Influences of implant condyle geometry on bone and screw strains in a temporomandibular implant

Custom design of a temporomandibular joint prosthesis: A kinematic approach evaluated by finite element analysis

STATEMENT OF PROBLEM

Designing temporomandibular joint (TMJ) prostheses that accurately replicate natural kinematic movement and stress distribution remains a challenge because standardized methods for determining the prosthetic kinematic center are lacking. Current designs often rely on empirical placements without considering individualized kinematic parameters, which can compromise functionality and longevity.

PURPOSE

The purpose of this study was to establish an optimal prosthetic kinematic center location for a custom TMJ prosthesis based on invariant TMJ anatomic landmarks to improve design efficiency, kinematic accuracy, and standardization in patient-specific applications.

MATERIAL AND METHODS

A woman diagnosed with TMJ dysfunction was selected for this study. A 3-dimensional model of her TMJ was reconstructed from computed tomography scans to create a custom prosthesis based on the Walter Lorenz model. Finite element analysis simulated mechanical responses to prosthetic kinematic center placements using anatomic references to guide positioning. Analyses included von Mises stress, minimum principal stress, and kinematic translation under set boundary conditions. The TMJ prosthesis was evaluated based on bone mechanical properties and constraints to replicate natural joint movement accurately.

RESULTS

The optimized prosthetic kinematic center location improved anteroposterior movement, effectively addressing translational deficiencies often caused by lateral pterygoid muscle resection. Maximum von Mises stress was recorded at 31 MPa, and minimum principal stress at -52.68 MPa, both within the material's tolerance, confirming structural stability. These results demonstrate consistent stress distribution and alignment with natural TMJ kinematics, suggesting potential improvements in prosthetic performance and patient comfort.

CONCLUSIONS

This prosthetic kinematic center-based design approach enhances kinematic precision and biomechanical function in TMJ prostheses, closely aligning prosthetic movement with natural condylar action. The method provides a standardized framework for individualized TMJ prosthesis design, potentially extending prosthesis longevity and functionality. Studies with larger sample sizes are recommended to verify the clinical applicability and long-term benefits of this approach.

Three-dimensional finite element analysis of the biomechanical properties of different material implants for replacing missing teeth

The purpose of this study was to analyze the biomechanical properties of implants made of different materials to replace missing teeth by using three-dimensional finite element analysis and provide a theoretic basis for clinical application. CBCT data was imported into the Mimics and 3-Matic to construct the three-dimensional finite element model of a missing tooth restored by an implant. Then, the model was imported into the Marc Mentat. Based on the variations of the implant materials (titanium, titanium-zirconia, zirconia and poly (ether-ether-ketone) (PEEK)) and bone densities (high and low), a total of eight models were created. An axial load of 150 N was applied to the crown of the implant to simulate the actual occlusal situation. Both the maximum values of stresses in the cortical bone and implant were observed in the Zr-low model. The maximum displacements of the implants were also within the normal range except for the PEEK models. The cancellous bone strains were mainly distributed in the apical area of the implant, and the maximum value (3225 μstrain) was found in PEEK-low model. Under the premise of the same implant material, the relevant data from various indices in low-density bone models were larger than that in high-density bone models. From the biomechanical point of view, zirconia, titanium and titanium-zirconia were all acceptable implant materials for replacing missing teeth and possessed excellent mechanical properties, while the application of PEEK material needs to be further optimized and modified.

Computational modelling of the fossa component fixation associated with alloplastic total temporomandibular joint replacements

The alloplastic total temporomandibular joint (TMJ) replacement is a complex surgical approach to end-stage TMJ disorders. The fixation of TMJ prostheses remains a critical issue for implant design and performance. For the fossa component, it is generally considered to use fixation screws to achieve tripod stability. However, the fossa may still come loose, and the mechanism remains unknown. A computational framework, consisting of a musculoskeletal model for calculating muscle and TMJ forces, and a finite element model for the fossa fixation simulation, was developed. A polyethylene (PE) fossa with stock prosthesis design was analyzed to predict contact pressures at the fixation interfaces, and stresses/strains in the fossa implant and bone during the static loading of normal chewing bite and maximum-force bite. The predicted maximum von Mises stresses were 33 MPa and 44 MPa for the bone, 13 MPa and 28 MPa for the PE fossa, and 131 MPa and 244 MPa for the screws, for the normal and maximum bites, respectively; the peak minimum principal strain was in the range of -2514 ∼ -3545 με for the bone. The results show that the sufficient initial mechanical strength of the fossa component fixation can be established using the screws in combination with bone support. The functional loads applied through the prosthetic TMJ bearing can be largely transferred to supporting bone without causing high level stresses. Tightening fixation screws with a pretension of 100 N can reduce transverse load to the screws and help prevent screw loosening. Further research is recommended to accurately quantify the transverse load and its influence on screw loosening during dynamic loading, and the frictional properties at the bone-implant interface.

