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Verplanken T, Vanroose R, Ureel M, Coopman R, Van Paepegem W. Numerical study of the impact of osteotomies and distractor location in surgically assisted rapid palatal expansion for transverse maxillary deficiency. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101916. [PMID: 38763267 DOI: 10.1016/j.jormas.2024.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION This paper employs finite element analysis to assess the biomechanical behavior of surgically assisted rapid palatal expansion (SARPE) with a bone-borne transpalatal distractor (TPD) by varying surgical parameters. MATERIAL AND METHODS Nine models were constructed to scrutinize the effects of pterygomaxillary disjunction (PMD), lateral osteotomy positioning, and TPD placement on displacement profiles and Von Mises stresses. These models encompassed variations such as no, unilateral or bilateral PMD, asymmetrical lateral osteotomy, and five TPD locations. RESULTS Performing a PMD reduces posterior resistance to transverse expansion, resulting in 10-20 % stress reduction around the maxillofacial complex. No significant changes in horizontal tipping were observed post-PMD. The asymmetric lateral osteotomy model exhibited larger displacements on the side with a more superiorly positioned osteotomy. Reduced stresses were observed at the maxillary body and medial pterygoid plate (superiorly), while increased stresses were observed at the medial (inferiorly) and lateral pterygoid plates. More posterior TPD placement facilitated more parallel expansion thus less horizontal tipping, albeit with increased vertical tipping. DISCUSSION SARPE procedures (distractor and osteotomy positions) can be tailored based on desired outcomes. PMD reduces stress within the maxillofacial complex but doesn't significantly affect tipping. Higher lateral osteotomies lead to increased displacements, more posterior distractors to more parallel expansion.
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Affiliation(s)
- Tomas Verplanken
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
| | - Robin Vanroose
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium.
| | - Matthias Ureel
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Renaat Coopman
- Department of Oro-Maxillofacial, Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Wim Van Paepegem
- Department of Materials, Textiles and Chemical Engineering, Ghent University, Ghent, Belgium
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Chen KY, Yang CY, Fan CN, Kuo CS, Fan SZ, Chen YW. The effects of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: A systematic review and meta-analysis. Orthod Craniofac Res 2024. [PMID: 38661079 DOI: 10.1111/ocr.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aims to assess the expansive effects of pterygomaxillary disjunction (PMD) in surgically assisted rapid maxillary expansion (SARME) surgery using a meta-analysis approach. MATERIALS AND METHODS The study conducted a comprehensive literature search across five databases: PubMed, Scopus, Medline, Embase, and Cochrane, adhering to the PRISMA 2020 guidelines. Dental alterations were assessed using either cone-beam computed tomography (CBCT) or dental casts, while skeletal changes were exclusively measured from CBCT scans. We analysed the dentoskeletal changes between PMD +/- groups and conducted a within-group comparison. The primary focus of the results was on the mean differences observed in pre- and post-operative measurements. RESULTS Dental expansion was larger in the PMD+ group but not statistically significant. Skeletal expansion showed a significantly larger expansion in the posterior region in the PMD+ group (P = .033). Without PMD, anterior palatal expansion was significantly larger (P = .03), and the buccal tipping of posterior teeth was also significantly larger (P = .011) to achieve acceptable dental expansion outcomes. CONCLUSIONS Both PMD +/- groups of SARME surgery can achieve satisfactory dental expansion outcomes. However, bone expansion and tooth inclination are also important factors that influence orthodontic treatment and post-expansion stability. By reducing the bony resistance with PMD, larger posterior palatal expansion and more parallel bony expansion are observed. In contrast, without PMD, there is smaller palatal expansion and greater tooth inclination in the posterior region. This could potentially lead to compromised periodontal conditions following expansion.
