Towards a viscoelastic model for the unfused midpalatal suture: development and validation using the midsagittal suture in New Zealand white rabbits

Finite element analysis of the influence of interdigitation pattern and collagen fibers on the mechanical behavior of the midpalatal suture

The midpalatal suture (MPS) corresponds to the tissue that joins the two maxillary bones. Understanding the mechanical behavior of this tissue is of particular interest to those patients who require orthodontic treatments such as Rapid Maxillary Expansion (RME). The objective of this research was to observe the influence of interdigitation and collagen fibers on the mechanical response of MPS. To this end, a finite element analysis in two-dimensional models of the bone-suture-bone interface was performed considering the characteristics of the MPS. The geometry of the suture was modeled with 4 different levels of interdigitation: null, moderate, scalloped and fractal. The influence of collagen fibers, aligned transversely along the suture, was considered by incorporating linked structures of the bone fronts. According to the results, the factor that has the greatest impact on the magnitude and distribution of stresses is the interdigitation degree. A higher level of interdigitation produces an increase in tissue stiffness and a lower influence of collagen fibers on the mechanical response of the tissue. Therefore, this research contributes to the understanding of the MPS biomechanics by providing information that may be useful to health staff when evaluating the feasibility of procedures such as RME.

Cranial suture morphometry and mechanical response to loading: 2D vs. 3D assumptions and characterization

Cranial sutures are complex soft tissue structures whose mechanics are often studied due to their link with bone growth in the skull. Researchers will often use a cross-sectional two-dimensional slice to define suture geometry when studying morphometry and/or mechanical response to loading. However, using a single cross section neglects the full suture complexity and may introduce significant errors when defining their form. This study aims to determine trends in suture path variability through skull thickness in a swine model and the implications of using a 'representative' cross section on mechanical modeling. To explore these questions, a mixture of quantitative analysis of computed tomography images and finite element models was used. The linear interdigitation and width of coronal and sagittal sutures were analyzed on offset transverse planes through the skull thickness. It was found that sagittal suture width and interdigitation were largely consistent through the skull thickness, whereas the coronal suture showed significant variation in both. The finite element study found that average values of displacement and strain were similar between the two-dimensionally variable and three-dimensionally variable models. Larger ranges and more complex distributions of strain were found in the three-dimensionally variable model. Outcomes of this study indicate that the appropriateness of using a representative cross section to describe suture morphometry and predict mechanical response should depend on specific research questions and goals. Two-dimensional approximations can be sufficient for less-interdigitated sutures and when bulk site mechanics are of interest, while taking the true three-dimensional geometry into account is necessary when considering spatial variability and local mechanical response.

Influence of interdigitation and expander type in the mechanical response of the midpalatal suture during maxillary expansion

BACKGROUND AND OBJECTIVE

The orthopedic Maxillary Expansion (ME) procedure is used for treating the transverse maxillary deficiency. This pathology consists in a smaller transverse dimension in the maxilla and leads to malocclusion. The treatment takes advantage of the existence of the midpalatal suture (MPS), which corresponds to the junction at the palatine bones of its horizontal portions. The technique employs a device, conventionally a palatal expander attached to the posterior teeth, to separate the two maxillary bones in the MPS. The objective of this study was to analyze, using the Finite Element Method, the biomechanical behavior of the MPS when an expansion is applied.

METHODS

A Computer Tomography image of the maxilla was reconstructed, the suture geometry was modeled with different interdigitation levels and types of hyrax devices. A total of 12 geometric models (three levels for interdigitation and four types of hyrax devices) were prepared and analyzed taking into account the chewing forces and the expansion displacement. For each case, maximum principal stresses on the maxilla (bone), and equivalent stresses on the expander device (stainless steel) were observed. In the MPS, maximum principal stresses and directional displacement were evaluated.

RESULTS

The results showed that the interdigitation does not have an important influence on the deformation behavior of the maxilla but it affects the stress distribution. In addition, the type of expander device and anchorage have a direct relationship with the treatment effectiveness; larger deformation in the expansion direction was obtained with skeletal when compared to dental anchorage.

CONCLUSIONS

A study that allows a better understanding of the oral biomechanics during the application of ME was presented. To our knowledge, it is the first study based on computational simulations that takes into account bone structures, like maxilla and part of the skull, to analyze the interdigitation influence on the MPS behavior when exposed to a ME.

A comparative finite element analysis of maxillary expansion with and without midpalatal suture viscoelasticity using a representative skeletal geometry

The goal of this investigation was to adapt and incorporate a nonlinear viscoelastic material model representative of the midpalatal suture’s viscoelastic nature into finite element analysis simulations of maxillary expansion treatment. Step-wise displacements were applied to a partial skull geometry to simulate treatment using an expansion screw appliance. Four simulation cases were considered for the midpalatal and intermaxillary sutures: 1. Neglecting suture tissue; 2. Linear elastic properties; 3. Viscoelastic properties; 4. A fused intermaxillary and viscoelastic midpalatal suture. Results from simulations indicated that removal of suture tissue and inclusion of viscoelastic properties resulted in the same maxillary displacement following 29 activations of 0.125 mm applied directly to the maxilla; however, assuming a fused intermaxillary suture significantly changed maxillary displacement patterns. Initial stress results within the suture complex were significantly influenced by the inclusion of suture viscoelasticity as compared to linear elastic properties. The presented study demonstrates successful incorporation of suture viscoelasticity into finite element analysis simulations of maxillary expansion treatment, and elucidates the appropriateness of various suture material property assumptions depending desired research outcomes.

