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Daqiq O, Roossien CC, Wubs FW, van Minnen B. Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing. Sci Rep 2024; 14:11795. [PMID: 38782942 PMCID: PMC11116419 DOI: 10.1038/s41598-024-62011-4] [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: 01/26/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
The clinical finite element analysis (FEA) application in maxillofacial surgery for mandibular fracture is limited due to the lack of a validated FEA model. Therefore, this study aims to develop a validated FEA model for mandibular fracture treatment, by assessing non-comminuted mandibular fracture fixation. FEA models were created for mandibles with single simple symphysis, parasymphysis, and angle fractures; fixated with 2.0 mm 4-hole titanium miniplates located at three different configurations with clinically known differences in stability, namely: superior border, inferior border, and two plate combinations. The FEA models were validated with series of Synbone polymeric mandible mechanical testing (PMMT) using a mechanical test bench with an identical test set-up. The first outcome was that the current understanding of stable simple mandibular fracture fixation was reproducible in both the FEA and PMMT. Optimal fracture stability was achieved with the two plate combination, followed by superior border, and then inferior border plating. Second, the FEA and the PMMT findings were consistent and comparable (a total displacement difference of 1.13 mm). In conclusion, the FEA and the PMMT outcomes were similar, and hence suitable for simple mandibular fracture treatment analyses. The FEA model can possibly be applied for non-routine complex mandibular fracture management.
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Affiliation(s)
- Omid Daqiq
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Charlotte Christina Roossien
- Engineering and Technology Institute Groningen, Department of Bio-Inspired MEMS and Biomedical Devices, University of Groningen, Nijenborgh 4, 9747 AG, Groningen, The Netherlands
| | - Frederik Wilhelm Wubs
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Nijenborgh 9, 9747 AG, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Ben Achour A, Apfeld F, Lauer G, Bräuer C, Leonhardt H, Franke A, Lipphaus A, Teicher U, Witzel U, Schröder TA. Development of a test bench for biomechanical simulation-a preliminary study of mandibular forces. Front Bioeng Biotechnol 2024; 12:1335159. [PMID: 38468690 PMCID: PMC10925755 DOI: 10.3389/fbioe.2024.1335159] [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: 11/08/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose: The aim of this study is to develop a test bench, which integrates different complexity levels and enables in that way a flexible and dynamic testing for mid and long term intervals as well as testing of maximum loads till implant failure of different osteosynthesis systems on the mandible. Material and Methods: For this purpose, an analysis of the state of the art regarding existing test benches was combined with interviews of clinical experts to acquire a list of requirements. Based on these requirements a design for a modular test bench was developed. During the implementation of the test stand, functional tests were continuously carried out and improvements made. Depending on the level of complexity, the test bench can be used either as an incorporated variant or as a standalone solution. In order to verify the performance and the degree of fulfilment of the requirements of these two variants of the test bench, preliminary studies were carried out for all levels of complexity. In these preliminary studies, commercially available osteosynthesis and reconstruction plates were investigated for their biomechanical behaviour and compared with data from the literature. Results: In total, fourteen test runs were performed for the different levels of complexity. Firstly, five test runs were executed to test the simplified load scenario in the incorporated variant of the test bench. High forces could be transmitted without failure of the miniplates. Secondly a quasi-static test scenario was examined using the incorporated variant with simplified load insertion. Five experiments with a number of cycles between 40,896 and 100,000 cycles were carried out. In one case the quasi-static testing resulted in a fracture of the tested reconstruction plate with a failure mode similar to the clinical observations of failure. The last four test runs were carried out using the standalone variant of the test bench simulating complex load patterns via the insertion of forces through imitated muscles. During the test runs joint forces were measured and the amplitude and vector of the resulting joint forces were calculated for both temporomandibular joints. Differences in the force transmission depending on the implant system in comparison to the zero sample could be observed. Conclusion: The presented modular test bench showed to be applicable for examination of the biomechanical behavior of the mandible. It is characterized by the adjustability of the complexity regarding the load patterns and enables the subsequent integration of further sensor technologies. Follow-up studies are necessary to further qualify and optimize the test bench.
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Affiliation(s)
- Anas Ben Achour
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Florian Apfeld
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
- Biomechanics Research Group, Chair of Product Development, Faculty of Mechanical Engineering, Ruhr University Bochum, Bochum, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Christian Bräuer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University of Rostock, Rostock, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Andreas Lipphaus
- Biomechanics Research Group, Chair of Product Development, Faculty of Mechanical Engineering, Ruhr University Bochum, Bochum, Germany
| | - Uwe Teicher
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Ulrich Witzel
- Biomechanics Research Group, Chair of Product Development, Faculty of Mechanical Engineering, Ruhr University Bochum, Bochum, Germany
| | - Tom Alexander Schröder
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
- Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden, Dresden, Germany
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Aftabi H, Zaraska K, Eghbal A, McGregor S, Prisman E, Hodgson A, Fels S. Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery. Comput Biol Med 2024; 169:107887. [PMID: 38160502 DOI: 10.1016/j.compbiomed.2023.107887] [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: 07/15/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery. These models offer cost-effective and patient-specific treatment tailored to the needs of individuals. To underscore the significance of biomechanical modeling, we conducted a review of 66 studies that utilized computational models in the biomechanical analysis of mandibular reconstruction surgery. The majority of these studies employed finite element method (FEM) in their approach; therefore, a detailed investigation of FEM has also been provided. Additionally, we categorized these studies based on the main components analyzed, including bone flaps, plates/screws, and prostheses, as well as their design and material composition.
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Affiliation(s)
- Hamidreza Aftabi
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada.
| | - Katrina Zaraska
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Atabak Eghbal
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sophie McGregor
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Eitan Prisman
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Antony Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sidney Fels
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
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Demir E, Yalçın G, Kalaycı A. Finite element analysis of biplanar customized reconstruction plates for lateral and central segmental defects of mandible. Comput Methods Biomech Biomed Engin 2024; 27:489-497. [PMID: 36920278 DOI: 10.1080/10255842.2023.2188105] [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: 09/09/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
The purpose of this study is to compare biplanar custom mandibular reconstruction plates with locking reconstruction plates in bridging central and lateral mandibular segmental defects by using the finite element method. Central and two different types of lateral segmental defects were created on mandibular model that was generated from computed tomography of a male patient. Segmental defects were fixed with conventional locking reconstruction plates and two different custom designed plates with caudobuccal and dorsobuccal cover. Stress formation on hardware and screws, strain on bone under masticatory simulation were evaluated with a finite element model. The stress values on plate and screws were higher in conventional reconstruction plate than custom plates. Simulations of central segmental defect revealed maximum von Mises stresses of 643.62 MPa and 101.83 MPa in conventional reconstruction plate and biplanar plate, respectively. Biplanar plates revealed slightly higher von Mises stresses than extended surfaced biplanar plates. The screws close to resection area were exposed to higher stress than farther screws for whole groups. In conventional reconstruction plate, the maximum von Mises stress values of fixation screws were 268.66 MPa and 95 MPa for central segmental defect and lateral segmental defect, respectively. The study reveals that the biplanar custom reconstruction plates had a favourable effect on stress distribution and can enhance function and aesthetics as supporting mandible and flaps from two different planes.
