The biomechanical effects of bimaxillary osteotomies to the patients with mandibular retraction under incisal clenching.

The purpose of this study is to investigate the biomechanical effect of bimaxillary osteotomies on patients with mandibular retraction. Mandibular retraction, as a typical maxillofacial deformity, and has great adverse effects on TMJ. Bimaxillary osteotomies are widely used to correct symptoms of mandibular retraction. It is necessary to understand the effect of surgery on temporomandibular disc (TMJ). Five patients with mandibular retraction and 10 asymptomatic subjects were involved in this study. Finite element models of preoperative, postoperative and control group were constructed based on the CT data. Nine sets of concentrated forces were used to simulate the muscle effect and contact method was used to simulate the interaction within the TMJs and dentitions. The results showed that bimaxillary osteotomies could effectively improve the maxillofacial morphology and alleviate the overload in TMJ. The facial asymmetry and right chewing side preference could cause imbalanced stress distributions in the TMJs and interfere the surgical treatment.

An Improved Finite Element Model of Temporomandibular Joint in Maxillofacial System: Experimental Validation.

Finite element (FE) analysis has become a popular method of exploring the biomechanical characteristics of temporomandibular joint (TMJ). However, the FE model should be improved and its reliability should be verified further. This study developed a complete maxillofacial model by cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI). The integrity and physiological environment of TMJ were considered. Then the FE model and corresponding 3D printed model were developed and loaded under the same conditions. The strains on the mandible and upper surface of the left articular disc were measured on the experimental model and compared with the FE model. The differences of the strains on the mandible were less than 6%. The strain distributions on the disc were also approximate between the experimental and simulated results. It indicated that the strains calculated from the improved FE model were reliable on the mandible and inside the TMJ.

A deep dive into the static force transmission of the human masticatory system and its biomechanical effects on the temporomandibular joint.

OBJECTIVE: This study aims to investigate the biomechanical behavior and reveal the force transmission patterns of the human masticatory system through advanced three-dimensional finite element (FE) models. METHODS: The FE model was constructed according to the medical images of a healthy male adult. It contains full skull structures, detailed temporomandibular joints (TMJs) with discs, complete dentitions, masticatory muscles, and related ligaments. Several static bite scenarios were simulated to demonstrate the effects of bite positions and muscle force recruitments on the force transmission patterns. RESULTS: Molar occlusal surfaces are the primary force transmission region for clenching. Sensitivity analysis demonstrated that the stiffness of the bite substance would not alter the force transmission patterns but could affect the maximum contact stresses on the discs and the occlusal surfaces. During the unilateral clenching tasks, the high-stress region on the discal surfaces shifted ipsilaterally. The presence or absence of the molar cushions would significantly affect the biomechanical response of the masticatory system. SIGNIFICANCE: FE analysis is an effective way of investigating biomechanical responses involving complicated interactions. Enriching the static analysis of the masticatory system with a detailed model can help understand better how the forces were transmitted and the significance of TMJs during the clenching process.

Effects of bilateral sagittal split ramus osteotomy and bimaxillary osteotomies on stress distribution of temporomandibular joints in patients with maxillofacial deformity under asymmetric occlusions.

Bilateral sagittal split ramus osteotomy (BSSRO) and bimaxillary osteotomies (BSSRO plus Lefort1 osteotomy) are representative surgeries to solve maxillofacial deformity. It is important to understand the biomechanical impact of the surgeries on the temporomandibular joint (TMJ). The purpose of this study is to compare the stress variations of the patients before and after the two surgeries. Twenty-four patients with maxillofacial deformities and 14 asymptomatic subjects were recruited to be the preoperative group and control group in this study. Ten patients were performed BSSRO and other 14 underwent bimaxillary osteotomies. Finite element models of the preoperative, postoperative, and control groups were established according to the CBCT data of the subjects. The muscle forces of the left and right unilateral occlusion were applied on the models. And the contact was used to simulate the interaction within the TMJs and between the maxillary and mandibular teeth. Under the asymmetric occlusion, bimaxillary osteotomies were found to be superior to BSSRO in the stress distributions of the TMJs. The magnitude of the asymmetric stresses was strongly correlated with the TMD symptoms in the patients. And the stress variation of the postoperative TMJs was the cause of the improvement or aggravation of the TMD symptoms.