Anatomical and mechanical properties of swine midpalatal suture in the premaxillary, maxillary, and palatine region

The mechanical properties of the midpalatal suture and their relationship with anatomical parameters are relevant for both tissue engineering and clinical treatments, such as in sutural distraction osteogenesis. Soft tissues were dissected from ten swine heads and the hard palate was sliced perpendicularly to the midpalatal suture. Thirteen specimens were collected from each animal and analysed with micro-computed tomography and 4-point-bending for sutural width (Sw), interdigitation (LII), obliteration (LOI), failure stress (σ _f ), elastic modulus (E), and bone mineral density (BMD). Values of the premaxillary, maxillary, and palatine region were compared with Kruskal-Wallis one-way ANOVA and Spearman's rank coefficient was used to analyse the correlation between parameters and their position along the suture (α = 0.05). LII had values of 1.0, 2.9, and 4.3, LOI had values of 0.0%, 2.5%, and 4.5%, and E had values of 12.5 MPa, 31.3 MPa, and 98.5 MPa, in the premaxillary, maxillary, and palatine region, respectively (p < 0.05). Failure stress and rigidity of the midpalatal suture increased from rostral to caudal, due to greater interdigitation and obliteration. These anatomical and mechanical findings contribute to characterise maxillary growth, and may help to understand its mechanical reaction during loading, and in virtual simulations.

Assessment of midpalatal suture ossification using cone-beam computed tomography

BACKGROUND AND OBJECTIVE

The degree of ossification of the midpalatal suture is an important factor in the selection of treatment procedure, especially in young individuals. Considering the discrepancies in the results of studies on the exact time of the closure of this suture, the present study was undertaken to evaluate ossification and morphology of the suture with the use of CBCT.

METHODS

In the present cross-sectional study, the CBCT images of the maxilla in 144 Iranian subjects (72 males, 72 females) with an age range of 10 to 70 years, referring to a private radiology center in Sari, Iran, were evaluated. The CBCT images were evaluated in the axial cross-sectional slice at 1 mm intervals to determine morphology and the maturation stage of the suture and its degree of ossification. The six developmental stages that were observed were as follows: stage A, a direct line without disturbances; stage B, a scalloped appearance in the suture; stage C, two parallel lines with a scalloped appearance that were connected at some points; stage CD, the anterior portion was similar to stage C, and the posterior region was similar to stage D; stage D, ossification only in the palatine bone; stage E, complete ossification of the suture. The degree of ossification of the suture was calculated with the use of the ratio of the length of the ossified segment to the entire length of the suture. Data were analyzed with Spearman's correlation test, Chi-squared test, t-test, ANOVA, Mann-Whitney U, and Kruskal-Wallis test. Intra-observer agreement was calculated with the use of weighted kappa coefficient. Data were analyzed with SPSS 17.

RESULTS

There was a strong correlation between the age groups and the developmental stages of the midpalatal suture in both genders (r=0.681, p<0.001). The ossification process occurred in the posterior to anterior direction in 98% of the cases. There was a significant relationship between aging and the degree of ossification (p<0.001); however, the difference was not significant between the two genders (p=0.193).

CONCLUSION

Although the rate of suture closure increased with aging, age was not a reliable factor alone to determine the developmental stage of the suture. Use of CBCT is necessary in all the patients to determine the degree of ossification and morphology of the midpalatal suture.

Viscoelastic response of the midpalatal suture during maxillary expansion treatment

OBJECTIVES

The viscoelastic response of the midpalatal suture during maxillary expansion treatment has been sparsely studied. The aim of our study was to use viscoelastic models to investigate the effect of appliance mechanics on sutural tissue.

MATERIALS AND METHODS

Four creep-strain models were utilized in predicting the midpalatal suture's response to a constant-force application during expansion treatment. The functional forms included a three-term separable, three-term inseparable, two-term inseparable, and single-term arrangement. The functions were then transformed into subsequent stress-relaxation representations to predict suture response as a result of 0.25, 0.20, 0.15, and 0.10 mm displacements. Finally, the single-term creep-strain representation was altered to simulate treatment decaying force during treatment. A force that decays 30 and 10% of an initially applied 0.98 N was considered for decaying functions over a 6-week period, and compared to strain resulting from a constant-force application.

RESULTS

This analysis illustrated that the decay in suture strain closely followed decay in force and that the path of decay had minimal impact on overall results. Also, it was found that a single screw activation would likely not cause suture soft tissue failure, even for a 0.25 mm displacement, and that suture stress rapidly decayed within minutes of activation.

CONCLUSION

Results from this study support the notion of maintaining a low-magnitude constant traction on the suture during treatment to avoid soft tissue failure and promote tissue remodeling.