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Affiliation(s)
- Esin Demir
- Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey
| | - Gökhan Yalçın
- Department of Mechanics of Materials, Selçuk University Faculty of Technology, Konya, Turkey
| | - Abdullah Kalaycı
- Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey
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Zhong S, Shi Q, Van Dessel J, Gu Y, Lübbers HT, Yang S, Sun Y, Politis C. Biomechanical feasibility of non-locking system in patient-specific mandibular reconstruction using fibular free flaps. J Mech Behav Biomed Mater 2023; 148:106197. [PMID: 37875041 DOI: 10.1016/j.jmbbm.2023.106197] [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: 09/01/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
Mandibular reconstruction with free fibular flaps is frequently used to restore segmental defects. The osteosythesis, including locking and non-locking plate/screw systems, is essential to the mandibular reconstruction. Compared with the non-locking system that requires good adaption between plate and bone, the locking system appears to present a better performance by locking the plate to fixation screws. However, it also brings about limitations on screw options, a higher risk of screw failure, and difficulties in screw placement. Furthermore, its superiority is undermined by the advancing of patient-specific implant design and additive manufacturing. A customized plate can be designed and fabricated to accurately match the mandibular contour for patient-specific mandibular reconstruction. Consequently, the non-locking system seems more practicable with such personalized plates, and its biomechanical feasibility ought to be estimated. Finite element analyses of mandibular reconstruction assemblies were conducted for four most common segmental mandibular reconstructions regarding locking and non-locking systems under incisal biting and right molars clenching, during which the influencing factor of muscles' capacity was introduced to simulate the practical loadings after mandibular resection and reconstruction surgeries. Much higher, somewhat lower, and similar maximum von Mises stresses are separately manifested by the patient-specific mandibular reconstruction plate (PSMRP), fixation screws, and reconstructed mandible with the non-locking system than those with the locking system. Equivalent maximum displacements are identified between PSMRPs, fixation screws, and reconstructed mandibles with the non-locking and locking system in all four reconstruction types during two masticatory tasks. Parallel maximum and minimum principal strain distributions are shared by the reconstructed mandibles with the non-locking and locking system in four mandibular reconstructions during both occlusions. Conclusively, it is feasible to use the non-locking system in case of patient-specific mandibular reconstruction with fibular free flaps based on the adequate safety, comparable stability, and analogous mechanobiology it presents compared with the locking system in a more manufacturable and economical way.
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Affiliation(s)
- Shengping Zhong
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Qimin Shi
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium; Yantai Research Institute, Harbin Engineering University, Qingdao Avenue 1, 264000, Yantai, PR China
| | - Jeroen Van Dessel
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Yifei Gu
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium; Department of Dentistry, Dushu Lake Hospital Affiliated to Soochow University, Chongwen Road 9, 215000, Suzhou, PR China
| | - Heinz-Theo Lübbers
- Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, Zurich, CH-8091, Switzerland
| | - Shoufeng Yang
- Yantai Research Institute, Harbin Engineering University, Qingdao Avenue 1, 264000, Yantai, PR China.
| | - Yi Sun
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Constantinus Politis
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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van Kootwijk A, Jonker BP, Wolvius EB, Saldivar MC, Leeflang MA, Zhou J, Tümer N, Mirzaali MJ, Zadpoor AA. Biomechanical evaluation of additively manufactured patient-specific mandibular cage implants designed with a semi-automated workflow: A cadaveric and retrospective case study. J Mech Behav Biomed Mater 2023; 146:106097. [PMID: 37678107 DOI: 10.1016/j.jmbbm.2023.106097] [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: 07/06/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Mandibular reconstruction using patient-specific cage implants is a promising alternative to the vascularized free flap reconstruction for nonirradiated patients with adequate soft tissues, or for patients whose clinical condition is not conducive to microsurgical reconstruction. This study aimed to assess the biomechanical performance of 3D printed patient-specific cage implants designed with a semi-automated workflow in a combined cadaveric and retrospective case series study. METHODS We designed cage implants for two human cadaveric mandibles using our previously developed design workflow. The biomechanical performance of the implants was assessed with the finite element analysis (FEA) and quasi-static biomechanical testing. Digital image correlation (DIC) was used to measure the full-field strains and validate the FE models by comparing the distribution of maximum principal strains within the bone. The retrospective study of a case series involved three patients, each of whom was treated with a cage implant of similar design. The biomechanical performance of these implants was evaluated using the experimentally validated FEA under the scenarios of both mandibular union and nonunion. RESULTS No implant or screw failure was observed prior to contralateral bone fracture during the quasi-static testing of both cadaveric mandibles. The FEA and DIC strain contour plots indicated a strong linear correlation (r = 0.92) and a low standard error (SE=29.32με), with computational models yielding higher strain values by a factor of 2.7. The overall stresses acting on the case series' implants stayed well below the yield strength of additively manufactured (AM) commercially pure titanium, when simulated under highly strenuous chewing conditions. Simulating a full union between the graft and remnant mandible yielded a substantial reduction (72.7±1.5%) in local peak stresses within the implants as compared to a non-bonded graft. CONCLUSIONS This study shows the suitability of the developed semi-automated workflow in designing patient-specific cage implants with satisfactory mechanical functioning under demanding chewing conditions. The proposed workflow can aid clinical engineers in creating reconstruction systems and streamlining pre-surgical planning. Nevertheless, more research is still needed to evaluate the osteogenic potential of bone graft insertions.
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Affiliation(s)
- A van Kootwijk
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - B P Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - M Cruz Saldivar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M A Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - J Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - N Tümer
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands.
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
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Maintz M, Msallem B, de Wild M, Seiler D, Herrmann S, Feiler S, Sharma N, Dalcanale F, Cattin P, Thieringer FM. Parameter optimization in a finite element mandibular fracture fixation model using the design of experiments approach. J Mech Behav Biomed Mater 2023; 144:105948. [PMID: 37348171 DOI: 10.1016/j.jmbbm.2023.105948] [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: 04/12/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
Only a few mandibular bone finite element (FE) models have been validated in literature, making it difficult to assess the credibility of the models. In a comparative study between FE models and biomechanical experiments using a synthetic polyamide 12 (PA12) mandible model, we investigate how material properties and boundary conditions affect the FE model's accuracy using the design of experiments approach. Multiple FE parameters, such as contact definitions and the materials' elastic and plastic deformation characteristics, were systematically analyzed for an intact mandibular model and transferred to the fracture fixation model. In a second step, the contact definitions for the titanium screw and implant (S-I), implant and PA12 mandible (I-M), and interfragmentary (IF) PA12 segments were optimized. Comparing simulated deformations (from 0 to -5 mm) and reaction forces (from 10 to 1'415 N) with experimental results showed a strong sensitivity to FE mechanical properties and contact definitions. The results suggest that using the bonded definition for the screw-implant contact of the fracture plate is ineffective. The contact friction parameter set with the highest agreement was identified: titanium screw and implant μ = 0.2, implant and PA12 mandible μ = 0.2, interfragmentary PA12 mandible μ = 0.1. The simulated reaction force (RMSE = 26.60 N) and surface displacement data (RMSE = 0.19 mm) of the FE analysis showed a strong agreement with the experimental biomechanical data. The results were generated through parameter optimization which means that our findings need to be validated in the event of a new dataset with deviating anatomy. Conclusively, the predictive capability of the FE model can be improved by FE model calibration through experimental testing. Validated preoperative quasi-static FE analysis could allow engineers and surgeons to accurately estimate how the implant's choice and placement suit the patient's biomechanical needs.