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Affiliation(s)
- Kuei-Yuan Chen
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Cheng-Yu Yang
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ning Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Shan Kuo
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Anesthesiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yuan-Wu Chen
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan
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Nowak R, Przywitowski S, Golusiński P, Olejnik A, Zawiślak E. Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)-A Retrospective Analysis of 185 Cases Treated at a Single Center. J Clin Med 2024; 13:2053. [PMID: 38610817 PMCID: PMC11012378 DOI: 10.3390/jcm13072053] [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: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The study aims to assess and classify complications in patients treated for maxillary transverse deficiency using surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) under general anesthesia. The classification of the complications aimed to assess the difficulty of their treatment as well as estimate its real cost. Methods: The retrospective study covered 185 patients who underwent surgery for a skeletal deformity in the form of maxillary constriction or in which maxillary constriction was one of its components treated by a team of maxillofacial surgeons at one center (97 females and 88 males, aged 15 to 47 years, mean age 26.1 years). Complications were divided into two groups: early complications (up to 3 weeks after surgery) and late complications (>3 weeks after surgery). In relation to the occurrence of complications, we analyzed the demographic characteristics of the group, type of skeletal deformity (class I, II, III), presence of open bite and asymmetry, surgical technique, type and size of appliance used for maxillary expansion, as well as the duration of surgery. Results: In the study group, complications were found in 18 patients (9.73%). Early complications were found in nine patients, while late complications were also found in nine patients. Early complications include no possibility of distraction, palatal mucosa necrosis, perforation of the maxillary alveolar process caused by the distractor and asymmetric distraction. Late complications include maxillary incisor root resorption, no bone formation in the distraction gap, and maxillary incisor necrosis. None of the patients required prolonged hospitalization and only one required reoperation. Conclusions: Complications were found in 18 patients (9.73%). All challenges were classified as minor difficulties since they did not suppress the final outcome of the treatment of skeletal malocclusion. However, the complications that did occur required additional corrective measures. Surgically assisted rapid maxillary expansion, when performed properly and in correlation with the correct orthodontic treatment protocol, is an effective and predictable technique for treating maxillary constriction.
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Affiliation(s)
- Rafał Nowak
- Department of Otolaryngology and Maxillofacial Surgery, Institute of Medical Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Szymon Przywitowski
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
| | - Paweł Golusiński
- Department of Otolaryngology and Maxillofacial Surgery, Institute of Medical Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Anna Olejnik
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
| | - Ewa Zawiślak
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
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Koç O, Koç N, Jacob HB. Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis. Dental Press J Orthod 2024; 29:e2423195. [PMID: 38451569 PMCID: PMC10914319 DOI: 10.1590/2177-6709.29.1.e2423195.oar] [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: 08/29/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. OBJECTIVE The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. MATERIAL AND METHODS Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. RESULTS Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). CONCLUSIONS Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.
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Affiliation(s)
- Osman Koç
- Yildiz Technical University, Department of Mechanical Engineering (Yildiz, Istanbul/Turkey)
| | - Nagihan Koç
- Independent researcher (Yildiz, Istanbul/Turkey)
| | - Helder Baldi Jacob
- The University of Texas Health Science Center Houston School of Dentistry, Department of Orthodontics (Houston/TX, USA)
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Koç O, Bolat Gumus E. Effects of different distractor positions on the formation of expansion, stress and displacement patterns in surgically assisted rapid maxillary expansion without pterygomaxillary disjunction: a finite element analysis study. Comput Methods Biomech Biomed Engin 2024; 27:56-66. [PMID: 36724781 DOI: 10.1080/10255842.2023.2170712] [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: 03/14/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
Skeletal orthopedic expansion of maxilla is accepted as a reliable method for the treatment of transverse maxillar deficiency in growing patients. The aim of the study was to evaluate the effects of different palatal distractor positions on the expansion, stress and displacement patterns of the structures of craniofacial complex in surgical assisted rapid maxillary expansion without pterygomaxillary disjunction (PTMD) with the help of finite element analysis(FEA). Four facial skeleton models with different distractor positions (first premolar, second premolar, first molar, second molar regions) were created. In all finite element models median and lateral osteotomies were performed, without PTMD. Stress distribution was evaluated after 5 mm activation of the transpalatal distraction in all models using the nonlinear solution method in FEA. Unilateral displacement(mm) and stress distribution(MPa) were measured in three directions (x, y, and z axes) of craniofacial and maxillofacial structures in the symmetrical finite element models. In all models, the unilateral transverse displacements of the anterior teeth were greater than those of the posterior teeth, and the greatest displacement was at the central incisor level. The greatest displacement values at the central incisor level, at the anterior nasal spine(ANS) and at the posterior nasal spine(PNS) levels was measured in Model-IV, III, II and I, respectively. Mean elemental stress(von Mises stress) in the medial pterygoid plate, screw and lateral pterygoid plate regions from highest to lowest was measured in Model-IV, III, II and I, respectively. The maxilla performed outward rotation and tipping movement in all models during the expansion period. Among the distractor positions, the second molar region was found to be the most advantageous one in terms of expansion pattern. Considering the patient's anatomy and clinical conditions, placing the palatal distractor as posteriorly as possible will result in more effective maxillary expansion.
