Resistance and Stress Finite Element Analysis of Different Types of Fixation for Mandibular Orthognathic Surgery

Stringhini, Diego José; Sommerfeld, Ricardo; Uetanabaro, Lucas Caetano; Leonardi, Denise Piotto; Araujo, Melissa Rodrigues de; Rebellato, Nelson Luís Barbosa; Costa, Delson João da; Scariot, Rafaela

doi:10.1590/0103-6440201600336

Cited by 22 publications

(18 citation statements)

References 16 publications

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“…However, surgical-orthodontic treatment as performed nowadays would probably present a similar or even higher final balance, since the complications and risks of orthognathic surgery have been minimized [22][23][24] . The metaanalysis of Verweij et al evaluated the most frequent surgical complications in patients requiring mandibular surgery with the bilateral sagittal split osteotomy (BSSO): a bad split occurred in 2.3% of patients, a postoperative infection occurred in 9.6%, it was necessary to remove the osteosynthesis material in 11.2%, and there were neurosensory disturbances in the lower lip in 33.9% of the patients 25 .…”

Section: Discussionmentioning

confidence: 99%

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Raposo

Peleteiro

Paço

et al. 2018

International Journal of Oral and Maxillofacial Surgery

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Abstract. This systematic review was performed to compare dental, skeletal, and aesthetic outcomes between orthodontic camouflage and surgical-orthodontic treatment, in patients with a skeletal class II malocclusion and a retrognathic mandible who have already finished their growth period. A literature search was conducted, and a modified Downs and Black checklist was used to assess methodological quality. The meta-analysis was conducted using the DerSimonianLaird random-effects method to obtain summary estimates of the standardized mean differences and corresponding 95% confidence intervals. Nine articles were included in the qualitative synthesis and seven in the meta-analysis. The difference between treatments was not statistically significant regarding SNA angle, linear measurement of the lower lip to Ricketts' aesthetic line, convexity of the skeletal profile, or the soft tissue profile excluding the nose. In contrast, surgical-orthodontic treatment was more effective with regard to ANB, SNB, and ML/NSL angles and the soft tissue profile including the nose. Different treatment effects on overjet and overbite were found according to the severity of the initial values. These results should be interpreted with caution, due to the limited number of studies included and because they were non-randomized clinical trials. Further studies with larger sample sizes and similar pre-treatment conditions are needed.

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Section: Discussionmentioning

confidence: 99%

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Raposo

Peleteiro

Paço

et al. 2018

International Journal of Oral and Maxillofacial Surgery

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“…Comparing results with other FEA orthognathic studies is difficult due to difference in model construction, mesh element numbers, and various simulation protocols. There are studies that use a full mandible [25] while others opted for the hemi-mandible [6] [7] [21]. The reason highly depend on the computer resources and in certain instances, the models require simplification to reduce computational demand.…”

Section: Discussionmentioning

confidence: 99%

A Finite Element Analysis Study Comparing 3 Internal Fixation Techniques in Mandibular Sagittal Split Osteotomy