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Affiliation(s)
- Michaela Maintz
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland; Institute for Medical Engineering and Medical Informatics IM(2), University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland.
| | - Bilal Msallem
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Michael de Wild
- Institute for Medical Engineering and Medical Informatics IM(2), University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland
| | - Daniel Seiler
- Institute for Medical Engineering and Medical Informatics IM(2), University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland
| | | | - Stefanie Feiler
- Group of Applied Mathematics in Life Sciences, Initial and Continuing Education, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland, AICOS Technologies Ltd., Allschwil, Switzerland
| | - Neha Sharma
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Federico Dalcanale
- Institute for Medical Engineering and Medical Informatics IM(2), University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland
| | - Philippe Cattin
- Center of Medical Image Analysis and Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Allschwil, Basel, Switzerland
| | - Florian Markus Thieringer
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
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Patient-specific miniplates versus patient-specific reconstruction plate: A biomechanical comparison with 3D-printed plates in mandibular reconstruction. J Mech Behav Biomed Mater 2023; 140:105742. [PMID: 36857975 DOI: 10.1016/j.jmbbm.2023.105742] [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: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Patient-specific 3D-printed miniplates for free flap fixation in mandibular reconstruction were recently associated with enhanced osseous union. Higher mechanical strains resulting from these plates are discussed as reasons, but biomechanical studies are missing. This study aims to examine, whether patient-specific 3D-printed miniplates provide an increased interosteotomy movement (IOM) and lower stiffness compared with reconstruction plates. METHODS Polyurethane (PU) mandible and fibula models (Synbone AG, Malans, Schweiz) were used to simulate mandibular reconstruction with a one segment fibula flap equivalent. Osteosynthesis was performed using either four patient-specific 3D-printed miniplates (3D-Mini) or one patient-specific 3D-printed reconstruction plate (3D-Recon). Mastication was simulated using cyclic dynamic loading with increasing loads until material failure or a maximum load of 1000 N. Continuous IOM recording was carried out using a 3D optical tracking system (ARAMIS, Carl Zeiss GOM Metrology, Braunschweig, Germany). FINDINGS The averaged stiffness at a load of 100-300 N load did not differ between the groups (p = 0.296). There was a faster 1.0 mm vertical displacement in the 3D-Mini group (26 376 ± 14 190 cycles versus 44 817 ± 30 430 cycles, p = 0.018). The IOM were higher with miniplate fixation in the distal gap (p = 0.040). In the mesial gap, there was no significant difference between the groups (p = 0.160). INTERPRETATION Fixation with patient-specific 3D-printed miniplates results in higher mechanical strains. Lower rates of pseudarthrosis, as seen in clinical studies, might be caused by this phenomenon. Surgeons should evaluate the primary use of 3D-printed miniplates in mandibular reconstruction due to advantages of intraoral plate removal alongside safe osteosynthesis.
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Ruf P, Orassi V, Fischer H, Steffen C, Duda GN, Heiland M, Kreutzer K, Checa S, Rendenbach C. Towards mechanobiologically optimized mandible reconstruction: CAD/CAM miniplates vs. reconstruction plates for fibula free flap fixation: A finite element study. Front Bioeng Biotechnol 2022; 10:1005022. [PMID: 36466355 PMCID: PMC9712730 DOI: 10.3389/fbioe.2022.1005022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/13/2022] [Indexed: 07/28/2023] Open
Abstract
Due to their advantages in applicability, patient-specific (CAD/CAM) reconstruction plates are increasingly used in fibula free flap mandible reconstruction. In addition, recently, CAD/CAM miniplates, with further advantages in postoperative management, have been introduced. However, biomechanical conditions induced by CAD/CAM systems remain partially unknown. This study aimed to evaluate the primary fixation stability of CAD/CAM fixators. For a patient-specific scenario, the biomechanical conditions induced in a one segmental fibula free flap stabilized using either a CAD/CAM reconstruction plate or CAD/CAM miniplates were determined using finite element analysis. The main output parameters were the strains between intersegmental bone surfaces and stresses in the fixation systems due to different biting scenarios. CAD/CAM miniplates resulted in higher mechanical strains in the mesial interosseous gap, whereas CAD/CAM reconstruction plate fixation resulted in higher strains in the distal interosseous gap. For all investigated fixation systems, stresses in the fixation systems were below the material yield stress and thus material failure would not be expected. While the use of CAD/CAM miniplates resulted in strain values considered adequate to promote bone healing in the mesial interosseous gap, in the distal interosseous gap CAD/CAM reconstruction plate fixation might result in more beneficial tissue straining. A mechanical failure of the fixation systems would not be expected.
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Affiliation(s)
- Philipp Ruf
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Vincenzo Orassi
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Claudius Steffen
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sara Checa
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Rothweiler RM, Zankovic S, Brandenburg LS, Fuessinger MA, Gross C, Voss PJ, Metzger MC. Feasibility of Implant Strain Measurement for Assessing Mandible Bone Regeneration. MICROMACHINES 2022; 13:1602. [PMID: 36295956 PMCID: PMC9610677 DOI: 10.3390/mi13101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Nonunion is one of the most dreaded complications after operative treatment of mandible fractures or after mandible reconstruction using vascularized and non-vascularized bone grafts. Often diagnosis is made at advanced stage of disease when pain or complications occur. Devices that monitor fracture healing and bone regeneration continuously are therefore urgently needed in the craniomaxillofacial area. One promising approach is the strain measurement of plates. An advanced prototype of an implantable strain measurement device was tested after fixation to a locking mandible reconstruction plate in multiple compression experiments to investigate the potential functionality of strain measurement in the mandibular region. Compression experiments show that strain measurement devices work well under experimental conditions in the mandibular angle and detect plate deformation in a reliable way. For monitoring in the mandibular body, the device used in its current configuration was not suitable. Implant strain measurement of reconstruction plates is a promising methodical approach for permanent monitoring of bone regeneration and fracture healing in the mandible. The method helps to avoid or detect complications at an early point in time after operative treatment.
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Affiliation(s)
- René Marcel Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sergej Zankovic
- G.E.R.N. Center for Tissue Replacement, Regeneration & Neogenesis, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79108 Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc-Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc-Christian Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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11
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Validation of Experimental and Finite Element Biomechanical Evaluation of Human Cadaveric Mandibles. LUBRICANTS 2022. [DOI: 10.3390/lubricants10080169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: Biomechanical analysis of human mandible is important not only to understand mechanical behavior and structural properties, but also to diagnose and develop treatment options for mandibular disorders. Therefore, the objective of this research was to generate analytical and experimental data on mandibles, construct custom 3D models, and compare the analytically derived maximum strains with strain gage data in five areas of interest for each mandible. Methods: We investigated the surface strains in the cadaveric human mandibles under different configurations of cyclic compressive loads in an experimental setting and compared these experimental strain data with results derived from computational finite element analysis (FEA), accurately replicating the experiments. Strains on the surface of each mandible were measured with strain gauges, and subsequently a subject-specific finite element (FE) volume mesh was generated from computed tomography (CT) scans of each mandible. Strain patterns of each mandible were derived from the FEA simulating the experimental setup and matched with the experimental data. Findings: Analysis of experimental data showed that strain as measured at the condylar locations was significantly different from those at other locations on the mandible, and that the sex and age of the subject did not have a significant correlation with the strain. Comparing the FE numerical predictions with the experimental data, we found a good statistical correlation and statistical agreement between in-vitro measurements and FE results. Interpretation: The study demonstrates that our methodology of generating subject-specific FE models is a valid and accurate, non-invasive method to evaluate the complex biomechanical behavior of human mandibles.
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12
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Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction. J Clin Med 2022; 11:jcm11123308. [PMID: 35743379 PMCID: PMC9224531 DOI: 10.3390/jcm11123308] [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: 05/20/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 12/10/2022] Open
Abstract
Mandible defects are conventionally reconstructed using titanium plates. However, titanium causes metallic artifacts which impair radiological imaging. This study aims at evaluating mechanical fatigue of radiolucent fiber-reinforced polyetheretherketone (f-PEEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyphenylsulfone (PPSU) polymer plates for mandible reconstruction. A total of 30 plates (titanium [n = 6], f-PEEK [n = 6], PEEK [n = 6], PEKK [n = 6], PPSU [n = 6]) were implanted in synthetic mandibulectomized polyurethane mandibles. Servo-pneumatic mechanical testing with cyclic application of 30−300 N at 3 Hz was conducted. Bite forces were 70% on the unresected and 30% on the resected side. Total number of cycles was set to 250,000. Testing was aborted in case of plate or screw failure. Axial load to failure was tested with a speed of 1 mm/s. Kruskal−Wallis and Dunn’s post hoc tests were used. Titanium, f-PEEK, and PEEK showed no failure in fatigue testing and PPSU (p < 0.001) failed against titanium, f-PEEK, PEEK, and PEKK. Titanium allowed the highest load to failure compared to f-PEEK (p = 0.049), PEEK (p = 0.008), PEKK (p < 0.001), and PPSU (p = 0.007). f-PEEK, PEEK, and PEKK withstood expected physiological bite force. Although titanium plates provided the highest fatigue strength, f-PEEK and PEEK plates showed no failure over 250,000 chewing cycles indicating sufficient mechanical strength for mandible reconstruction.