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Affiliation(s)
- Osman Koç
- Department of Mechanical Engineering, Yildiz Technical University, Yildiz, Istanbul, Turkey
| | - Esra Bolat Gumus
- Faculty of Dentistry, Department of Orthodontics, Akdeniz University, Antalya, Turkey
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Chhatwani S, Kouji-Diehl O, Kniha K, Modabber A, Hölzle F, Szalma J, Danesh G, Möhlhenrich SC. Significance of bone morphology and quality on the primary stability of orthodontic mini-implants: in vitro comparison between human bone substitute and artificial bone. J Orofac Orthop 2023; 84:362-372. [PMID: 35304617 PMCID: PMC10587204 DOI: 10.1007/s00056-022-00385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
AIM This study evaluated artificial bone models against a human bone substitute to assess the primary stability of orthodontic mini-implants (OMIs) at varying implant sites with different morphologies and qualities. MATERIALS AND METHODS A total of 1200 OMI placements of four types were inserted into four artificial bone models of different density (D1, D2, D3, D4) and into a human bone substitute (HB). The implants varied in diameter (2.0 and 2.3 mm) and length (9 and 11 mm). Each specimen had four implant sites: no defect, one-wall defect, three-wall defect, and circular defect. The implant stability quotient (ISQ) values were measured using resonance frequency analysis (RFA) and insertion placement torque values (IPT) were assessed for primary stability. Correlation analysis was performed to evaluate the different models. RESULTS The highest IPT value was registered for the 2.0 mm × 11 mm implant inserted into D1 with no defect (37.53 ± 3.02 Ncm). The lowest ISQ value was measured for the 2.3 mm × 9 mm OMI inserted into D3 with a circular defect (12.33 ± 5.88) and the highest for the 2.3 mm × 9 mm implant inserted into HB with no defect (63.23 ± 2.57). A strong correlation (r = 0.64) for IPT values and a very strong correlation (r = 0.8) for ISQ values was found between D2 and HB. CONCLUSION Bone defects and bone quality affected the primary stability of implants in terms of ISQ and IPT values. Results for bone model D2 correlated very well with the HB substitution material.
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Affiliation(s)
- Sachin Chhatwani
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany.