The influence of maxillary incisor angles on the stress distributions of temporomandibular joints under incisal biting.

BACKGROUND AND OBJECTIVE: The incisal biting was one of the most regular jaw activities. The direction of bite force on the incisor tip and the mandible position were relevant to the incisor angle as biting. This study was carried out to explore the influence on the temporomandibular joint (TMJ) caused by the incisor angle. METHODS: Twenty individuals belonging to three incisor subtypes of the buccal type were recruited. In addition, the 3D models including the maxillary, mandible and discs were established based on their cone-beam computed tomography and magnetic resonance imaging scannings. Then, the mandibular ligaments and the discal attachments were simulated in the finite element models to analyze the stress distributions of the TMJs under incisal biting. RESULTS: The TMJ stresses of subtype I showed normal range and distribution. The stresses of the intermediate temporal bone tended to increase in subtype II. The intermediate and posterior bands of the discs sustained greater tensile stresses in subtype III. CONCLUSIONS: Abnormal stress distributions are harmful to TMJs, so the incisor cusp was not suggested to incline to the palatal side too much.

Biomechanical comparison of the effect of bilateral sagittal split ramus osteotomy with or without Le Fort I osteotomy on the temporomandibular joints of the patients with maxillofacial deformities under centric occlusion.

Mandibular deformities negatively affect the daily activities of the patients and may cause temporomandibular disorders (TMD). Bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I osteotomy are effective treatments to correct the mandibular deformities. The aim of this study was to investigate and compare the effects of the BSSRO with or without Le Fort I on the stress distributions of the temporomandibular joints (TMJs) of the patients with mandibular deformities under centric occlusion based on finite element (FE) method. Preoperative and postoperative cone-beam computed tomography (CBCT) images of twenty-four patients diagnosed with mandibular prognathism, including ten patients with BSSRO and another 14 patients with bimaxillary osteotomy (BSSRO with Le Fort I), were used to construct maxillofacial models. Ten asymptomatic individuals were also performed CBCT scanning and defined as the control group. In addition, the muscle forces and boundary conditions corresponding to centric occlusions were applied on each model. For the preoperative groups with both the BSSRO and bimaxillary osteotomies, the average peak contact stresses of the TMJs were both greater than those of the control group. After the surgeries, the contact stresses of the discs and temporal bones of both groups considerably decreased. However, the contact stresses on the condyles slightly increased after BSSRO but decreased after bimaxillary osteotomy. The TMJs of the patients with maxillofacial deformities suffered abnormal tensile and compressive stresses compared with the asymptomatic subjects under centric occlusion. Both of the BSSRO and bimaxillary osteotomy could improve the risk stress distributions of the TMJs.

The effects of the size and strength of food on jaw motion and temporomandibular joints.

Mastication displays much importance in people's lives. The masticatory mandibular motion associated with dental kinematics also impacts temporomandibular joint (TMJ) kinematics and even TMJ health status. How food properties impact kinematical parameters of TMJs is a meaningful question for the conservative treatment of temporomandibular disorders (TMD) and evidence for the diet recommendation of TMD patients. The aim of this study was to find the primary mechanical properties influencing the masticatory motion. The potato boluses with different boiling times and sizes were chosen. The optical motion tracking system was adopted to record the masticatory trials of chewing boluses with various mechanical properties. The mechanical experiments revealed that increasing boiling time could reduce compressive strength. Moreover, multiple regression models were built to find the primary property of food influencing the TMJ kinematics, including condylar displacement, velocity, acceleration, and crushing time. The results showed that the bolus size had a significant primary influence on condylar displacements. The chewing times had a significantly minor influence on condylar displacements, while bolus strength had only a small impact on condylar displacements. Furthermore, condylar displacements on the non-working side were more affected by bolus size and chewing times than on the working sides. The crushing time of the bolus was significantly influenced by the compressive strength. Meals with small sizes and soft properties were therefore advised to lessen condylar displacements and relax the crushing process, and further reduce the loadings in the TMJ.

The pressure in the temporomandibular joint in the patients with maxillofacial deformities.