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van Kootwijk A, Moosabeiki V, Saldivar MC, Pahlavani H, Leeflang MA, Kazemivand Niar S, Pellikaan P, Jonker BP, Ahmadi SM, Wolvius EB, Tümer N, Mirzaali MJ, Zhou J, Zadpoor AA. Semi-automated digital workflow to design and evaluate patient-specific mandibular reconstruction implants. J Mech Behav Biomed Mater 2022; 132:105291. [PMID: 35660552 DOI: 10.1016/j.jmbbm.2022.105291] [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: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/31/2022]
Abstract
The reconstruction of large mandibular defects with optimal aesthetic and functional outcomes remains a major challenge for maxillofacial surgeons. The aim of this study was to design patient-specific mandibular reconstruction implants through a semi-automated digital workflow and to assess the effects of topology optimization on the biomechanical performance of the designed implants. By using the proposed workflow, a fully porous implant (LA-implant) and a topology-optimized implant (TO-implant) both made of Ti-6Al-4V ELI were designed and additively manufactured using selective laser melting. The mechanical performance of the implants was predicted by performing finite element analysis (FEA) and was experimentally assessed by conducting quasi-static and cyclic biomechanical tests. Digital image correlation (DIC) was used to validate the FE model by comparing the principal strains predicted by the FEM model with the measured distribution of the same type of strain. The numerical predictions were in good agreement with the DIC measurements and the predicted locations of specimen failure matched the actual ones. No statistically significant differences (p < 0.05) in the mean stiffness, mean ultimate load, or mean ultimate displacement were detected between the LA- and TO-implant groups. No implant failures were observed during quasi-static or cyclic testing under masticatory loads that were substantially higher (>1000 N) than the average maximum biting force of healthy individuals. Given its relatively lower weight (16.5%), higher porosity (17.4%), and much shorter design time (633.3%), the LA-implant is preferred for clinical application. This study clearly demonstrates the capability of the proposed workflow to develop patient-specific implants with high precision and superior mechanical performance, which will greatly facilitate cost- and time-effective pre-surgical planning and is expected to improve the surgical outcome.
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Affiliation(s)
- A van Kootwijk
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - V Moosabeiki
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands.
| | - M Cruz Saldivar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - H Pahlavani
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M A Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - S Kazemivand Niar
- Department of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - P Pellikaan
- Amber Implants BV, Prinses Margrietplantsoen 33, 2595 AM, The Hague, the Netherlands
| | - B P Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - S M Ahmadi
- Amber Implants BV, Prinses Margrietplantsoen 33, 2595 AM, The Hague, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GE, Rotterdam, the Netherlands
| | - N Tümer
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - J Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD, Delft, the Netherlands
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Long-Term Follow-Up of Dogs and Cats after Stabilization of Thoracolumbar Instability Using 2-0 UniLock Implants. Vet Med Int 2022; 2022:5112274. [PMID: 35521052 PMCID: PMC9064500 DOI: 10.1155/2022/5112274] [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: 12/07/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Traumatic vertebral fracture or luxation often results in spinal instability requiring surgical stabilization. This study describes the long-term outcome of spinal stabilization using a unilateral 5-hole 2-0 UniLock implant in eight dogs and two cats with trauma-induced thoracolumbar vertebral luxation/subluxation and presumed instability, as assessed by a combination of preoperative radiographs and MRI using a 3-compartment method. The UniLock plate was secured with four monocortical locking screws in adjacent vertebral bodies. Additional pins and facet screws were used in several patients. Postoperative radiographs and MRI studies showed restoration of the main spinal axis in all patients and satisfactory implantation of the screws in the vertebral bodies, with no intrusion in the vertebral canal or in the adjacent intervertebral disc spaces. Neurological status improved in nine patients six weeks postoperatively. Partial implant failure was detected in three patients with no long-term consequences. After 12 months, seven patients reached full recovery with no neurological deficit, two patients were euthanized (including one owing to an unrelated condition), and one remained paraparetic. The results of this study demonstrate that using a 2-0 UniLock implant to stabilize the thoracolumbar spine results in satisfactory long-term recovery in most dogs and cats with traumatic spinal luxation/subluxation and presumed instability. Complications may occur but do not require revision surgery and do not affect clinical outcomes.
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15
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Lin CL, Wang YT, Chang CM, Wu CH, Tsai WH. Design Criteria for Patient-specific Mandibular Continuity Defect Reconstructed Implant with Lightweight Structure using Weighted Topology Optimization and Validated with Biomechanical Fatigue Testing. Int J Bioprint 2022; 8:437. [PMID: 35187275 PMCID: PMC8852200 DOI: 10.18063/ijb.v8i1.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
This study developed design criterion for patient-specific reconstructed implants with appearance consideration and structural optimization of various mandibular continuity defects. The different mandible continuity defects include C (from left to right canines), B (from 1st premolar to 3rd molar), and A (from 3rd molar to ramus) segments defined based on the mandible image. The finite element (FE) analysis and weighted topology optimization methods were combined to design internal support beam structures within different reconstructed implants with corresponding occlusal conditions. Five continuity mandibular defects (single B/C/A+B and combination of B+C and B+C+B segments) were restored using additive manufacturing (AM) reconstructed implant and bone plate to confirm reasonable design criterion through biomechanical fatigue testing. The worst mandible strength was filtered based on the material mechanics and results from segmental bone length, thickness, and height statistics from the established database containing mandible images of 105 patients. The weighted optimization analysis results indicated that the sizes and positions of internal supporting beams within the reconstructed C, B, and A+B implants can be defined parametrically through corresponding segmental bone length, width, and height. The FE analysis found that the weight variation percentage between the parametric designed implants and original core solid implants in the C, B, and A+B was reduced by 54.3%, 63.7%, and 69.7%, respectively. The maximum stress values of the reconstructed implant and the remaining bone were not obviously reduced but the stress values were far lower than the material ultimate strength. The biomechanical fatigue testing indicated that all cases using the AM reconstructed implant could pass the 250,000 dynamic load. However, condyle head, bone plate fracture, and bone screw loosening could be found in cases using bone plates. This study developed a design criterion for patient-specific reconstructed implants for various mandibular continuity defects applicable for AM to further clinical use.
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Affiliation(s)
- Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Tzu Wang
- Department of Mechanical and Electro-Mechanical Engineering, TamKang University, New Taipei City, Taiwan
| | - Chun-Ming Chang
- National Applied Research Laboratories, Instrument Technology Research Center, Hsinchu, Taiwan
| | - Cheng-Hsien Wu
- Department of Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, School of Dentistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Heng Tsai
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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16
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Khatib B, Couey M, Patel A, Cheng A, Bell RB. A "Custom" Plate in a Day-Accurate Predictive Hole Fabrication Using Point-of-Care 3-Dimensional Printing. J Oral Maxillofac Surg 2021; 80:559-568. [PMID: 34958739 DOI: 10.1016/j.joms.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In computer surgical planned (CSP) fibular reconstructions of the mandible, custom plates facilitate accurate and efficient transfer of the digital plan intraoperatively by a way of predrilled fixation holes. Stock plates are more easily accessible and are more economical but typically preclude the utilization of these predictive holes. The purpose of this article is to describe an accurate and economical alternative to custom plates, while still having the ability to create predictive holes for plate alignment and execution of a digital surgical plan. METHODS An in vitro accuracy study was performed on a point-of-care resin-printed predictive hole guide termed "prebent plate analog" (PPA). Twenty stock 2.0 reconstruction plates prebent against a 3-dimensional printed mandibular model reconstructed with a 2-piece fibula were used to fabricate 20 PPAs. The proximal and distal 4 holes of each prebent plate and corresponding PPA were assessed using a heat map overlay, measuring difference in millimeters between matching points of the predictive hole segments. The median distance from the points of reference in the PPA versus the prebent plate was calculated for each predictive hole position in addition to the average error of the PPA to the stock plate. RESULTS Eighteen PPAs were used for statistical analysis; 2 were damaged in transport. The mean error between the body (-0.265) and condylar segments (-0.116 mm) and mean difference in error between the proximal predictive holes (-0.124 mm) and distal predictive holes (-0.215 mm) on the PPA were not statistically different (P = .061, P = .314 general estimating equation regression, respectively). The mean error across the PPA predictive holes and corresponding holes of the prebent plates was -0.194 mm (P < .001, general estimating equation regression). CONCLUSIONS The PPA is a precise and accurate analog that faithfully replicates the position of proximal and distal components of a prebent stock plate, thereby allowing for predictive hole placement in lieu of a custom plate in fibula mandibular reconstruction cases.