| | - Ouafaa Kouji-Diehl
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jozsef Szalma
- Department of Oral and Maxillofacial Surgery, University of Pecs, Dischka Győző str. 5, 7621, Pecs, Hungary
| | - Gholamreza Danesh
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
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Koç O, Jacob HB. Surgically assisted rapid palatal expansion: is the pterygomaxillary disjunction necessary? A finite element study. Semin Orthod 2022. [DOI: 10.1053/j.sodo.2022.10.017] [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: 11/05/2022]
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Age-dependent interactions of maxillary sutures during RME and their effects on palatal morphology : CBCT and dental cast analysis. J Orofac Orthop 2022; 83:412-431. [PMID: 36205766 DOI: 10.1007/s00056-022-00429-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE The effects of rapid maxillary expansion (RME) on the transverse palatine and midfacial sutures have been extensively scrutinized. Unlike the dentition stage, age-dependency was not yet regarded when investigating morphological changes of the tooth-bearing palate. Therefore, the first aim of the present study was to analyse age-dependent sutural and morphological changes of the palate in selected patients by cone-beam computed tomography (CBCT) and dental cast analysis. Secondly, age-dependent effects of RME on width, height, and depth of the palate in the region of the maxillary palatine processes were investigated by a comprehensive dental cast study, so that the combination of results could be used to provide a biomechanical explanation of the occurring changes. METHODS CBCT datasets of 9 patients (between 7.3 and 13.8 years) were measured around the median palatal suture and compared with the results of an individualised dental cast analysis. In addition, possible effects on other maxillary sutures were investigated. In the dental cast study, changes after RME in the tooth-bearing palate were analysed three-dimensionally in 60 children and adolescents. It was possible to divide those into three equally sized, age-dependant groups (PG1: < 10 years, n = 20; PG2: ≥ 10 < 12 years, n = 20; PG3: ≥ 12 years, n = 20). RESULTS The CBCT analysis reveals age-related differences in sutural responses. The opening width of the median palatine suture decreases cranially (frontal) and dorsally (horizontal). The opening mode thus changes from parallel to triangular in both planes. The transverse palatine suture completely opens in younger patients only (PG1 and PG2). The width increases are always significant in all patients. While in PG1 the width increase is greater posteriorly than anteriorly, this is always reversed in PG2 and PG3. The palatal height always increases significantly anteriorly, but posteriorly only in the youngest patients (PG 1) median and paramedian. In PG 2 and PG 3, the posterior height change is very small. That is the reason why the anteroposterior comparison reveals a much more pronounced height increase anteriorly than posteriorly. CONCLUSION The comparison of selected CBCT data with a dental cast analysis allows the conclusion that the maxillary expansion after RME in children up to 10 years is rather parallel, whereas it occurs V‑shaped (anterior > posterior transversal, inferior > superior vertical) with increasing age, especially in adolescents from the age of 12. In addition to an age-progressive rigidity of the pterygopalatomaxillary junction, morphological changes of the transverse palatine suture during growth seem to be causal. Thus, age-dependent effects of palatal expansion occur due to a positional change of maxillary centres of rotation and resistance. From dental cast measurements, especially at the skeletal-basal level, conclusions can be drawn about the median palatal suture opening mode.
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Chhatwani S, Schudlich K, Möhlhenrich SC, Pugachev A, Bicsak A, Ludwig B, Hassfeld S, Danesh G, Bonitz L. Evaluation of symmetry behavior of surgically assisted rapid maxillary expansion with simulation-driven targeted bone weakening. Clin Oral Investig 2021; 25:6717-6728. [PMID: 33948683 PMCID: PMC8602202 DOI: 10.1007/s00784-021-03958-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Surgically assisted rapid maxillary expansion (SARME) is a treatment modality to overcome maxillary constrictions. During the procedure of transverse expansion, unwanted asymmetries can occur. This retrospective study investigates the transverse expansion behavior of the maxilla utilizing a simulation-driven SARME with targeted bone weakening. MATERIALS AND METHODS Cone beam computer tomographies of 21 patients before (T1) and 4 months after treatment (T2) with simulation-driven SARME combined with a transpalatal distractor (TPD) and targeted bone weakening were superimposed. The movements of the left, right, and frontal segments were evaluated at the modified WALA ridge, mid root level, and at the root tip of all upper teeth. Linear and angular measurements were performed to detect dentoalveolar changes. RESULTS Dentoalveolar changes were unavoidable, and buccal tipping of the premolars (6.1° ± 5.0°) was significant (p < 0.05). Transverse expansion in premolar region was higher (6.13 ± 4.63mm) than that in the molar region (4.20 ± 4.64mm). Expansion of left and right segments did not differ significantly (p > 0.05). CONCLUSION Simulation-driven SARME with targeted bone weakening is effective to achieve symmetrical expansion in the transverse plane. CLINICAL RELEVANCE Simulation-driven targeted bone weakening is a novel method for SARME to achieve symmetric expansion. Dental side effects cannot be prohibited.
