1
|
Demir O, Uslan I, Buyuk M, Salamci MU. Development and validation of a digital twin of the human lower jaw under impact loading by using non-linear finite element analyses. J Mech Behav Biomed Mater 2023; 148:106207. [PMID: 37922761 DOI: 10.1016/j.jmbbm.2023.106207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
Mandibular fractures are one of the most frequently observed injuries within craniofacial region mostly due to tumor-related problems and traumatic events, often related to non-linear effects like impact loading. Therefore, a validated digital twin of the mandible is required to develop the best possible patient-specific treatment. However, there is a need to obtain a fully compatible numerical model that can reflect the patients' characteristics, be available and accessible quickly, require an acceptable level of modeling efforts and knowledge to provide accurate, robust and fast results at the same time under highly non-linear effects. In this study, a validated simulation methodology is suggested to develop a digital twin of mandible, capable of predicting the non-linear response of the biomechanical system under impact loading, which then can be utilized to design treatment strategies even for multiple fractures of the mandibular system. Using Computed Tomography data containing cranial (skull) images of a patient, a 3-dimensional mandibular model, which consists cortical and cancellous bones, disks and fossa is obtained with high accuracy that is compatible with anatomical boundaries. A Finite Element Model (FEM) of the biomechanical system is then developed for a three-level validation procedure including (A) modal analysis, (B) dynamic loading and (C) impact loading. For the modal analysis stage: Free-free vibration modes and frequencies of the system are validated against cadaver test results. For the dynamic loading stage: Two different regions of the mandible are loaded, and maximum stress levels of the system are validated against finite element analyses (FEA) results, where the first loading condition (i) transfers a 2000 N force acting on the symphysis region and, the second loading condition (ii) transfers a 2000 N force acting on the left body region. In both cases, equivalent muscle forces dependent on time are applied. For the impact loading stage: Thirteen different human mandibular models with various tooth deficiencies are used under the effects of traumatic impact forces that are generated by using an impact hammer with different initial velocities to transfer the impulse and momentum, where contact forces and fracture patterns are validated against cadaver tests. Five different anatomical regions are selected as the impact site. The results of the analyzes (modal, dynamic and impact) performed to validate the digital twin model are compared with the similar FEA and cadaver test results published in the literature and the results are found to be compatible. It has been evaluated that the digital twin model and numerical models are quite realistic and perform well in terms of predicting the biomechanical behavior of the mandible. The three-level validation methodology that is suggested in this research by utilizing non-linear FEA has provided a reliable road map to develop a digital twin of a biomechanical system with enough confidence that it can be utilized for similar structures to offer patient-specific treatments and can help develop custom or tailor-made implants or prosthesis for best compliance with the patient even considering the most catastrophic effects of impact related trauma.
Collapse
Affiliation(s)
- Osman Demir
- Gulhane Medical Design and Manufacturing Application and Research Center-SBU-METUM, University of Health Sciences, 06010, Ankara, Turkey; Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey.
| | | | - Murat Buyuk
- Department of Engineering Sciences, Middle East Technical University, 06800, Ankara, Turkey.
| | - Metin Uymaz Salamci
- Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey; Additive Manufacturing Technologies Research and Application Center-EKTAM, Gazi University, 06980, Ankara, Turkey.
| |
Collapse
|
2
|
Shen Z, Zhang P, Cheng B, Liu F, He D. Computational modelling of the fossa component fixation associated with alloplastic total temporomandibular joint replacements. J Mech Behav Biomed Mater 2023; 147:106104. [PMID: 37729840 DOI: 10.1016/j.jmbbm.2023.106104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
The alloplastic total temporomandibular joint (TMJ) replacement is a complex surgical approach to end-stage TMJ disorders. The fixation of TMJ prostheses remains a critical issue for implant design and performance. For the fossa component, it is generally considered to use fixation screws to achieve tripod stability. However, the fossa may still come loose, and the mechanism remains unknown. A computational framework, consisting of a musculoskeletal model for calculating muscle and TMJ forces, and a finite element model for the fossa fixation simulation, was developed. A polyethylene (PE) fossa with stock prosthesis design was analyzed to predict contact pressures at the fixation interfaces, and stresses/strains in the fossa implant and bone during the static loading of normal chewing bite and maximum-force bite. The predicted maximum von Mises stresses were 33 MPa and 44 MPa for the bone, 13 MPa and 28 MPa for the PE fossa, and 131 MPa and 244 MPa for the screws, for the normal and maximum bites, respectively; the peak minimum principal strain was in the range of -2514 ∼ -3545 με for the bone. The results show that the sufficient initial mechanical strength of the fossa component fixation can be established using the screws in combination with bone support. The functional loads applied through the prosthetic TMJ bearing can be largely transferred to supporting bone without causing high level stresses. Tightening fixation screws with a pretension of 100 N can reduce transverse load to the screws and help prevent screw loosening. Further research is recommended to accurately quantify the transverse load and its influence on screw loosening during dynamic loading, and the frictional properties at the bone-implant interface.