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Affiliation(s)
- Baber Khatib
- Attending Head and Neck/ Microvascular Reconstructive Surgeon, Providence, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR; Attending Maxillofacial Surgeon, Legacy Emanuel/Good Samaritan Medical Center, Portland, OR; Consultant Head and Neck Institute, Portland, OR.
| | - Marcus Couey
- Fellow in Head and Neck Oncologic and Reconstructive Microvascular Surgery/Immuno-oncology Providence, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR
| | - Ashish Patel
- Attending Head and Neck/Microvascular Surgeon, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR; Director of Maxillofacial Trauma, Trauma Service, Legacy Emanuel Medical Center, Portland, Oregon Consultant Head and Neck Institute, Portland, OR
| | - Allen Cheng
- Director, Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, Portland OR; Consultant, Head and Neck Institute, Portland, OR
| | - R Bryan Bell
- Physician Executive and Director, Surgical Oncology, Radiation Oncology and Clinical Programs, Medical Director, Head and Neck Cancer Program Providence Cancer Institute Member and Director of Surgical Oncology Research Earle A. Chiles Research Institute
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Demir E, Yalçın G, Kalaycı A, Sağlam H. Biomechanical evaluation of caudally and buccally screwed customised reconstruction plates for lateral segmental defects of mandible. Br J Oral Maxillofac Surg 2021; 59:928-934. [PMID: 34454776 DOI: 10.1016/j.bjoms.2020.10.017] [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: 09/21/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare locking reconstruction plates with caudobuccally screwed custom mandibular reconstruction plates in bridging lateral mandibular segmental defects. The in vitro study was conducted on 13 polyurethane mandibles. A total of 7 mandibles with lateral segmental defects were bridged with locking reconstruction plates in group I, 6 mandibles with the same standard defect were bridged with caudobuccally screwed customised reconstruction plates in group II. Mean yield displacement, yield load, and displacement at 80 N (Newtons), 100 N, 200 N, 300 N loading were compared among the 2 groups. The mean (SD) displacement for Group I was 11.27 (3.6) mm, Group II was 21.08 (2.5) mm. Group II had significantly greater (p=0.0001) displacement when compared with Group I. The mean (SD) force before failure for Group I was 638.4 N (127.2), Group II was 1398. 3 N (162.7). Group II withstood significantly greater force than Group I (p=0.0001). The study reveals that the caudobuccally screwed custom reconstruction plates can significantly enhance yield load as preserving the preoperative shape of the face and mandible.
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Affiliation(s)
- E Demir
- Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey.
| | - G Yalçın
- Department of Mechanics of Materials, Selçuk University Faculty of Technology, Konya, Turkey
| | - A Kalaycı
- Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey
| | - H Sağlam
- Department of Mechanics of Materials, Selçuk University Faculty of Technology, Konya, Turkey
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18
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Improving mandibular reconstruction by using topology optimization, patient specific design and additive manufacturing?-A biomechanical comparison against miniplates on human specimen. PLoS One 2021; 16:e0253002. [PMID: 34101755 PMCID: PMC8186800 DOI: 10.1371/journal.pone.0253002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/26/2021] [Indexed: 11/28/2022] Open
Abstract
In this study, topology optimized, patient specific osteosynthesis plates (TOPOS-implants) are evaluated for the mandibular reconstruction using fibula segments. These shape optimized implants are compared to a standard treatment with miniplates (thickness: 1.0 mm, titanium grade 4) in biomechanical testing using human cadaveric specimen. Mandible and fibula of 21 body donors were used. Geometrical models were created based on automated segmentation of CT-scans of all specimens. All reconstructions, including cutting guides for osteotomy as well as TOPOS-implants, were planned using a custom-made software tool. The TOPOS-implants were produced by electron beam melting (thickness: 1.0 mm, titanium grade 5). The fibula-reconstructed mandibles were tested in static and dynamic testing in a multi-axial test system, which can adapt to the donor anatomy and apply side-specific loads. Static testing was used to confirm mechanical similarity between the reconstruction groups. Force-controlled dynamic testing was performed with a sinusoidal loading between 60 and 240 N (reconstructed side: 30% reduction to consider resected muscles) at 5 Hz for up to 5 · 105 cycles. There was a significant difference between the groups for dynamic testing: All TOPOS-implants stayed intact during all cycles, while miniplate failure occurred after 26.4% of the planned loading (1.32 · 105 ± 1.46 · 105 cycles). Bone fracture occurred in both groups (miniplates: n = 3, TOPOS-implants: n = 2). A correlation between bone failure and cortical bone thickness in mandible angle as well as the number of bicortical screws used was demonstrated. For both groups no screw failure was detected. In conclusion, the topology optimized, patient specific implants showed superior fatigue properties compared to miniplates in mandibular reconstruction. Additionally, the patient specific shape comes with intrinsic guiding properties to support the reconstruction process during surgery. This demonstrates that the combination of additive manufacturing and topology optimization can be beneficial for future maxillofacial surgery.
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Muftuoglu G, Bayram B, Aydin P. Comparison of locking and non-locking reconstruction plate-screw system in lateral mandibular defects by finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:e65-e69. [PMID: 33161169 DOI: 10.1016/j.jormas.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/03/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to analyze and compare stress distribution on bone screws and plate systems in locking and non-locking screw-plates design in lateral mandibular defects. MATERIAL AND METHODS Solid mathematical model of mandible was created by three-dimensional finite elements analysis and 25 mm length of lateral resection (L defect) was performed on the model. Models were reconstructed with 2.4 locking and non-locking reconstruction plate system. Each masticator muscles attached to mandible were simulated as direction, attachment area and magnitude on 3D model to compare with reality. The stress formation on bone and hardware system were evaluated. RESULT The stress values on the cortical bone, plate and screw system were higher in conventional plate model than the locking system model. The highest stress values were measured in the proximal segment especially in conjunction with conventional screw system. Furthermore, the distribution of stress on the bone surface was more homogenous in the locking system. CONCLUSION It is evident that the use of the locking system in 25 mm length lateral mandibular defects provides an additional advantage over conventional systems in reconstruction models.