Biomechanical analysis of a temporomandibular joint prosthesis for lateral pterygoid muscle reattachment

OBJECTIVE

To analyze the biomechanical properties of a novel temporomandibular joint (TMJ) prosthesis with an attachment area for the lateral pterygoid muscle (LPM).

STUDY DESIGN

Three prosthesis models were created and compared using finite element analysis for the displacement, stress, and strain when simulating the maximum bite force loading. A verification experiment and a compression test were conducted.

RESULTS

The displacement, stress, and strain of the novel TMJ prosthesis were larger than the solid condylar neck prosthesis and similar to the slotted condylar neck prosthesis, but the values were far less than the yield strength of titanium alloy. The maximum stress and strain in the novel TMJ prosthesis was concentrated in the inner and boundary areas of the LPM reattachment region beside the thinnest part of the prosthesis neck. The difference in the strain values measured using the verification test and those using finite element analysis was <20%. Compression testing of the novel TMJ prosthesis revealed that the mandible fractured when the force reached 588.97 N, whereas the prosthesis itself did not break or deform.

CONCLUSIONS

The mechanical distribution of the novel prosthesis was feasible under maximum bite force for potential clinical application.

Biomechanical simulation of temporomandibular joint replacement (TMJR) devices: a scoping review of the finite element method

The aim of this study was to perform a literature review on the use of finite element modeling (FEM) for the evaluation of the biomechanical behavior of temporomandibular joint replacement (TMJR) devices. An electronic search of online medical and scientific literature database was conducted using selected search terms. The search identified 307 studies, of which 19 were considered relevant to this study. Of the 19 selected studies, 10 (52.6%) investigated the influence of geometry and fixation methods, while two (10.5%) evaluated the behavior of artificial condyle-fossa structures. The TMJR devices assessed in these studies included TMJ Inc. (aka Christensen; 63.2%), Zimmer Biomet (15.7%), Stryker (10.5%), and a theoretical intramedullary condylar component (5.3%); 26.3% of the studies evaluated custom TMJR devices. Such studies provided important data on the distribution of strain and stress through TMJR structural components and surrounding bone by using different software systems and methods. The mean stress values were lower on a custom TMJR condyle-ramus component and the supporting bone than on the stock device. FEM proved to be an accurate and valuable biomechanical simulation tool for studying the current TMJR devices and should be considered a useful tool for the improvement and development of future joint replacement devices.

Biomechanical evaluation of Chinese customized three-dimensionally printed total temporomandibular joint prostheses: A finite element analysis

PURPOSE

This work aims to evaluate the biomechanical behavior of Chinese customized three-dimensional (3D)-printing total temporomandibular joint (TMJ) prostheses by means of finite element analysis.

METHODS

A 3D model was established by Mimics 18.0, then output in a stereolithography (STL) format. Two models were established to investigate the strain behaviors of an intact mandible and a one-side implanted mandible respectively. Hypermesh and LS-DYNA software were used to establish computer-aided engineering finite element models. The stress distribution on the custom-made total TMJ prosthesis and the strain distribution on the mandible were analyzed by loading maximal masticatory force.

RESULTS

The maximum stress on the surface of the ultra-high-molecular weight polyethylene was 19.61 MPa. With respect to the mandibular component, the maximum stress in the mandibular component was located at the anterior and posterior surface of the condylar neck, reaching 170.01 MPa. The peak von Mises stress was observed on the topside screw of the mandible, which was found to be 236.08 MPa. For the intact model, it was observed that the strain distribution was basically symmetrical. For the model with the prosthesis, the curve of strain distribution was fundamentally consistent with that in the intact mandible, except for the last 24 mm along the control line. A prominent strain decrease between 41.4% and 58.3% was observed in this area.

CONCLUSIONS

Chinese customized 3D-printed total TMJ prostheses exhibit uniform stress distribution without changing the behavior of the opposite side natural joint. Furthermore, the prostheses have a great potential to be improved in design and materials with a promising future.

A new condyle implant design concept for an alloplastic temporomandibular joint in bone resorption cases

The purpose of this article is to present and evaluate an innovative intramedullary implant concept developed for total alloplastic reconstruction in bone resorption cases. The main goal of this innovative concept is to avoid the main problems experienced with temporomandibular (TMJ) devices on the market, associated with bone fixation and changes in kinematics. A three-dimensional finite element model was developed based on computed tomography (CT) scan images, before and after implantation of the innovative implant concept. To validate the numerical model, a clean cadaveric condyle was instrumented with four rosettes and loaded before and after implantation with the innovative concept TMJ implant. The experimental results validate the numerical models comparing the intact and implanted condyles, as they present good correlation. They show that the most critical region is around rosette #1, with an increase in strains in the proximal region of the condyle of 140%. The maximum principal strain and stress generated with the implant is less than 2200 με and 75 MPa in the posterior region of the cortical bone. Shortly after insertion of this press-fit implant, stress and strain results appear to be within the normal limits and show some similarities with the intact condyle. If these responses do not change over time, the screw fixation used at present could be avoided or replaced. This solution reduces bone resection and lessens surgical damage to the muscles.