Collapse
Affiliation(s)
- Zhenhao Shen
- School of Mechanical Engineering, North University of China, PR China
| | - Pengyu Zhang
- School of Mechanical Engineering, North University of China, PR China
| | - Bo Cheng
- School of Mechanical Engineering, North University of China, PR China
| | - Feng Liu
- School of Mechanical Engineering, North University of China, PR China.
| | - Dongmei He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology, PR China.
| |
Collapse
|
3
|
Chen K, Zhang Z, Jiang J, Wang J, Wang J, Sun Y, Xu X, Guo C. Prediction of condylar movement envelope surface based on facial morphology. Heliyon 2023; 9:e17769. [PMID: 37483714 PMCID: PMC10362184 DOI: 10.1016/j.heliyon.2023.e17769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
The present study aimed to predict the envelope surfaces from facial morphology. Condylar envelope surfaces for 34 healthy adults were formed and simplified as sagittal section curves. Cephalometric and maximum mandibular moving distances measurement were performed on the participants. There was no statistically significant difference (p = 0.763) between the left and right maximum lateral movements. There was a statistically significant difference in the mandibular body length between the sexes. The envelope surfaces were divided into type 1 with Hp2 ≥ 1/3 Hp1 and type 2 with Hp2 < 1/3 × Hp1. SNA and SNB for type 2 were significantly greater than those for type 1 (p < 0.001). Therefore, the participants were divided into four groups based on gender and envelope surface morphology. The curves could be fitted using the second-order Fourier function (R-square ≥0.95). Six facial parameters were selected and a matrix was used to map facial morphology to the envelope surface. Individual sagittal curves were predicted using the matrix and facial parameters, and the envelope surface was predicted using the curve and the condyle model. Deviation analysis for the predicted envelope surface using the actual envelope as a reference was carried out (root mean square = 0.9970 mm ± 0.2918 mm). This method may lay a foundation for the geometric design of artificial fossa components of temporomandibular joint replacement systems. It may improve prosthesis design without flexible tissue repair and guide the movement of the artificial joint head.
Collapse
Affiliation(s)
- Kenan Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Zhehao Zhang
- State Key Laboratory of Tribology, Tsinghua University, Beijing, 100084, PR China
| | - Junqi Jiang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Junlin Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Jing Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Yuchun Sun
- Center of Digital Dentistry, Faculty of Prosthodontics, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory for Dental Materials, Beijing, PR China
| | - Xiangliang Xu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials, Beijing, PR China
| |
Collapse
|
4
|
Schottey O, Huys SE, van Lenthe G, Mommaerts MY, Sloten JV. Development of a topologically optimized patient-specific mandibular reconstruction implant for a Brown class II defect. Annals of 3D Printed Medicine 2023. [DOI: 10.1016/j.stlm.2023.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
|
5
|
Huys SE, Pastor-alonso D, Theuns P, van Lenthe G, Vander Sloten J, Mommaerts MY. A novel 3D-printed, patient-specific alloplastic temporomandibular joint replacement allowing enthesis reconstruction: A finite element analysis. Annals of 3D Printed Medicine 2022; 6:100058. [DOI: 10.1016/j.stlm.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
6
|
De Moor E, Huys SEF, van Lenthe GH, Mommaerts MY, Vander Sloten J. Mechanical evaluation of a patient-specific additively manufactured subperiosteal jaw implant (AMSJI) using finite-element analysis. Int J Oral Maxillofac Surg 2021; 51:405-411. [PMID: 34059405 DOI: 10.1016/j.ijom.2021.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022]
Abstract
Edentulism with associated severe bone loss is a widespread condition that hinders the use of common dental implants. An additively manufactured subperiosteal jaw implant (AMSJI) was designed as an alternative solution for edentulous patients with Cawood and Howell class V-VIII bone atrophy. A biomechanical evaluation of this AMSJI for the maxilla in a Cawood and Howell class V patient was performed via finite-element analysis. Occlusal and bruxism forces were incorporated to assess the loading conditions in the mouth during daily activities. The results revealed a safe performance of the implant structure during the foreseen implantation period of 15 years when exerting average occlusion forces of 200 N. For the deteriorated state of class VIII bone atrophy, increased stresses on the AMSJI were evaluated, which predicted implant fatigue. In addition, excessive bruxism and maximal occlusion forces might induce implant failure due to fatigue. The models predicted bone ingrowth at the implant scaffolds, resulting in extra stability and secondary fixation. For all considered loading conditions, the maximal stresses were located at the AMSJI arms. This area is most sensitive to bending forces and, hence, allows for further design optimization. Finally, the implant is considered safe for normal daily occlusion activities.