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Affiliation(s)
- G Muftuoglu
- Private Practice, Dentgroup, Istanbul, Turkey
| | - B Bayram
- Baskent University Faculty of Dentistry Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - P Aydin
- Baskent University Faculty of Dentistry Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
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20
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Bedogni A, Bettini G, Bedogni G, Menapace G, Sandi A, Michelon F, Di Carlo R, Franco P, Saia G. Safety of boneless reconstruction of the mandible with a CAD/CAM designed titanium device: The replica cohort study. Oral Oncol 2020; 112:105073. [PMID: 33160150 DOI: 10.1016/j.oraloncology.2020.105073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We evaluated the safety of REPLICA, a CAD/CAM-designed patient-specific titanium mandible, in patients with mandibular defects not suitable for reconstruction with traditional techniques. PATIENTS AND METHODS We performed a cohort study with a composite primary outcome assigned at the end of a 1-year follow-up. The outcome was assigned in the presence of all the following: 1) absence of intraoral or skin extrusion of REPLICA; 2) decrease or cessation of oral pain; 3) stability or increase in mouth opening; 4) resumption of oral feeding without the need of nasogastric tube; 5) absence of fracture at multidetector computer tomography (MDCT); 6) absence of displacement (MDCT); 7) absence of screw loosening (MDCT). The secondary outcome was the patient-reported QOL at 6 months of follow-up as detected by the EORTC QLQ-C30 and QLQ-H&N35 questionnaires. RESULTS Between March 2012 and June 2017, 18 consecutive patients, with a median (IQR) age of 67 (65;74) underwent reconstruction of mandibular defects with REPLICA at our Unit. The primary outcome was reached by 14 of the 18 patients. QOL data were available for 15 patients at the 6-month follow-up, showing a good profile of general and disease-specific QOL. CONCLUSION REPLICA offered a safe solution at 1-year for the treatment of mandibular defects not suitable for reconstruction with traditional techniques, and was associated with subjective well-being and satisfaction. Further studies are needed to assess the full range of indications of REPLICA.
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Affiliation(s)
- Alberto Bedogni
- Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy; Regional Center for the Prevention, Diagnosis and Treatment of Medication and Radiation-related Bone Diseases of the Head and Neck, Azienda Ospedale-Università Padova, Padova, Italy.
| | - Giordana Bettini
- Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy; Regional Center for the Prevention, Diagnosis and Treatment of Medication and Radiation-related Bone Diseases of the Head and Neck, Azienda Ospedale-Università Padova, Padova, Italy.
| | - Giorgio Bedogni
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Giorgia Menapace
- Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Sandi
- Sintac S.r.l., Biomedical Engineering, via Ragazzi del '99, 13, 38123 Trento, Italy.
| | - Fabio Michelon
- Sintac S.r.l., Biomedical Engineering, via Ragazzi del '99, 13, 38123 Trento, Italy.
| | - Roberto Di Carlo
- Unit of Otolaryngology, Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - Piero Franco
- Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy.
| | - Giorgia Saia
- Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy.
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KARGARNEJAD SAHAND, GHALICHI FARZAN, POURGOL-MOHAMMAD MOHAMMAD, OSKUI IZ, GARAJEI ATA. BIOMECHANICAL EVALUATION OF RECONSTRUCTED EXTENSIVE MANDIBULAR DEFECTS BY DIFFERENT MODELS USING FINITE ELEMENT METHOD. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rehabilitation of major mandibular defects after tumor resection has become a serious challenge for surgeons. In this research, four various models were designed to repair a critical mandibular lateral defect. Biomechanical behavior of the models was assessed by Finite Element Method. These models are including Fibular-Free Flap (FFF), Customized Prosthesis (CP), Tray Implant without Bone Graft (TI-wo-BG), and Tray Implant with Bone Graft (TI-w-BG). FFF is a subset of microvascular free flap technique in which some segments of patient’s fibula bone are used to restore mandibular defects. CP is a hollow and light prosthesis which is fabricated using Additive Manufacturing technology from Ti alloy powder. TI-wo-BG is similar to a crib which is designed according to the geometry of the patient’s mandible. TI-w-BG, in fact, is a TI-wo-BG which is filled with small cortico-cancellous chips in order to benefit potential profit of bone grafting. The chewing operation and loading on the mandible was simulated considering the three mandibular muscular forces including masseter, medial pterygoid, and temporalis. The result of FEM analysis of TI-wo-BG and TI-w-BG showed that in both models, screw number 6 endured a strain of 5684 and 2852[Formula: see text][Formula: see text]m/m which exceeded pathological and mild overload risk, respectively. This may increase the probability of screw loosening and system failure. The results proved the stability of the FFF and CP models. In addition, it can be concluded that stress and strain on the screw’s interfaces can decrease by improving the plate and increasing the friction at the interface of plate, bone and screw.
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Affiliation(s)
- SAHAND KARGARNEJAD
- Faculty of Biomedical Engineering, Sahand University of Technology, P.O. Box: 51335/1996, Sahand New Town, Tabriz, Iran
| | - FARZAN GHALICHI
- Faculty of Biomedical Engineering, Sahand University of Technology, P.O. Box: 51335/1996, Sahand New Town, Tabriz, Iran
| | - MOHAMMAD POURGOL-MOHAMMAD
- Mechanical Engineering Department, Sahand University of Technology, P.O. Box: 51335/1996, Sahand New Town, Tabriz, Iran
| | - I. Z. OSKUI
- Faculty of Biomedical Engineering, Sahand University of Technology, P.O. Box: 51335/1996, Sahand New Town, Tabriz, Iran
| | - ATA GARAJEI
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran, Iran
- The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- The Cancer Institute, Imam Hospital Complex, Keshavarz Blvd., Tehran, Iran
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22
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Koper DC, Leung CAW, Smeets LCP, Laeven PFJ, Tuijthof GJM, Kessler PAWH. Topology optimization of a mandibular reconstruction plate and biomechanical validation. J Mech Behav Biomed Mater 2020; 113:104157. [PMID: 33187871 DOI: 10.1016/j.jmbbm.2020.104157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Reconstruction plates, used to bridge segmental defects of the mandible after tumor resection or traumatic bone tissue loss, are subjected to repeated stresses of mastication. High stress concentrations in these plates can result in hardware failure. Topology optimization (TO) could reduce the peak stress by computing the most optimal material distribution in a patient-specific implant (PSI) used for mandibular reconstruction. The objective of this study was biomechanical validation of a TO-PSI. METHODS A computer-aided design (CAD) model with a segmental defect was created based on the geometry of a polyurethane mandible model. A standard-PSI was designed to bridge the defect. A TO-PSI was then designed with a maximum stress equal to the ultimate tensile stress of Ti6Al4V (930 MPa) during a loading condition of 378 N. Finite element analysis (FEA) was used to analyze stresses in both PSI designs during loading. The standard-PSI and TO-PSI designs were produced in triplicate by selective laser melting of Ti6Al4V, fixated to polyurethane mandible models with segmental defects identical to the CAD model, and subsequently subjected to continuous compression with a speed of 1 mm/min on a universal testing machine, while recording the load. Peak loads before failure in the TO-PSI group within a 30% range of the predicted peak load (378 N) were considered a successful biomechanical validation. RESULTS Fracture of the TO-PSI occurred at a median peak load of 334 N (range 304-336 N). These values are within the 30% range of the predicted peak load. Fracture of the mandible model in the standard-PSI group occurred at a median peak load of 1100 N (range 1010-1460 N). Failure locations during biomechanical testing of TO-PSI and standard-PSI samples corresponded to regions in the FEA where stresses exceeded the ultimate tensile strength of titanium and polyurethane, respectively. CONCLUSION This study demonstrates a successful preliminary biomechanical validation of TO in the design process for mandibular reconstruction plates. Further work is needed to refine the finite element model, which is necessary to ultimately design TO-PSIs for clinical use.
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Affiliation(s)
- David C Koper
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands; Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Carine A W Leung
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Lars C P Smeets
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Paul F J Laeven
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Peter A W H Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
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Patient specific glass fiber reinforced composite versus titanium plate: A comparative biomechanical analysis under cyclic dynamic loading. J Mech Behav Biomed Mater 2019; 91:212-219. [DOI: 10.1016/j.jmbbm.2018.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/21/2018] [Accepted: 12/13/2018] [Indexed: 01/07/2023]
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24
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Clinical experience with a novel structure designed bridging plate system for segmental mandibular reconstruction: The TriLock bridging plate. J Craniomaxillofac Surg 2018; 46:1679-1690. [DOI: 10.1016/j.jcms.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/05/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022] Open
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Medial radio-carpal arthrodesis in three cats with a 2.0 mm locking maxillofacial plate system. Vet Comp Orthop Traumatol 2017; 24:294-8. [DOI: 10.3415/vcot-10-06-0100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 04/27/2011] [Indexed: 11/17/2022]
Abstract
SummaryThe medical records of three cats that were presented with severe carpal injury requiring radiocarpal arthrodesis were reviewed. Medial plating using the Compact 2.0 LOCKTM system a was performed in all three cases. Although screw positioning may be difficult because of the large distance between the holes of the plate and the relatively large size of screws, plate loosening or metacarpal fractures did not occur. Long-term clinical and radiographic follow-up (6 months to 4.5 years) revealed excellent outcome in two cats. In the third cat, the radiocarpal joint did not undergo complete fusion. At four and a half years following surgery, recurrence of forelimb lameness was associated with breakage of the plate.
