of Medicine and Management, Kaohsiung, Taiwan
| | - Chun-Ming Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Sheng Chen
- Dental Department, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Wei-Chin Huang
- Laser and Additive Manufacturing Technology Center, Industrial Technology Research Institute, Taiwan
| | - Yung-Chung Chen
- School of Dentistry and Institute of Oral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chih Chang
- Department of biomedical engineering, Hungkuang University, Taichung, Taiwan
| | - Sung-Ho Liu
- Laser and Additive Manufacturing Technology Center, Industrial Technology Research Institute, Taiwan
| | - Tsung-Lung Yang
- KSVGH Originals & Enterprises, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ling-Lin Wang
- KSVGH Originals & Enterprises, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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