Collapse
Affiliation(s)
- E De Moor
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| | - S E F Huys
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| | - G H van Lenthe
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| | - M Y Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium.
| | - J Vander Sloten
- Department of Mechanical Engineering, Biomechanics section, KU Leuven, Leuven, Belgium.
| |
Collapse
|
7
|
Zhong YQ, Sun Q, He DM, Zou LX, Lu C. Study on the lateral pterygoid muscle status after artificial temporomandibular joint replacement. Int J Oral Maxillofac Surg 2021; 50:1496-1501. [PMID: 33824048 DOI: 10.1016/j.ijom.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to explore the status of the lateral pterygoid muscle (LPM) after detachment in artificial temporomandibular joint replacement (TJR) surgery. Patient clinical and computed tomography imaging data were collected before and after unilateral artificial TJR with LPM detachment. The volume of the LPM on the operated and unoperated sides was measured before and after surgery (at 1, 3, 6, 12 months) using ProPlan CMF 3.0 software. The volumes of the LPM on both sides, the patient's mandibular movements, quality of life (QoL), and pain and diet scores (visual analogue scales) were evaluated and compared at the different follow-up stages. Ten patients were included in the study. After surgery, the volume of the operated LPM was significantly reduced to 60.78% at 3 months (P=0.007), and gradually stabilized to 51.58% at 6 months (P=0.025) and 54.68% at 1 year postoperative (P=0.002). There were no significant LPM volume changes on the unoperated side (P=0.67). Lateral movement of the operated joint was significantly reduced (P=0.021) and correlated with the LPM volume change after surgical detachment (P=0.042). The LPM shrank after detachment in the artificial TJR surgery and the muscle detachment affected the movement of the replaced joint.
Collapse
Affiliation(s)
- Y Q Zhong
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Q Sun
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - D M He
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
| | - L X Zou
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - C Lu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| |
Collapse
|
8
|
Linsen SS, Schön A, Mercuri LG, Teschke M. Unilateral, Alloplastic Temporomandibular Joint Reconstruction, Biomechanically What Happens to the Contralateral Temporomandibular Joint?-A Prospective Cohort Study. J Oral Maxillofac Surg 2021; 79:2016-2029. [PMID: 33631133 DOI: 10.1016/j.joms.2021.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Unilateral alloplastic total temporomandibular joint reconstruction (TMJR) might influence the contralateral side joint function. This study's purpose was to estimate the risk for contralateral TMJR and the jaw function of the contralateral untreated temporomandibular joint (TMJ). PATIENTS AND METHODS A prospective cohort study design was used for patients who underwent unilateral alloplastic TMJR. The primary predictor was time after TMJR, and the secondary predictors were pre-TMJR mandibular angle resection, prior ipsilateral TMJ surgeries, and TMJR design (custom, stock). The primary outcome variable was the need for contralateral TMJR. The secondary outcome variables were the results of jaw function-jaw tracking, maximum voluntary clenching, surface electromyography, and pressure pain thresholds (PPT) and patient's quality-of-life (oral health-related quality-of-life [OHrQoL]). Data were collected preoperatively (T0), and 1 year (T1), 2-3 years (T2), and ≥ 4 years postoperatively (T4). Analysis of variance with post hoc Tukey -HSD test and multiple linear regression analysis were used for statistical analysis. P < .05 was considered significant. RESULTS Thirty-nine patients were enrolled, 15 males and 24 females, with an average age of 48.9 ± 16.2 years. Two patients (5.1%) required a contralateral TMJR. Contralateral condylar motion, incisal laterotrusion, and protrusion slightly decreased, while incisal opening (P = .003), rotation angle (P = .013), opening deflection, surface electromyography activity, maximum voluntary clenching (P = .01), PPTs, and OHrQoL all increased. Pre-TMJR mandibular angle resection had an impact on PPTs and subjective outcomes and prior ipsilateral TMJ surgeries on the opening rotation angle. CONCLUSIONS Based on this study, bilateral TMJR does not appear necessary when the contralateral TMJ is healthy. Unilateral alloplastic TMJR is associated with improved contralateral jaw function and OHrQoL.