BACKGROUND: Temporomandibular disorder (TMD) symptoms were found to be common in the patients with maxillofacial deformities. The mandibular structure was in relation with the stress within temporomandibular joint (TMJ). However, the current studies on the TMJ stresses in the patients with different maxillofacial deformities are not comprehensive enough. PURPOSE: The aim of this study was to investigate the compression and morphology of the TMJ in the patients with different maxillofacial deformities under central occlusion. METHODS: 24 patients and 10 asymptomatic individuals were included in this study and divided into patient groups and control group. The 3D models were reconstructed. Muscle forces and boundary conditions corresponding to the central occlusion were applied. Nine morphological parameters of mandible were evaluated. RESULTS: The minimum principal stresses in the articular disc and condyle were significantly greater than those of the control group (P<0.05). For the articular disc, the compression on the non-deviation side was greater than those on the deviation side in patients with asymmetrical mandibles. There was difference between both sides in the mandibular prognathism and retrusion groups. The joint space of patients was significantly lower than that of the control group (P<0.05). CONCLUSIONS: Maxillofacial deformities might change the condylar position within the articular fossa, which decreased the joint space and increased the compression within TMJ. The patients with asymmetry mandible suffered greater pressure within TMJ on the non-deviation side. The bilaterally over-developed and under-developed mandible in patients might also increase the compression within TMJ.

Descriptions of the dynamic joint space of the temporomandibular joint.

BACKGROUND: Clinical diagnosis and treatment depended heavily on the motion analysis of the human joints. Although the dynamic joint space (DJS) of other organs was widely used in academic investigations, they were not universally used in the temporomandibular joint (TMJ) field, which was also important for the motion evaluation of the TMJ. The objectives of this study are to introduce the DJS of the TMJ and characterize the DJS regulars of mandibular movements. METHODS: Ten asymptomatic subjects were selected to instruct this application. The mouth opening and closing, mandibular protrusion, and left and right protrusions, were tracked by the optical motion tracking system. According to trajectories of markers and reconstructed models from computed tomography, the motions of the mandibles could be obtained. The DJSes, which were described as the minimum Euclidian distances, were subsequently calculated based on the geometrical surfaces between the condyle and fossa during the motions. Then, the DJS map could be drawn based on the calculated values. RESULTS: The DJS map manifested a decreasing trend when the condyle crossed the glenoid fossa, while it generally increased after the condyle crossed the fossa during the mouth opening. The results showed that the average maximum and minimum anterior joint spaces were 5.39 mm and 2.07 mm during mouth opening respectively with a great discrepancy existing among the subjects. The average maximum and minimum anterior joint spaces were 4.74 mm and 2.19 mm during mandibular protrusion. As for left and right protrusions, the DJS of the contralateral side was greater than that of the ipsilateral side. CONCLUSION: In comparison to morphological analyses or only mandibular motions, the DJS provides more dynamic and interactive information about the TMJ. The research and methodology may help us comprehend TMJ motions and temporomandibular disorders.

Effects on loads in temporomandibular joints for patients with mandibular asymmetry before and after orthognathic surgeries under the unilateral molar clenching.

Orthognathic surgery is a useful treatment for the correction of mandibular deformity. Different from other occlusions, unilateral occlusion is frequently used in mastication and influences functions of temporomandibular joints (TMJs). However, stress distributions in TMJ before and after orthognathic surgeries are not under consideration in treatments, crucial to pre- and postoperative temporomandibular disorders (TMDs). The study aims to analyze stress distributions in TMJs for patients with mandibular asymmetry before and after orthognathic surgeries under the unilateral molar clenching. Ten asymptomatic subjects (control group) and 10 patients with mandibular asymmetry were recruited for the study. All patients underwent orthognathic surgeries and were grouped as preoperative and postoperative for the purpose of comparing stress variation in TMJ before and after surgery. Finite element models corresponding to the unilateral molar clenching were constructed. The contact stresses at the ipsilateral side for asymptomatic subjects were significantly greater than those at the contralateral side, while the third principal stresses at the contralateral side were significantly greater than those at the ipsilateral side. No significant difference of stress distribution in TMJ between two sides appeared for the preoperative group. After surgeries, the stress distributions were close to the normal states. The stress of the preoperative group was found to be significantly higher than those of the control and postoperative groups. The variations in stresses before and after the surgery were consistent with the signs and symptoms or recoveries of TMD. Orthognathic surgery could alleviate the high level of stresses caused by mandibular asymmetry and is helpful for the recovery of TMD.