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CAD–CAM plates versus conventional fixation plates for primary mandibular reconstruction: A biomechanical in vitro analysis. J Craniomaxillofac Surg 2017; 45:1878-1883. [DOI: 10.1016/j.jcms.2017.08.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/19/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022] Open
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Gutwald R, Jaeger R, Lambers FM. Customized mandibular reconstruction plates improve mechanical performance in a mandibular reconstruction model. Comput Methods Biomech Biomed Engin 2016; 20:426-435. [PMID: 27887036 PMCID: PMC5359746 DOI: 10.1080/10255842.2016.1240788] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this paper was to analyze the biomechanical performance of customized mandibular reconstruction plates with optimized strength. The best locations for increasing bar widths were determined with a sensitivity analysis. Standard and customized plates were mounted on mandible models and mechanically tested. Maximum stress in the plate could be reduced from 573 to 393 MPa (−31%) by increasing bar widths. The median fatigue limit was significantly greater (p < 0.001) for customized plates (650 ± 27 N) than for standard plates (475 ± 27 N). Increasing bar widths at case-specific locations was an effective strategy for increasing plate fatigue performance.
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Affiliation(s)
- Ralf Gutwald
- a Department of Oral and Maxillofacial Surgery , University Hospital of Freiburg , Freiburg , Germany
| | - Raimund Jaeger
- b Fraunhofer Institute for Mechanics of Materials IWM , Polymer Tribology & Biomedical Materials - Group , Freiburg , Germany
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Computer-Assisted Designed and Manufactured Procedures Facilitate the Lingual Application of Mandible Reconstruction Plates. J Oral Maxillofac Surg 2016; 74:1879-95. [DOI: 10.1016/j.joms.2016.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/29/2016] [Accepted: 03/14/2016] [Indexed: 11/23/2022]
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Raith S, Varga V, Steiner T, Hölzle F, Fischer H. Computational geometry assessment for morphometric analysis of the mandible. Comput Methods Biomech Biomed Engin 2016; 20:27-34. [DOI: 10.1080/10255842.2016.1196196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Stefan Raith
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, Aachen, Germany
| | - Viktoria Varga
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Steiner
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Horst Fischer
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, Aachen, Germany
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Clinical Usefulness of Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Autogenous Particulate Cancellous Bone and Marrow Harvested From Tibia and/or Ilia. J Craniofac Surg 2016; 27:586-92. [DOI: 10.1097/scs.0000000000002472] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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31
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Bujtár P, Simonovics J, Váradi K, Sándor GK, Avery C. The biomechanical aspects of reconstruction for segmental defects of the mandible: A finite element study to assess the optimisation of plate and screw factors. J Craniomaxillofac Surg 2014; 42:855-62. [DOI: 10.1016/j.jcms.2013.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/09/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
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32
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Mandibular reconstruction with a bioactive-coated cementless Ti6Al4V modular endoprosthesis in Macaca fascicularis. Int J Oral Maxillofac Surg 2014; 43:758-68. [DOI: 10.1016/j.ijom.2013.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/14/2013] [Accepted: 09/30/2013] [Indexed: 11/21/2022]
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Liu YF, Xu LW, Zhu HY, Liu SSY. Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing. Biomed Eng Online 2014; 13:63. [PMID: 24886431 PMCID: PMC4049493 DOI: 10.1186/1475-925x-13-63] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 05/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. METHODS Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. RESULTS With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of the mandible, grafts for defect repair can be cut from fibular bone, shaped with high accuracy during surgery, and fixed with a well-fitting preformed locking plate, so that the predesigned plan can be performed in the clinic and the oral function and appearance of the patient are recovered. This method requires 20% less operating time compared with conventional surgery, and the advantages in cost and convenience are significant compared with those of existing commercial services in China. CONCLUSIONS This comparison between two groups of cases illustrates that, with the proposed method, the accuracy of mandibular defect repair surgery is increased significantly and is less time-consuming, and patients are satisfied with both the recovery of oral function and their appearance. Until now, more than 15 cases have been treated with the proposed methods, so their feasibility and validity have been verified.
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Affiliation(s)
- Yun-feng Liu
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou 310014, China.
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34
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Li P, Shen L, Li J, Liang R, Tian W, Tang W. Optimal design of an individual endoprosthesis for the reconstruction of extensive mandibular defects with finite element analysis. J Craniomaxillofac Surg 2014; 42:73-8. [DOI: 10.1016/j.jcms.2013.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022] Open
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35
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Landes C, Ballon A, Ghanaati S, Ebel D, Ulrich D, Spohn U, Heunemann U, Sader R, Jaeger R. Evaluation of the Fatigue Performance and Degradability of Resorbable PLDLLA-TMC Osteofixations. Open Biomed Eng J 2013; 7:133-46. [PMID: 24363786 PMCID: PMC3869107 DOI: 10.2174/1874120701307010133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/24/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022] Open
Abstract
The fatigue performance of explanted in-situ degraded osteofixations/osteosyntheses, fabricated from poly (70L-lactide-co-24DL-lactide-6-trimethylane-carbonate or PLDLLA-TMC) copolymer was compared to that of virgin products. The fatigue test was performed on 21 explants retrieved from 12 women and 6 men; 16-46 years by a custom-designed three-point bend apparatus using a staircase method and a specified failure criterion (an increase of the deflection of the specimen > 1 mm) with run-out designated as “no failure” after 150,000 loading cycles. While all the virgin products showed run-out at 38N, all of the specimens fabricated from explants failed at this load level. For the explant specimens, although there was a trend of decreased failure load with increased in-situ time, this decrease was pronounced after 4 months in-situ, however, not yet statistically significant, while a 6-month in-situ explant had significantly less failure load. Three and four month in-situ explants had highly significant differences in failure load between measurements close and distant to the osteotomy line: p=0.0017 (the region of maximum load in-situ). In the virgin products, there were only traces of melt joining and cooling, left from a stage in the manufacturing process. For the implants retrieved after 4.5 months in-situ, the fracture surfaces showed signs of degradation of the implants, possibly caused by hydrolysis, and for those retrieved after 9 months in-situ, there were cracks and pores. Thus, the morphological results are consistent with those obtained in the fatigue test. The present results suggest that resorbable osteofixations fabricated from PLDLLA-TMC are stable enough to allow loading of the healing bone and degrade reliably
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Affiliation(s)
- Constantin Landes
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Alexander Ballon
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Shahram Ghanaati
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Daniel Ebel
- Fraunhofer Institute for Mechanics of Materials IWM, Wöhlerstraße 11, 79108 Freiburg, Germany
| | - Dieter Ulrich
- Fraunhofer Institute for Mechanics of Materials IWM, Wöhlerstraße 11, 79108 Freiburg, Germany
| | - Uwe Spohn
- Fraunhofer Institute for Mechanics of Materials IWM, Biological and Biocompatible Materials - group, Fraunhofer-IWM, Walter-Hülse-Str. 1, 06120 Halle
| | - Ute Heunemann
- Fraunhofer Institute for Mechanics of Materials IWM, Biological and Biocompatible Materials - group, Fraunhofer-IWM, Walter-Hülse-Str. 1, 06120 Halle
| | - Robert Sader
- Oral, Craniomaxillofacial and Plastic Facial Surgery, The Center of Surgery, Goethe University Medical Centre, Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Raimund Jaeger
- Fraunhofer Institute for Mechanics of Materials IWM, Wöhlerstraße 11, 79108 Freiburg, Germany
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36
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Biomechanical Evaluation of a New MatrixMandible Plating System on Cadaver Mandibles. J Oral Maxillofac Surg 2013; 71:1900-14. [DOI: 10.1016/j.joms.2013.06.218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 05/28/2013] [Accepted: 06/23/2013] [Indexed: 11/21/2022]
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37
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Locking versus nonlocking plates in mandibular reconstruction with fibular graft—a biomechanical ex vivo study. Clin Oral Investig 2013; 18:1291-1298. [DOI: 10.1007/s00784-013-1105-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
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38
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Five-year follow-up of modified implant-supported overdenture in an iliac crest autograft failure: clinical report. J Craniofac Surg 2013; 24:e523-6. [PMID: 24036834 DOI: 10.1097/scs.0b013e3182a23777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The treatment of extensive pathologic lesions in the jaw, most of the time, can generate rehabilitation problems to the patient. The solid ameloblastoma is a locally invasive odontogenic tumor with a high recurrence rate. Its treatment is aggressive and accomplished through resection with safety margin. The criterion standard for reconstruction is autogenous bone, but it can provide a high degree of resorption, causing inconvenience to the patient because of lack of rehabilitative option. This study aimed to describe a patient with ameloblastoma treated through resection and reconstruction with autogenous bone graft, in which, after an extensive resorption of the graft was made, a modified bar was applied to support a prosthetic implant overdenture.