Collapse
Affiliation(s)
- Sabine S Linsen
- Assistant Professor, Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Bonn, Germany.
| | - Andreas Schön
- Assistant Professor, Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Louis G Mercuri
- Visiting Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL; and Clinical Consultant, TMJ Concepts, Ventura, CA
| | - Marcus Teschke
- Private Practice, Praxis fuer Gesichtschirurgie und Kiefergelenkschirurgie, Hamburg, Germany
| |
Collapse
|
9
|
Zou L, Zhong Y, Xiong Y, He D, Li X, Lu C, Zhu H. A Novel Design of Temporomandibular Joint Prosthesis for Lateral Pterygoid Muscle Attachment: A Preliminary Study. Front Bioeng Biotechnol 2021; 8:630983. [PMID: 33585426 PMCID: PMC7873886 DOI: 10.3389/fbioe.2020.630983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction: In temporomandibular joint (TMJ) replacement operation, due to the condylectomy, the lateral pterygoid muscle (LPM) lost attachment and had impact on the mandible kinematic function. This study aimed to design a novel TMJ replacement prosthesis for LPM attachment and to verify its feasibility by preliminary in vitro and in vivo experiments. Materials and Methods: An artificial TMJ prosthesis designed with a porous structure on the condylar neck region for LPM attachment was fabricated by a 3D printed titanium (Ti) alloy. A rat myoblast cell line (L6) was tested for adhesion and biocompatibility with porous titanium scaffolds in vitro by cell counting Kit-8 (CCK-8), scanning electron microscope (SEM), flow cytometry (FCM), real-time quantitative polymerase chain reaction (RT-qPCR), immunocytofluorescense, western blotting, etc. The porous titanium scaffolds were further embedded in the rat intervertebral muscle to analyze muscle growth and biomechanical strength in vivo. The novel artificial TMJ prosthesis was implanted to reconstruct the goat's condyle and LPM reattachment was analyzed by hard tissue section and avulsion force test. Results: L6 muscle cells showed good proliferation potential on the porous Ti scaffold under SEM scanning and FCM test. In RT-qPCR, immunocytofluorescense and western blotting tests, the L6 cell lines had good myogenic capacity when cultured on the scaffold with high expression of factors such as Myod1 and myoglobin, etc. In the in vivo experiment, muscles penetrated into the porous scaffold in both rats and goats. In rat's intervertebral muscle implantation, the avulsion force was 0.716 N/mm2 in 4 weeks after operation and was significantly increased to 0.801 N/mm2 at 8 weeks (p < 0.05). In goat condylar reconstruction with the porous scaffold prosthesis, muscles attached to the prosthesis with the avulsion force of 0.436 N/mm2 at 8 weeks, but was smaller than the biological muscle-bone attachment force. Conclusion: The novel designed TMJ prosthesis can help LPM attach to its porous titanium scaffold structure area for future function.