Impact of mandibular prognathism on morphology and loadings in temporomandibular joints.

Loadings in temporomandibular joints (TMJs) are essential factors in dysfunction of TMJs, and are barely noticed in treatment of maxillofacial deformity. The only approach, which can access stresses in TMJs, could expend day's even weeks to complete. The objective of the study was to compare the differences of the morphological and biomechanical characteristics of TMJs between asymptomatic subjects and patients with mandibular prognathism, and to preliminarily analyze the connection between the two kinds of characteristics. Morphological measurements and finite element analysis (FEA) corresponding to the central occlusion were carried out on the models of 13 mandibular prognathism patients and 10 asymptomatic subjects. The results indicated that the joint spaces of the patients were significantly lower than those of the asymptomatic subjects, while the stresses of patients were significantly greater than those of asymptomatic subjects, especially the stresses on discs. The results of Pearson correlation analysis showed that weak or no correlations were found between the von Mises stresses and the joint spaces of asymptomatic subjects, while moderate, even high correlations were found in the patients. Thus, it was shown to be a feasible way to use morphological parameters to predict the internal loads of TMJs.

Biomechanical behaviour of temporomandibular joints during opening and closing of the mouth: A 3D finite element analysis.

Temporomandibular joints (TMJs) constitute a pair of joints that connect the jawbone to the skull. TMJs are bilateral joints which work as one unit in conducting daily functions such as speaking, mastication, and other activities associated with the movement of the jaw. Issues associated with the TMJs may arise due to various factors-one such factor being the internal load on the TMJ. These issues may contribute to temporomandibular disorders (TMD). This study aims to evaluate the mandibular trajectories and the associated stress changes during the process of opening the mouth on the TMJs of an asymptomatic subject. The mouth opening motion was recorded by a motion capturing system using models of the mandible and maxilla constructed based on the computed tomography (CT). Two discs constructed based on magnetic resonance imaging (MRI). Finite element analysis was performed on the relative motion of the mandible to the maxilla and validated. The process modelled by these displacements provided less than 10% error in terms of deformation. The simulation results indicate that the lateral intermediate zone-the head and neck of the mandible-and the articular eminence sustained the most significant stresses during the mouth opening motion. The results also suggested that the stresses increase as the range of opening increases with the greatest von Mises stress, tensile, and compressive stress found at the position of maximal opening.

The influence of bilateral sagittal split ramus osteotomy on the stress distributions in the temporomandibular joints of the patients with facial asymmetry under symmetric occlusions.

The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints (TMJs) of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy (BSSRO) under the symmetric occlusions using the three-dimensional (3D) finite element method.Ten facial asymmetry patients (Preoperative group, age 24.6 ±â€Š4.8 years) and 10 asymptomatic subjects (Control group, age 26.8 ±â€Š4.9 years) were recruited. After the patients underwent BSSRO, they were further assigned as the Postoperative group. 3D geometries of the finite element models of the mandible, disc, maxilla, and teeth were reconstructed according to cone-beam computed tomography (CBCT) image data. Contact elements were used to simulate the interaction of the disc-condyle, disc-temporal bone, and upper-lower dentition. The muscle forces and boundary conditions corresponding to the central and anterior occlusions were applied on the models of the 3 groups. The finite element models were validated with experimental data showing the accuracy of the simulation results.The simulation predicted preoperative significant differences of stresses between non-deviated sides and deviated sides were disappeared after the surgery under the central and anterior occlusions (P < .05). Almost all stresses in the patient models had significantly decreased after BSSRO, leveling it to the stress values of the normal subjects. Moreover, the simulation results coincided with the clinical cases which showed that BSSRO had helped to release or remove the signs and symptoms of temporomandibular disorders (TMD).In conclusion, BSSRO could correct the asymmetric stress distributions of TMJs and decrease the magnitude of the stresses for the patients with facial asymmetry. Those decreases also associated with the recovery of TMD.

A double button adjustable loop device is biomechanically equivalent to tension band wire in the fixation of transverse patellar fractures-A cadaveric study.