Hassan¹,

Ring²,

Stassen³

2018

IJOHNS

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Purpose: To analyse, and compare using finite element analysis, the biomechanical properties of the 1.7 mm miniplate fixation against 2 conventional fixation techniques (2.0 mm bi-cortical screws and 2.0 mm miniplate) used in the mandibular sagittal split osteotomy. Methods: A 3-D virtual mandible model was constructed using images from CT scan. Sagittal split osteotomy was carried out virtually, and the fixation techniques were applied onto the model. 9 virtual models consisted of the 3 fixation techniques with mandibular movements of 3 mm setback, 3 mm advancement and 7 mm advancement were developed. Bite forces of 50, 75 and 100 N were applied for incisor bite simulation and 100, 200 and 300 N for molar biting force. Finite element analysis was carried out in Solidworks, and readings of stresses and displacement were recorded. Wilcoxon rank sum test was applied and P-value of 0.05 was set for statistical analysis. Results: In this manuscript the authors have compared 3 internal fixation techniques in mandibular sagittal split osteotomy. There was a statistically significant difference for both stress and displacement readings between the 1.7 mm miniplate, the 2.0 mm bi-cortical screws and the 2.0 mm miniplate for all mandibular movements. For the 1.7 mm miniplate vs 2.0 mm bi-cortical screws, the stress reading was (P = 3.063e−08, W = 314), and for displacement was (P = 5.811e−05, W = 282). For the 1.7 mm miniplate vs 2.0 mm miniplate, the stress reading was (P = 9.862e−4, W = 263) and for displacement was (2.05e−2, W = 235). Conclusion: The 1.7 mm miniplate has adequate strength to be used in mandibular sagittal split osteotomy, although statistically less rigid when compared to the conventional 2.0 mm miniplate and 2.0 mm bi-cortical screws, especially in larger movements.

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“…Some studies considered isotropy in the mandible bone and did not include teeth in their models for simplicity (24,37). In 2016, Stringhini et al developed a full mandible model which included the cortical and cancellous bone, teeth, pulp, and periodontal tissues, which consisted of 1489170 elements (47). The model's complexity requires more computer resources, and longer running time to carry out the analyses.…”

Section: Comparison Of Displacements In Fixation Techniquesmentioning

confidence: 99%

“…At this moment, forces are generated by the elevator muscles of mastication, namely the masseter, temporalis and medial pterygoid muscles(62). An FEA study by Oguz et al in 2009 applied forces to the angle of mandible to simulate the masseter force while Stringhini et al in 2016 applied forces from the masseter, medial pterygoid and temporalis (41,47). Simulation model's C and D recorded less stress and displacements as these models were similar to model's A and B but were restrained in the angle region.…”

Section: Simulation Modelsmentioning

confidence: 99%

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Comparison of Three Internal Fixation Techniques in Mandibular Sagittal Split Osteotomy, A Finite Element Analysis

Hassan

Stassen

Ring

2018

British Journal of Oral and Maxillofacial Surgery

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The sagittal split osteotomy is a versatile technique used in Mandibular orthognathic surgery. There are many types of internal fixation techniques available to provide fixation following the mandible split. The choice of fixation is mainly on surgeon preference, and can range from bi-cortical screws fixation and miniplate fixation. This study used Finite Element Analysis to investigate biomechanical properties of three internal fixation techniques. A pre-operative CT scan of a patient's skull was used to develop a half fully dentate mandible computer model. A sagittal split osteotomy was performed on the computer model and all fixation techniques applied to the model. Finite element analysis was used to study the effect of different fixation techniques on various mandibular movements and force magnitudes. The results of this study have shown consistently that the bi-cortical screws fixation records the least stress and displacement in all simulation models. Stress is mostly concentrated in the inferior-distal screw for the bi-cortical screws fixation whereas the stresses in miniplates are generally dissipated in the connector region of the plate. The 1.7mm miniplate was the least rigid fixation. The stresses in surrounding bone of the fixations were variable for each technique. Miniplate fixations had higher bone stresses in the setback movement but lower with mandibular advancements. Within the limitations of the study, the application of bi-cortical screws has shown to be the most rigid fixation, although with increased stresses in surrounding bone at mandibular advancements. The 1.7mm and 2.0mm miniplates are less rigid than the bi-cortical screws but handled stresses within the ultimate yield strength. Stress The force per unit area applied to an object. Von Mises Stress The equivalent tensile stress used to predict the yielding of materials, when they are placed under loads from different directions.

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Resistance and Stress Finite Element Analysis of Different Types of Fixation for Mandibular Orthognathic Surgery

Cited by 22 publications

References 16 publications

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis

A Finite Element Analysis Study Comparing 3 Internal Fixation Techniques in Mandibular Sagittal Split Osteotomy

Comparison of Three Internal Fixation Techniques in Mandibular Sagittal Split Osteotomy, A Finite Element Analysis

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