Collapse
Affiliation(s)
- Luxiang Zou
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatolog, Shanghai, China
| | - Yingqian Zhong
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatolog, Shanghai, China
| | - Yinze Xiong
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dongmei He
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatolog, Shanghai, China
| | - Xiang Li
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chuan Lu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatolog, Shanghai, China
| | - Huimin Zhu
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatolog, Shanghai, China
| |
Collapse
|
10
|
Merema BBJ, Kraeima J, de Visscher SAHJ, van Minnen B, Spijkervet FKL, Schepman K, Witjes MJH. Novel finite element-based plate design for bridging mandibular defects: Reducing mechanical failure. Oral Dis 2020; 26:1265-1274. [PMID: 32176821 PMCID: PMC7507837 DOI: 10.1111/odi.13331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of such reconstructions is mostly caused by plate fracture and screw pull-out. This study aims to develop a reliable, mechanically superior, yet slender patient-specific reconstruction plate that reduces failure due to these causes. PATIENTS AND METHODS Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D-VSP) with a novel patient-specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy. RESULTS All PS plates were placed accurately according to the 3D-VSP. Mean 3D screw entry point deviation was 1.54 mm (SD: 0.85, R: 0.10-3.19), and mean screw angular deviation was 5.76° (SD: 3.27, R: 1.26-16.62). FEA indicated decreased stress and screw pull-out inducing forces. No mechanical failures appeared (mean follow-up: 16 months, R: 7-29). CONCLUSION Reconstructing mandibular continuity defects with bookshelf-reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull-out and plate fractures.
Collapse
Affiliation(s)
- Bram B. J. Merema
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Baucke van Minnen
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Fred K. L. Spijkervet
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kees‐Pieter Schepman
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Max J. H. Witjes
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| |
Collapse
|
11
|
Zou L, Zhang L, He D, Yang C, Zhao J, Ellis E. Clinical and Radiologic Follow-Up of Zimmer Biomet Stock Total Temporomandibular Joint Replacement After Surgical Modifications. J Oral Maxillofac Surg 2018; 76:2518-2524. [DOI: 10.1016/j.joms.2018.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
|
12
|
Rodrigues Y, Mathew M, Mercuri L, da Silva J, Henriques B, Souza J. Biomechanical simulation of temporomandibular joint replacement (TMJR) devices: a scoping review of the finite element method. Int J Oral Maxillofac Surg 2018; 47:1032-42. [DOI: 10.1016/j.ijom.2018.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
13
|
Chen X, Wang Y, Mao Y, Zhou Z, Zheng J, Zhen J, Qiu Y, Zhang S, Qin H, Yang C. Biomechanical evaluation of Chinese customized three-dimensionally printed total temporomandibular joint prostheses: A finite element analysis. J Craniomaxillofac Surg 2018; 46:1561-1568. [PMID: 30025603 DOI: 10.1016/j.jcms.2018.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/03/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023] Open
Abstract
PURPOSE This work aims to evaluate the biomechanical behavior of Chinese customized three-dimensional (3D)-printing total temporomandibular joint (TMJ) prostheses by means of finite element analysis. METHODS A 3D model was established by Mimics 18.0, then output in a stereolithography (STL) format. Two models were established to investigate the strain behaviors of an intact mandible and a one-side implanted mandible respectively. Hypermesh and LS-DYNA software were used to establish computer-aided engineering finite element models. The stress distribution on the custom-made total TMJ prosthesis and the strain distribution on the mandible were analyzed by loading maximal masticatory force. RESULTS The maximum stress on the surface of the ultra-high-molecular weight polyethylene was 19.61 MPa. With respect to the mandibular component, the maximum stress in the mandibular component was located at the anterior and posterior surface of the condylar neck, reaching 170.01 MPa. The peak von Mises stress was observed on the topside screw of the mandible, which was found to be 236.08 MPa. For the intact model, it was observed that the strain distribution was basically symmetrical. For the model with the prosthesis, the curve of strain distribution was fundamentally consistent with that in the intact mandible, except for the last 24 mm along the control line. A prominent strain decrease between 41.4% and 58.3% was observed in this area. CONCLUSIONS Chinese customized 3D-printed total TMJ prostheses exhibit uniform stress distribution without changing the behavior of the opposite side natural joint. Furthermore, the prostheses have a great potential to be improved in design and materials with a promising future.
Collapse
Affiliation(s)
- Xuzhuo Chen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yexin Wang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yi Mao
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhihang Zhou
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jisi Zheng
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jinze Zhen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yating Qiu
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shanyong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Haiyi Qin
- National Die and Mold CAD Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Chi Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| |
Collapse
|
14
|
Bekcioglu B, Bulut E, Bas B. The Effects of Unilateral Alloplastic Temporomandibular Joint Replacement on the Opposite-Side Natural Joint: A Finite-Element Analysis. J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.joms.2017.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Xu X, Luo D, Guo C, Rong Q. A custom-made temporomandibular joint prosthesis for fabrication by selective laser melting: Finite element analysis. Med Eng Phys 2017; 46:1-11. [DOI: 10.1016/j.medengphy.2017.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|