Two-screw osteosynthesis of the mandibular condylar head with different screw materials: a finite element analysis

Schönegg, Daphne; Koch, Andreas; Müller, Günter T; Blumer, Michael; Wagner, Maximilian

doi:10.1080/10255842.2023.2209247

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Therefore, in future studies, we aim to use 3D printed mandibles made of a material with known properties that are comparable to real human bone instead of Synbone mandible replicas. Finally, according to the literature, FEA is a promising tool in the OMF surgery for investigating different types of fracture management and different osteosynthesis systems or implants [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]50 . This study shows that our FEA model is an applicable tool for analysing simple mandibular fracture problems; therefore, the outcome of this study is a promising step towards developing a validated FEA model suitable for many different situations (e.g., complex mandibular fractures or other bone fractures in the OMF region).…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

Daqiq,

Roossien,

Wubs

et al. 2024

Sci Rep

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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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Section: Discussionmentioning

confidence: 99%

“…In recent years, there have been more FEA studies in the OMF area [14][15][16][17][18][19][20][21][22][23] However, the application of FEA in clinical cases is limited in OMF surgery due to non-availability of a validated FEA model that can be routinely applied to mandibular fracture treatment. In principle, regarding complex fractures (e.g., comminuted…”

mentioning

confidence: 99%

Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

Daqiq,

Roossien,

Wubs

et al. 2024

Sci Rep

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“…Fixation is mostly done with two or three screws. It is thought that two-screw fixation may be sufficient for the correct rigidity of the bone union [15]. In some cases, omitting the third screw application would not change the osseous outcome of osteosynthesis, but would reduce the invasiveness observable in the condition of the lateral pterygoid muscle.…”

Section: Discussionmentioning

confidence: 99%

Lateral Pterygoid Muscle Alteration in Patients Treated Surgically Due to Mandibular Head Fractures

Kozakiewicz,

Pruszyńska

2023

JCM

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The goal of surgical treatment of mandibular head fracture is to restore anatomical relations; however, it also carries other implications. The purpose of this study is to present the alteration in the size of lateral pterygoid muscles after surgical treatment of unilateral mandibular head fractures and the impact of this change on the range of motion of the mandible. Another issue addressed is the persistence of changes in the appearance of the lateral pterygoid muscles after surgical treatment. In this study, 66 patients with unilateral mandibular head fracture were included. An additional 15 patients from this group who were treated only conservatively were separated as an extra reference group to exclude completely the effect of surgery on the appearance of the pterygoid lateral muscle (even on the opposite side to the surgically treated side). The range of mandibular movements was measured at specific time intervals up to 24 months post-operationally. Then, the lengths and widths of the lateral pterygoid muscles on the operated and healthy site were measured in CT images. The results were compared with a control group which consisted of muscles of the intact site (opposite site to the fracture). A significant reduction in the length-to-width ratio of the lateral pterygoid muscle on the operated side by approx. 20% is observed. This suggests that the muscle becomes more spherical, and thus the range of lateral movement to the contralateral side is permanently reduced.

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Two versus three magnesium screws for osteosynthesis of mandibular condylar head fractures: a finite element analysis

Schönegg,

Müller,

Blumer

et al. 2024

Clin Oral Invest

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Objectives Previous finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA. Materials and methods A previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS® Mandible Hexadrive cortical screws. Results The three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30% reduction in maximum von Mises stress for the top screw and a 46% reduction for the bottom screw. Conclusions Fracture treatment with three magnesium screws could be a valuable and sufficiently stable alternative to the established treatment with titanium screws. Further studies on screw geometry could help improve material stability under mechanical loading, enhancing the performance of magnesium screws in clinical applications. Clinical relevance The use of magnesium screws for osteosynthesis of mandibular condylar head fractures offers the benefit of reducing the need for second surgery for hardware removal. Clinical data is needed to determine whether the advantages of resorbable screw materials outweigh potential drawbacks in condylar head fracture treatment.

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Two-screw osteosynthesis of the mandibular condylar head with different screw materials: a finite element analysis

Cited by 3 publications

References 24 publications

Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing

Lateral Pterygoid Muscle Alteration in Patients Treated Surgically Due to Mandibular Head Fractures

Two versus three magnesium screws for osteosynthesis of mandibular condylar head fractures: a finite element analysis

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