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Affiliation(s)
- S Chhatwani
- Department of Orthodontics, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Str. 45, 58455, Witten, Germany.
| | - K Schudlich
- Department of Orthodontics, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Str. 45, 58455, Witten, Germany
| | - S C Möhlhenrich
- Department of Orthodontics, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Str. 45, 58455, Witten, Germany
| | - A Pugachev
- CADFEM Medical GmbH, Marktplatz 2, 85567, Grafing, Germany
| | - A Bicsak
- Department of Cranial and Maxillofacial Surgery, Faculty of Health, University of Witten/Herdecke, Klinikum Nord, Münsterstr. 240, 44145, Dortmund, Germany
| | - B Ludwig
- Private orthodontic clinic, Am Bahnhof 54, 56841, Traben-Trarbach, Germany
| | - S Hassfeld
- Department of Cranial and Maxillofacial Surgery, Faculty of Health, University of Witten/Herdecke, Klinikum Nord, Münsterstr. 240, 44145, Dortmund, Germany
| | - G Danesh
- Department of Orthodontics, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Str. 45, 58455, Witten, Germany
| | - L Bonitz
- Department of Cranial and Maxillofacial Surgery, Faculty of Health, University of Witten/Herdecke, Klinikum Nord, Münsterstr. 240, 44145, Dortmund, Germany
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Chen J, Xu Y, Li C, Zhang L, Yi F, Lu Y. Displacement and stress distribution of the craniomaxillofacial complex under different surgical conditions: a three-dimensional finite element analysis of fracture mechanics. BMC Oral Health 2021; 21:596. [PMID: 34809636 PMCID: PMC8607715 DOI: 10.1186/s12903-021-01941-1] [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: 09/25/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To provide a simplified treatment strategy for patients with maxillary transverse deficiency. We investigated and compared the fracture mechanics and stress distribution of a midline palatal suture under dynamic loads during surgically-assisted rapid palatal expansion. Methods Based on the cone-beam computed tomography (CBCT) data of a 21-year-old female volunteer, a three-dimensional model of the cranio-maxillofacial complex (including the palatal suture) was constructed. A finite element analysis model was constructed based on meshwork. After the yield strength of the palatal suture was set, an increasing expansion force (0–500 N) was applied within 140 ms to calculate the time–load curve, which mimicked nonsurgical bone expansion (model A). The same method was used to evaluate the fracture process, time and stress distribution of the palatal suture in maxillary lateral osteotomy-assisted (model B) and LeFort osteomy I (LFIO)-assisted expansion of the maxillary arch (model C).
Results Compared with model A, the palatal suture of model B and model C showed a faster stress accumulation rate and shorter fracture time, and the fracture time of model B and model C was almost identical. Compared with model A, we discovered that model B and model C showed greater lateral extension of the maxilla, and the difference was reflected mainly in the lower part of the maxilla, and there was no difference between model B and model C in lateral extension of the maxilla. Conclusions Compared with arch expansion using nonsurgical assistance (model A), arch expansion using maxillary lateral wall-osteotomy (model B) or LFIO had a faster rate of stress accumulation, shorter time of fracture of the palatal suture and increased lateral displacement of the maxilla. Compared with arch expansion using LFIO (model C), arch expansion using lateral osteotomy (model B) had a similar duration of palatal suture rupture and lateral maxillary extension. In view of the trauma and serious complications associated with LFIO, maxillary lateral wall-osteotomy could be considered a substitute for LFIO.
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Affiliation(s)
- Junjie Chen
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Hunan, 410008, Changsha, China
| | - Yuhan Xu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Hunan, 410008, Changsha, China
| | - Chengri Li
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Hunan, 410008, Changsha, China
| | - Lingling Zhang
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Hunan, 410008, Changsha, China
| | - Fang Yi
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Hunan, 410008, Changsha, China
| | - Yanqin Lu
- Hunan Key Laboratory of Oral Health Research & Hunan 3D Printing Engineering Research Center of Oral Care & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Academician Workstation for Oral-maxilofacial and Regenerative Medicine & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Hunan, 410008, Changsha, China.
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