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Background: To ensure the long-term success of temporomandibular joint implants, it is imperative to understand their biomechanical performances under the mastication cycle. Purpose: This study aims to compare the biomechanical performance of two commercially available stock implants under a complete mastication cycle. This study has been further extended to understand the influence of bone-implant interface conditions on pre-clinical testing of implants. Methods: In the present study, patient-specific QCT-based finite element models of a human mandible were developed. The left temporomandibular joint was virtually replaced by stock implants (narrow and standard). A complete mastication cycle involving six clenching tasks was simulated. A comparative biomechanical assessment between the intact and the implanted mandibles was performed based on maximum principal stress and strain distributions on the mandible. Results: As compared to contralateral occlusion, ipsilateral clenching resulted in higher strains in the mandible. However, contralateral occlusion produced a larger von Mises stress on the implant than ipsilateral occlusion. Furthermore, intercuspal biting was found to have produced the highest strain (1750-1880 μ) and stress (16.02-16.54 MPa) in the mandible. As compared to immediate post-operative non-osseointegrated conditions, an overall reduction of stress (narrow implant: 0.14 MPa; standard implant: 0.12 MPa) and strain (narrow implant: 30 μ ; standard implant: 20 μ ) was observed in post-operative osseointegrated phase. Conclusions: Although stresses and strains in mandible and implants are reduced in osseointegrated condition, standard temporomandibular joint implant produced higher stresses in cortical bone compared to narrow implant during non-osseointegrated conditions, which suggests the possible preference of narrow implant over standard ones.
Background: To ensure the long-term success of temporomandibular joint implants, it is imperative to understand their biomechanical performances under the mastication cycle. Purpose: This study aims to compare the biomechanical performance of two commercially available stock implants under a complete mastication cycle. This study has been further extended to understand the influence of bone-implant interface conditions on pre-clinical testing of implants. Methods: In the present study, patient-specific QCT-based finite element models of a human mandible were developed. The left temporomandibular joint was virtually replaced by stock implants (narrow and standard). A complete mastication cycle involving six clenching tasks was simulated. A comparative biomechanical assessment between the intact and the implanted mandibles was performed based on maximum principal stress and strain distributions on the mandible. Results: As compared to contralateral occlusion, ipsilateral clenching resulted in higher strains in the mandible. However, contralateral occlusion produced a larger von Mises stress on the implant than ipsilateral occlusion. Furthermore, intercuspal biting was found to have produced the highest strain (1750-1880 μ) and stress (16.02-16.54 MPa) in the mandible. As compared to immediate post-operative non-osseointegrated conditions, an overall reduction of stress (narrow implant: 0.14 MPa; standard implant: 0.12 MPa) and strain (narrow implant: 30 μ ; standard implant: 20 μ ) was observed in post-operative osseointegrated phase. Conclusions: Although stresses and strains in mandible and implants are reduced in osseointegrated condition, standard temporomandibular joint implant produced higher stresses in cortical bone compared to narrow implant during non-osseointegrated conditions, which suggests the possible preference of narrow implant over standard ones.
Background: Restoration of the mandibular region after segmental resection surgery is crucial for masticatory function and facial aesthetics. The precision of three‐dimensional printers has advanced in recent years, enabling the development of fully customized reconstruction plates. In recent years, three‐dimensional printing technology has been applied in the field of dental and oral surgery. Among these, the selective laser melting method has been developed. This case report was aimed at exploring the utility in restoring mandibular morphology.Cases: Patients diagnosed with medication‐related osteonecrosis of the jaw (MRONJ) in Oral and Maxillofacial Surgery at Kanazawa Medical University Hospital who underwent mandibular disarticulation and immediate completely customized reconstruction plate (COSMOFIX) were included. Case 1 involved a female in her 70s with MRONJ on the right side of the mandible. Case 2 involved a female who received bisphosphonates for extensive metastatic breast cancer, resulting in MRONJ affecting the bilateral mandible. Case 3 involved a woman who developed MRONJ on the right side of the mandible during alendronate treatment for osteoporosis. Completely customized reconstruction plates were used for reconstruction after segmental resections.Findings: The three patients adapted to the remaining bone. The reconstructed and preoperative mandibular morphologies were similar.Conclusions: In conclusion, the use of completely customized reconstruction plates obviates the need for bending and other adaptations, reduces surgical time, and improves postoperative aesthetics. Of significance, preparing completely customized reconstruction plate requires about 3 weeks; thus, careful case selection and scheduling are indispensable.
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