The purpose of this study was to investigate how sagittal split ramus osteotomy (SSRO) and Le Fort 1 osteotomy affected the stress distribution of the temporomandibular joint (TMJ) during an anterior teeth bite using the three-dimensional (3D) finite element method. 14 orthognathic surgery patients were examined with mandibular prognathism, facial asymmetry and mandibular retraction. They underwent Le Fort 1 osteotomy in conjunction with SSRO. In addition, 10 asymptomatic subjects were recruited as the control group. The 3D models of the mandible, disc and maxilla were reconstructed according to cone-beam computed tomography (CBCT). Contact was used to simulate the interaction of the disc-condyle, disc-temporal bone, and upper-lower dentition. Muscle forces and boundary conditions corresponding to the anterior occlusions were applied on the models. The stresses on the articular disc and condyle in the preoperative group were significantly higher than normal. The contact stress and minimum principal stress in TMJ for patients with temporomandibular disorder (TMD) were abnormally higher. The peak stresses of the TMJ of the patients under anterior occlusions decreased after bi-maxillary osteotomy. No postoperative TMD symptoms were found. Maxillofacial deformity led to excessive stress on the TMJ. Bi-maxillary osteotomy can partially improve the stress distributions of the TMJ and relieve the symptoms of TMD.
Purpose: This study aimed to analyze the changes of the stress distributions in TMJs for the pre- and postoperative patients with mandibular prognathism under unilateral occlusions, a frequent occlusion in mastication. Methods: Pre- and six-mouth postoperative cone-beam computed tomography images of thirteen patients diagnosed with mandibular prognathism were scanned and used to construct complete maxillofacial models, assigned as the Pre and Post group, respectively. Another ten asymptomatic individuals were defined as the Control group. The inhomogeneous properties were assigned to the models. The muscle forces and boundary conditions corresponding to left and right unilateral occlusions were applied on the models. The analysis of variation (ANOVA) was chosen for the comparison among the groups. Results: The results showed that the Pre group had abnormal stress distributions ang higher stress level in TMJs, compared with those of the Post and Control groups. Moreover, from clinical cases, symptoms of temporomandibular disorders (TMDs) always followed with increased stresses. Conclusion: Generally, orthognathic surgeries could improve the stress distribution in TMJs of the patients with mandibular prognathism under the unilateral occlusions. However, the postoperative complications, especially symptoms of TMD, were closely related to changes of stress for patients with mandibular prognathism after orthognathic surgeries. Individual virtual surgery and finite element analysis should be conducted to prevent complications in TMJ.
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