INTRODUCTION: Tension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems. The aim of our study is to compare the fixation rigidity of patella fractures using Tightrope versus conventional tension-band wiring (TBW) in a cadaveric model. MATERIALS AND METHODS: TBW fixation was compared to TightRope fixation of transverse patella fractures in 5 matched pairs of cadaveric knees. The knees were cyclically brought through 0-90° of motion for a total of 500 cycles. Fracture gapping was measured before the start of the cycling, and at 50, 100, 200 and 500 cycles using an extensometer. The mean maximum fracture gapping was derived. Failure of the construct was defined as a displacement of more than 3mm, patella fracture or implant breakage. RESULTS: All but one knee from each group survived 500 cycles. The two failures were due to a fracture gap of more than 3mm during cycling. There was no significant difference in the mean number of cycles tolerated. There was no implant breakage. There was no statistical significant difference in mean maximum fracture gap between the TBW and TightRope group at all cyclical milestones after 500 cycles (0.3026±0.4091mm vs 0.3558±0.7173mm, p=0.388). CONCLUSIONS: We found no difference between the TBW and Tightrope fixation in terms of fracture gapping and failure. With possible lower risk of complications such as implant migration and soft tissue irritation, we believe tightrope fixation is a feasible alternative in fracture management of transverse patella fractures.

The influence of tibial component fixation techniques on resorption of supporting bone stock after total knee replacement.

Periprosthetic bone resorption after tibial prosthesis implantation remains a concern for long-term fixation performance. The fixation techniques may inherently aggravate the "stress-shielding" effect of the implant, leading to weakened bone foundation. In this study, two cemented tibial fixation cases (fully cemented and hybrid cementing with cement applied under the tibial tray leaving the stem uncemented) and three cementless cases relying on bony ingrowth (no, partial and fully ingrown) were modelled using the finite element method with a strain-adaptive remodelling theory incorporated to predict the change in the bone apparent density after prosthesis implantation. When the models were loaded with physiological knee joint loads, the predicted patterns of bone resorption correlated well with reported densitometry results. The modelling results showed that the firm anchorage fixation formed between the prosthesis and the bone for the fully cemented and fully ingrown cases greatly increased the amount of proximal bone resorption. Bone resorption in tibial fixations with a less secure anchorage (hybrid cementing, partial and no ingrowth) occurred at almost half the rate of the changes around the fixations with a firm anchorage. The results suggested that the hybrid cementing fixation or the cementless fixation with partial bony ingrowth (into the porous-coated prosthesis surface) is preferred for preserving proximal tibial bone stock, which should help to maintain post-operative fixation stability. Specifically, the hybrid cementing fixation induced the least amount of bone resorption.

Analysis of bone-prosthesis interface micromotion for cementless tibial prosthesis fixation and the influence of loading conditions.

A lack of initial stability of the fixation is associated with aseptic loosening of the tibial components of cementless knee prostheses. With sufficient stability after surgery, minimal relative motion between the prosthesis and bone interfaces allows osseointegation to occur thereby providing a strong prosthesis-to-bone biological attachment. Finite element modelling was used to investigate the bone-prosthesis interface micromotion and the relative risk of aseptic loosening. It was anticipated that by prescribing different joint loads representing gait and other activities, and the consideration of varying tibial-femoral contact points during knee flexion, it would influence the computational prediction of the interface micromotion. In this study, three-dimensional finite element models were set up with applied loads representing walking and stair climbing, and the relative micromotions were predicted. These results were correlated to in-vitro measurements and to the results of prior retrieval studies. Two load conditions, (i) a generic vertical joint load of 3 x body weight with 70%/30%M/L load share and antero-posterior/medial-lateral shear forces, acted at the centres of the medial and lateral compartments of the tibial tray, and (ii) a peak vertical joint load at 25% of the stair climbing cycle with corresponding antero-posterior shear force applied at the tibial-femoral contact points of the specific knee flexion angle, were found to generate interface micromotion responses which corresponded to in-vivo observations. The study also found that different loads altered the interface micromotion predicted, so caution is needed when comparing the fixation performance of various reported cementless tibial prosthetic designs if each design was evaluated with a different loading condition.