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Bedogni A, Bettini G, Ferronato G, Fusetti S, Saia G. Replacement of fractured reconstruction plate with customized mandible implant: A novel technique. Laryngoscope 2013; 124:401-4. [DOI: 10.1002/lary.24230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/10/2013] [Accepted: 05/10/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Bedogni
- Unit of Oral and Maxillofacial Surgery, Department of Surgery; Azienda Ospedaliera Universitaria Integrata Verona; Verona
| | - Giordana Bettini
- Unit of Maxillofacial Surgery, Department of Neurosciences; University of Padova; Padova Italy
| | - Giuseppe Ferronato
- Unit of Maxillofacial Surgery, Department of Neurosciences; University of Padova; Padova Italy
| | - Stefano Fusetti
- Unit of Maxillofacial Surgery, Department of Neurosciences; University of Padova; Padova Italy
| | - Giorgia Saia
- Unit of Maxillofacial Surgery, Department of Neurosciences; University of Padova; Padova Italy
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40
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Probst FA, Mast G, Ermer M, Gutwald R, Schmelzeisen R, Pautke C, Otto S, Schiel S, Ehrenfeld M, Cornelius CP, Metzger MC. MatrixMANDIBLE Preformed Reconstruction Plates—A Two-Year Two-Institution Experience in 71 Patients. J Oral Maxillofac Surg 2012; 70:e657-66. [DOI: 10.1016/j.joms.2012.06.175] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/13/2012] [Accepted: 06/04/2012] [Indexed: 11/27/2022]
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41
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Peacock ZS, Afshar S, Lukas SJ, Kaban LB. Customized Repair of Fractured Mandibular Reconstruction Plates. J Oral Maxillofac Surg 2012; 70:e563-73. [DOI: 10.1016/j.joms.2012.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/03/2012] [Accepted: 06/05/2012] [Indexed: 11/30/2022]
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42
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Kloss FR, Singh S, Hächl O, Rentenberger J, Auberger T, Kraft A, Klima G, Mitterlechner T, Steinmüller-Nethl D, Lethaus B, Rasse M, Lepperdinger G, Gassner R. BMP-2 immobilized on nanocrystalline diamond-coated titanium screws; demonstration of osteoinductive properties in irradiated bone. Head Neck 2012; 35:235-41. [DOI: 10.1002/hed.22958] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/07/2022] Open
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43
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Metzger MC, Vogel M, Hohlweg-Majert B, Mast H, Fan X, Rüdell A, Schlager S. Anatomical shape analysis of the mandible in Caucasian and Chinese for the production of preformed mandible reconstruction plates. J Craniomaxillofac Surg 2011; 39:393-400. [DOI: 10.1016/j.jcms.2010.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 08/31/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022] Open
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44
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Review of biomechanical models used in studying the biomechanics of reconstructed mandibles. Int J Oral Maxillofac Surg 2011; 40:393-400. [PMID: 21195588 DOI: 10.1016/j.ijom.2010.11.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
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Yachouh J, Frison L, Goudot P. [Validating a loading protocol for weakened mandibular models]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2010; 111:123-127. [PMID: 20347462 DOI: 10.1016/j.stomax.2009.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 09/28/2009] [Accepted: 10/19/2009] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The purpose of this study was to validate an experimental model of weakened synthetic mandible loaded in a device simulating masticatory forces by studying the reproducibility of the fracture threshold. MATERIALS AND METHODS Both sides of five synthetic mandibles were weakened by progressive synthetic bone resection. The synthetic mandibles were submitted, after each resection, to static chewing exercises in the simulator. The threshold fracture was recorded. RESULTS The fracture threshold mean resection height was 19.33 mm with a percentage of error of 6.72%. DISCUSSION The low percentage of error allowed us to validate this experimental model. A comparison with other experimental or finite element models confirmed our protocol and results. We plan to apply this protocol to fresh weakened mandibles.
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Affiliation(s)
- J Yachouh
- Service de stomatologie, chirurgie maxillofaciale et chirurgie plastique de la face, CHRU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Wong RCW, Tideman H, Kin L, Merkx MAW. Biomechanics of mandibular reconstruction: a review. Int J Oral Maxillofac Surg 2009; 39:313-9. [PMID: 19944568 DOI: 10.1016/j.ijom.2009.11.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/07/2009] [Accepted: 11/03/2009] [Indexed: 12/23/2022]
Abstract
Knowledge of the biomechanics of the mandible allows the surgeon to understand the forces acting on the mandible during function and the resulting deformation that can occur. This allows the appropriate selection and placement of osteosynthesis plates to neutralize these forces. Many methods have been proposed for mandibular reconstruction, each of which has strengths and weaknesses. Most papers evaluating these techniques have focused on survival rates and the quality of the grafted bones, and there have been few studies of the biomechanics (stress distribution and strength) of the various types of reconstructed mandibles. This paper reviews the biomechanics of the mandible and the various methods of reconstruction reported in past studies.
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Affiliation(s)
- R C W Wong
- Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore.
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Wongchuensoontorn C, Liebehenschel N, Schwarz U, Schmelzeisen R, Gutwald R, Ellis E, Sauerbier S. Application of a new chair-side method for the harvest of mesenchymal stem cells in a patient with nonunion of a fracture of the atrophic mandible--a case report. J Craniomaxillofac Surg 2009; 37:155-61. [PMID: 19155179 DOI: 10.1016/j.jcms.2008.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/21/2008] [Accepted: 11/05/2008] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This case report describes a new clinical method for chair-side processing of a cell mixture which contains mesenchymal stem cells (MSCs) which was applied for the first time in the treatment of a nonunion of an atrophic fractured mandible. METHODS Bone marrow was aspirated and a corticocancellous bone graft was harvested from the iliac crest of a 56-year-old woman with medical comorbidities and a fracture of the atrophic mandible. The fracture was stabilized with a reconstruction bone plate, and mononuclear cells including MSCs were concentrated by centrifugation and applied in combination with a particulate bone transplant. A sample of the grafted cells was characterized by flow cytometric analysis and by their ability to differentiate into various cell types. RESULTS The fracture healed uneventfully. No complications occurred during the 4-month follow-up. CONCLUSION Adding MSCs is a feasible alternative to enhance bone healing. This chair-side method requires little training and no cell laboratory support.
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