Experimental and numerical predictions of Biomet(®) alloplastic implant in a cadaveric mandibular ramus

The purpose of this study was to evaluate experimentally the behaviors of an intact and an implanted cadaveric ramus, to compare and analyze load mechanism transfers between two validated finite element models. The intact, clean cadaveric ramus was instrumented with four rosettes and loaded with the temporal reaction load. Next, the Biomet microfixation implant was fixed to the same cadaveric mandibular ramus after resection. The mandibular ramus was reconstructed from computed tomographic images, and two finite element models were developed. The experimental results for the mandibular ramus present a linear behavior of up to 300 N load in the condyle, with the Biomet implant influencing strain distribution; the maximum influence was near the implant (rosette #4) and approximately 59%. The experimental and numerical results present a good correlation, with the best correlation in the intact ramus condition, where R(2) reaches 0.935 and the slope of the regression line is 1.045. The numerical results show that screw #1 is the most critical, with maximum principal strains in the bone around 21,000 με, indicating possible bone fatigue and fracture. The experimental results show that the Biomet temporomandibular joint mandibular ramus implant changes the load transfer in the ramus, compared to the intact ramus, with its strain-shielding effect. The numerical results demonstrate that only three screws are important for the Biomet TMJ fixation. These results indicate that including two proximal screws should reduce stresses in the first screws and strains in the bone.

Christensen vs Biomet Microfixation alloplastic TMJ implant: Are there improvements? A numerical study

The objective of this study was to compare the load transfer mechanism and behavior of two total temporomandibular joint (TMJ) prostheses: Biomet and Christensen TMJ models were simulated. Computed tomography (CT) images from a specific patient were used to generate two models for use in simulation of implantation for the total temporomandibular prostheses. Three finite element models were created in all. One considered the intact temporomandibular joint and two received a temporomandibular implant. In the simulation we considered the five most important muscles acting on the mandible and incisor teeth support. The Christensen model reduced strain in the opposite condyle by around 50% while increasing strain in the implanted condyle. The changes in the posterior side of the implanted condyle present an increase of five times the minimum principal strain, suggesting some bone fatigue. With the Biomet implant, the reduction in strain in the implanted condyle on the posterior side was around 100%, suggesting the possibility of some bone loss proximally near the resection plane. Based on our results, we conclude that in both models the implants influence the behavior of the mandible by improving the symmetry of the mandible and strain distribution. The Biomet implant modifies the behavior of the mandible slightly and presents some improvements over the Christensen TMJ model in strain distribution and tensions in the opposite intact disc similar to the non-implanted situation.

Prognosis of implant longevity in terms of annual bone loss: a methodological finite element study

Dental implant failure is mainly the consequence of bone loss at peri-implant area. It usually begins in crestal bone. Due to this gradual loss, implants cannot withstand functional force without bone overload, which promotes complementary loss. As a result, implant lifetime is significantly decreased. To estimate implant success prognosis, taking into account 0.2 mm annual bone loss for successful implantation, ultimate occlusal forces for the range of commercial cylindrical implants were determined and changes of the force value for each implant due to gradual bone loss were studied. For this purpose, finite element method was applied and von Mises stresses in implant-bone interface under 118.2 N functional occlusal load were calculated. Geometrical models of mandible segment, which corresponded to Type II bone (Lekholm & Zarb classification), were generated from computed tomography images. The models were analyzed both for completely and partially osseointegrated implants (bone loss simulation). The ultimate value of occlusal load, which generated 100 MPa von Mises stresses in the critical point of adjacent bone, was calculated for each implant. To estimate longevity of implants, ultimate occlusal loads were correlated with an experimentally measured 275 N occlusal load (Mericske-Stern & Zarb). These findings generally provide prediction of dental implants success.

Mechanotransduction in bone: Intervening in health and disease

Mechanotransduction has been proven to be one of the most significant variables in bone remodeling and its alterations have been shown to result in a variety of bone diseases. Osteoporosis, Paget’s disease, orthopedic disorders, osteopetrosis as well as hyperparathyroidism and hyperthyroidism all comprise conditions which have been linked with deregulated bone remodeling. Although the significance of mechanotransduction for bone health and disease is unquestionable, the mechanisms behind this important process have not been fully understood. This review will discuss the molecules that have been found to be implicated in mechanotransduction, as well as the mechanisms underlying bone health and disease, emphasizing on what is already known as well as new molecules potentially taking part in conveying mechanical signals from the cell surface towards the nucleus under physiological or pathologic conditions. It will also focus on the model systems currently used in mechanotransduction studies, like osteoblast-like cells as well as three-dimensional constructs and their applications among others. It will also examine the role of mechanostimulatory techniques in preventing and treating bone degenerative diseases and consider their applications in osteoporosis, craniofacial development, skeletal deregulations, fracture treatment, neurologic injuries following stroke or spinal cord injury, dentistry, hearing problems and bone implant integration in the near future.